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14010127-DPCITE' OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21530 STEVENS CREEK BLVD CONTRACTOR: SAGARCHI PERMIT NO: 14010127 ENTERPRISES INC OWNER'S NAME: BSP CUPERTINO UNION LLC � 495 E BROKAW RD #F ] DATE ISSUED: 10/23/2014 1 'S PHONE: 8319059668 LICENSED CONTRACTOR'S DECLARATION 'License Class Lic. #_ c (:f 9 Contractor _�� Dat \ I hereby affirm that I am licensed under the pro is,on o hapt r 9 (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. 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. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �!yB§ ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date SAN JOSE, CA 95112 J PHONE NO: (408) 458 -6670 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL INSTALL MODULAR UNIT FOR TEMPORARY SERVICE STATION OFFICE SPACE (NO MERCANTILE IN TRAILER) (300 SQ FT). Sq. Ft Floor Area: I Valuation: $2000 I APN Number: 35720027.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. ' I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C,) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profess V CONSTRUCTION PERMIT IT APPLICATION �1 � COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 C— UPERTINO (408) 777- 3228:• FAX (408) 777 73333 • building(a�cupertino.org I I NFW C(1NCTRTTr'TThN F-1 AT?TNTTON . I I AT.TFR ATIC)N / TT F-1 RFVTATON / T)FFFRRFT) ORT(1INAT. PRRMTT ii PROJECT ADDRESS //� '�j `//-/� A (1�, '� APN #`� . ^,/_ • OWNER NAME (/0 E -MAIL p, �.� (",[ (� t] [i� v /� STREET ADDRESS /'1 J `may � &�,Ai4s ®- ; CIT "�q1�, I ��,!(� /�°� � FAX � CONTACT NAME J� ` l PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX i ❑ OWNER .❑ OWNER- BUILDER ❑ OWNER AGENT ❑ ,CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT. CONTRACTOR NAME �(r -lug v� LICENSE NUMBER LICENSE TYPE BUS. LIC # . COMPANY NAME co c P �iJ 0 \ STREET ADDRES C . PHO /Iy W'��r��(/'�,1✓�` {� r, 1P ./� (� ARCHITECT/ENGINEER NAME ENSE NUMBER (' BUS. LIC # , COMPANY NAME •4% E -MAIL t� v i l:s�% 4 STREET ADDRESS N , \ J[/ %&HONIP CITY, STAT DESCRIPTION OF WORK-7-0'7 Zv .Q I !J EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG . NEW FLOOR DEMO' •TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH E3 ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? [3 NO ADDITION? []NO PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF - IS THE BLDG AN ❑ YES '- RECEI s =; TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO n t� By my signature below, I certify to each of the following: I am the property owner or authorize roperty owner's behalf. have read this application and the information I h vided is co t. I ha read the Description of Work and verify it is e. I agree to comply with all applicable local V ordinances and state laws relatin buil ng co tru io a r'ze re re ntatives of Cupertino to enter th identified pr erty for inspection purposes. Signature of Applicant/Agent r Date: SUPPLEMENTAL INFORMAT O REQUIRED =C$ECK'TPE ' :" PLAN : IiotlT�rrc se OVER THE COUNTEit CI BUILDLGrPiAPtRVIEw 6 _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. , _ ©>LxrR ss ��, �� PLANI`tJ( AN REVIE' Cori�mercial Bldgs: Provide a completed Hazardous Materials Disclosure C�ksTANna= ❑ _ PUPLIC WORICS y forni if any Hazardous Materials are, being used as part of this project. CL ❑ MEDEPT�' Copy of Planning Approval Letter or Meeting with'Planning prior to LARGE �p _ ❑MAJOR, SANTTAAYSEVIUBDISTRTGX submittal of Building Permit application. . _ � � It R r � n0 .ENVIRONMENTAL =HEALTH. k� a�. - m BldgApp_201 L doc revised 06121111 ); CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESSc 27.530 STEVENS CREEK BLVD DATE: 07/22/2074 REVIEWED BY: MELISSA APN: 357 20 027 �`D /,:; i i *k � s't $�5= � � <�a ;a.m�'� ! 5`^ v "�Y�F.• ac �' us s �b'«ad i" °3 X b y -' x, � .+' ,Vech. Plan Check Phimb: Plart Check Elec. Plan Check AAch, Permit Fee: Plumb. Permit.Fee: 'VALUATION: 1$2,000 Other Elee. Insp. %PERMIT TYPE: Building. Permit PLAN CHECK TYPE: Tenant Improvement llec. Insp. Fee: PRIMARY Commercial Building' USE: $0.00 �FIERMIT ENTAMATION TYPE: F0701 WORK INSTALL TEMPORARY OFFICE /MODULAR UNIT SCOPE I PME Permit Fee: i i *k � s't $�5= � � <�a ;a.m�'� ! 5`^ v "�Y�F.• ac �' us s �b'«ad i" °3 X b y -' x, � .+' ,Vech. Plan Check Phimb: Plart Check Elec. Plan Check AAch, Permit Fee: Plumb. Permit.Fee: Fee, Permit Pee: Other• Meek Imp. Other Plumb Insp. Other Elee. Insp. .Mech. bssp'. Fee:, Pluufli. /nsp. Pee: llec. Insp. Fee: NOTE: This estimate does not include-fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These ees are based on the preftnWina information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Resoluiion 11 -053:1 . 711113) FEE QTY/FEE MISC ITEMS. Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC. Fee: Reg. ®OT. 0.0 hrs $0.00 PME Plan. Check; $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. 0 OT F0701 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax.. Administrative Fee :. G Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 0 # Modular Structures G $834.00 IMODUSTRU Travel Documentation'F'eczs : . Strong Motion.Fee: .. 1BSEISMICO $0.50 Select an Administrative Item Bldg Stds Commission .Fee: 1BCBSC $1.00 „SUBT;OTALS# $1.50 $834.00 g'OTALFEE �T; $835.50 Revised: 01/15/2014