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B-2016-1505CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMI NO: B-2016-1505 19419 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) CARTMELL/TAM CONSTRUCTION INC LOS ALTOS HILLS, CA 94022 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 05/09/2016 OWNER'S PHONE: 408-777-3081 PHONE O: (650) 948-6930 LICENSED ONTR CTOR' DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lie. #969426 Contractor CARTMELL/TAM CONSTRUCTION INCDate 01/31/2018 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL X COMMERCIAL — with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: STE # 200 - T.I. TO CREATE OFFICE AREA (450 S.F.)(MAIN I hereby affirm under penalty of perjury one of the following two declarations: STREET/FLEX 1/2ND FLR - SHERIFF'S SUB -STATION) 1. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. G%i have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $25000.00 APPLICANT CERTIFICATION certify that I have read this, application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 316 20 112 A (Tenant Improvements),B (Tenant Improvements) representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applic derstands and will comply with all non -point WITHIN 180' DAYS F PERMIT ISSUANCE OR source regulations per upe ' o Municipal Code, Section 9.18. 180DAYS AL LED INSPECTION. Signature Date 05/09/2016 Issued b • SSA Date: 05/09/2016 R -B E ARATION I hereby affirm that I a exempt from the Contractor's License Law for one of the JE -ROOFS: following two reasons: All roofs shall be inspected prior to y roofing material being installed. If a roof is 1. I, as owner o the property, or my employees with wages as their sole installed without first obtaining an in pection, I agree to remove all new materials for compensati; , will do the work, and the structure is not intended or offered for inspection. sale (Sec.7 44, Business & Professions Code) 2. I, as owne of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: 05/09/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous matee als requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this Ca&fornia Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 2 532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Ba , a Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the er no Munic' 1 Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety C d„S ons 2 0 ; 5 33, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized a APPLICANT CERTIFICATION Date: 05/09/2016 I certify that I have read this application and state that the above information is CONSTRU LENDINGAGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a consguction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is i sued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree. Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal AR TE TIS DECLARATION Code, Section 9.18. 1 understand my plans shall be us A as public records. Licensed Signature Date 05/09/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 44300 TORRE AVENUE + CUPERTINO, CA 85014-3255 CUPBIiTI°N0 (408) 777-3228 - FAX (408) 777-3333 f buildin ou erlino.or NEW CONSmucT1oN ❑ ADDITION ALTERATION/T1 ❑ REVISION /DBFERItED ORIG NAL PERMIT #f PROJECT ADDRESS / 0/ l ` Vt�i�l i ✓ F �+t/ V tG' `i APN #k �-, (� +ter OWtNBRNAMR . ,t� f JOY � /VV i. PIitjNli `"1 A_a 91�%V4, I�o- ' l IYiAi +� Y i> �N�i �rr�fA STILERTADDItHS } 2 1 T CITY. STAT fi`'U" q 1 'Y" FAX CONTACT' NAMt3(/" //__11 P JEAUL -ke— A-- 3 /C-00 sM a o� v� a -R-OA STRBI T ADDRESS CRY, STATE, ZIP FAX ❑ ownit ❑. oWNali-Blium t HBRAOBNT CI CONTRACTOR 13 CONTRACTORAOtlNT 13 ARCHITECT © UNC INBUR 0 DEVflWPaR 0 TENANT CONTRACTOR NAME 'y71• 71M 1COMPANYN J1.f'I1 ]ICIIHSIINtM�B & IAi�CH- NSR TY,4fA/Rt,ql,i� BUS. LIC N fr pY R-MAI}U t '. SRERPADDRESS CITY.TR , ARGH1THMPNOINJIBIt j LrJjOW LICENSE NMRHFL 5Q -^7� Bus, Lid 'it C -C�X4J1 ITA U64 'JAL STEEET p7 W F 2-b ICRMOU-6-4 `! L/i+t7 }P,109 16 J V dloo j oBscttt>~iloHol:woRlc 1 X12 U I /� Awl a -t MI I PROPOAA0 OH 'R.TYPT #STORIES USB TYPE C)CC, SQ,FT. ($) VALUATION13 BKISTO ARBAM '. NEW FLOOR DEMO ARRA AREA TOTAL Wr ARBA. BATHROOM IMMODDLARIIA K1TCIHEN OrIMP, IiBMOAS3LARBA REMODBLARBA - PORCHARRA DIICKARBA '1'OTALDE0KiPORCHARRA j QARAGRAWRA: El DETACII [:I ArfAcil II QWBi,LINO UNlT,S: 1SA'rIL'CaND [E41T YL�S 11RINGADA$117 [3144 srcoNDsTOUY []Y]js ADDITID147 []NO PRB.APPi.ICATIDN [7YE0 1lrYE80AOV]D1COPY0F PLANNEIOAPPL$ 0140 PLAWI NO APPROVALLIITTBR 19TUPsBLDOluzl ©YES EICHLER Uomn? [] NO CiiTV TALVALUATION: 00 By my signature below, I certify to each ofthe fallowhlg: I FIIR the propolty owner or authadzed agent to on the propelty ow ees behalf; 1 have read t4is appticRtlan awd die inthrination 1 have ptnvi&d is aartcat 1 ha v ad a Descliptton of Work and verify it is accurate. I agr e o Dply with allapplicable loind ordinances and state laws relating t 001 uc 'o . i Iho 'ze repressor hives of Cupertino to enter the above-idaotied 'opctly for inspection purposes. Signature ofApplfcantlAgent; Date, /I SUPPLEMENTAL INFORMATION D RE UM Q :. �:PT�L�ciIECKTITL+ ;'..�.. � -ItgU'i'ING SLIP -_•.. LAili nvusw ©oy$ii as cay;trsit O •BUMD]NO FW. New SitD o • Multifamily dwellings; Apply for detnolition permit for ouc ttgbuilding(s). Demolition permit is required prior to issuance of building ;. ,' permit for now building. D 7 XPI;ESS El PVAMING PLANIIEV3" Coimneroial Bldgs: Piovide a completed Hazardous Materials Disclosure El STANDARjj C NYORKS T& if any Hazardous Materials are being used as part of this project. � LAilcly C7 PIR# N13P7 _ Copy of Platining Approval Lotter or Meeting Ivith Plaluung prior to .0 , yrAsOR ❑ BAryiTAitY SR4S $RDIST1tIC9 submittal of Building Per ilt application, =` • : o • TsP1VTxDiyiYl6rixA�Tl�iumti: :.: , :. 1dgApp 2011.doc revised 06/21111 600A ill Department City Of Cupertino l Q3` 0 Tme -venae Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fay: 408-777-3333 CSB ADDRESS: 19419 Stevens Creek Blvd. #200 PER., I B-2016-1505 OWNER'S *' N)\4;Main Street Cupertino Aggregator .:._ _. PHONE # (650) 948-6930 G ..NFA, A CONTRACTOR:Cartmell/Tam Construction, Inc. .... _:_. BUSINESS LICENSE #36752 A D ESS44001 Page Mill Road CI'T`Y/ P'CODE: Los Altos Hills, 94022 *Our municipal code requires all businesses nesses working in the cite to have a City of Cupertino business license. NO BBI DING ,FIN L OR FINAL OCCUPANCY INSPECTION(S) NVILL BE SCHEDULED.UNTIL THE GENT ER L CON' 'ICAC'.iolt AND ALL 8 CC 1 T crotis I;I"If oB,i.kINED A CITY C IIPi%IITI-NT0 BUSINESS LICENSE. I am not using. any subcontractors: Signature Bate Please chock applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS B­USI�ICENSE Cabinets & Millvvork Cement Finishing Electrical TDN Electric, Inc. 28386 Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing V heating The Trillo Companies, Inc. 29816 V 1ns lation. South Bay Interiors, Inc. 25499 Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tanli Sleet Metal V Sheet RockSouth Bay Interiors 25499 Tile Contractor Signature Date