13090038 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10869 N WOLFE RD CONTRACTOR:MIDSTATE PERMIT NO:13090038
CONSTRUCTION
OWNER'S NAME: CUPERTINO VILLAGE LP 11'80 HOLM RD DATE ISSUED:10/16/2013
,OWNER'S PHONE: '6507467503 PETALUMA,CA 95954 PHONE NO:(707)762-3200
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
LI
License Class_ Lie.# ' 1 PHASE 1; FOUNDATION ONLY ON LEVEL 1; SOUTH OF
,�.(, 1 GRID
Contractor ll�l S�A\-� 6oHS-T. Date / LP LINE-R1 ONLY; TO INCLUDE ELECTRICAL(SERVICE)
I hereby affirm that I am licensed under the provisions of Chapter 9 PLUMBING(SEWER)
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
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.: Sq.Ft Floor Area: Valuation:$I800000
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 APN Number:31605052.I0869 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT 80 DAYS OF PERMIT ISSUANCE OR
building construction,and hereby.authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA F OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 4` �G
granting of this permit. Additionally,the applicant understands and will comply Issued by: / Date: 2.
with all non-point so a egulati s per the Cupertino Municipal Code,Section
9.18.
//� / RE-ROOFS:
Si tui, °�'✓ Date 1U ( All roofs shall be inspected prior to any roofirig material being installed.If a roof is
ti.R `_ installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner.of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 65 ,25S 3,and 25534. ff
Section 3700 of the Labor Code,for the performance of the work for which thisxr Date
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have-read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.I8.
Signature_ Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
b
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildingO)cupertino.org 51�,
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN# 921{.i! ®r• O gV)
OWNER NAME PHONE( 7Aj � -/E-MAIL
STREET ADDRESS�r_ C�/l/'�` ,✓�6� �Y�/ ' '!�/l .6`^✓'1 E!;/`(/�`L � FAX
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CONTACT NAME PHONE
STREET ADDRESt� V./t.J e *-� �6gw4XVT
EZIPnKe
❑OWNER ❑ OWNER-BUILDEROWNERAGENr ElCONTRACTOR 11 CONTRACTOR AGENT ElARCHITECT 11ENGINEER 11DEVELOPER 11TENANT
CONTRACTOR NAME 4n LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHrrECT/ENGINEER NAME LICENSE NUMBER V I BUS.LIC#
C PA NAME ,� � E-MAIL syh�,� 1 CO„dRAX
N-{ rs/ a�/` GJl0rl
STREET ADDRESS CITY,STATE ZIP O
ievc*uv: l d. 11 ;W.5 0&O(P
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
4"VI p I� L USE TYPE OCC. SQ.FT. VALUATION(S)
NEW FLOOR ✓/��' DEMO TOTAL
AREA
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCli—M7 DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
[]ATTACH
#DWELLING UNITS: IS A SECOND UNrr []YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF 1S THE BLDG AN ❑YES RE D'B'Y "rz - TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 4 .. elV l loo
ly
By my signature below,I certify of the following: I am the property owner or authorize ent to act on the property owner's behalf. I have read this
application and the informatio I pr ided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws re it � construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent. Date:00.0& r
SUPPLEMENTAL INFORMATION REQUIRED
PLAN'CHECK TYPE Ro[ITuvG'sLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑_PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAICD cRD - wQ PUBLICwoRKs
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑:ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
AUG 302013
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: Cupertino Village-Parking Struc DATE: 08/27/2013 REVIEWED BY: A. Salvador
APN: BP#: `VALUATION: 1$1,800,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY Civil/Religious activities PENTAMATION
USE: Commercial Building in BQ zone? 0 Yes (F)No PERMIT TYPE-
WORK
S
WORK New 2-1_evel Parking Structure 1st level: 35,003 s.f.; 2nd level: 31,728 s.f.
SCOPE
I
OCCUPANCY TYPE: TYPE . FLR AREA
CONSTR. PC FEES PC FEE ID BP FEES BP FEE ID
S-2 (Low-Hazard) II-B,III-B,IV,V-B 66,731 $8,180.12 1S2PLNCK $30,819.96 1S2INSP
TOTALS: 66,731 $8,180.12 v $30,819.96x .
'. y - *3y z, ' �"' x"`"`.�, ` tK, *.�£-k. ' re •yr'`3T+xi�"
M
^,.> ..:'- „,,,>h�v,?'..92 "aa,s' x �:.` -•. €Y- .,'max-.,':. ..+:z ..—:$-:''.
Xtech. Plan Check Phmib. Mar)Check Elec..Plan Check
1F1ech. permil Fee: Flumb. Permit Fee: I lec.. Permit Fee:
Other Ilech.Irt.rp. 0
Yher Phalrah Insp. Ll I
Other fYec.Insp,
11erh.1nsp.Fee: Plumb. lisp. Fee: I;'Iec.Insp,.Fee:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $8,180.12 Select a Misc Bldg/Structure
Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $30,819.96
Suppl. Insp.Fee:(D Reg. Q OT Q.Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax: IBCONSTAXC $0.00
A.dIninis trative Fee: 0
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: IPLLONGC $18,684.68 hours Inspections E)
Travel Documentation Tees: $0.00 1 Inspection,Hourly 0
Strong Motion Fee: IBSEISMICO $378.00 Select an Administ--"= T`____
Bldg Stds Commission Fee: IBCBSC $72.001 1
58,134.76 $0.00
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