15110181CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6 RESULTS WAY
CONTRACTOR: SC BUILDERS INC PERMIT NO. 15110181
OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET
910 THOMPSON PL DATE ISSUED: 11/25/2015
OWNER'S PHONE: 6504211832
SUNNYVALE, CA 94085 PHONE NO: (408)328-0688
0 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
APPLE T1 TO ADD (4) SECURITY DOORS.
License Class 'i� Lic. # —7 6-1 tcl I.-
I hereby affirm that I am licensed under the provisions of Chapter 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
Sq. Ft Floor Area:
Valuation: $95000
performance of the work for which this permit is issued.
1 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: 35720041,6
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
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM 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
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
'
Signature Date 11 1;2-5 1 15—
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
13 OWNER-BUILDER DECLARATION
Signature of Applicant:----- Date:
I hereby affirin'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
1, 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. 1 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 25505 34.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: <
permit is issued.
—iN
I certify that in the performance of the work for which this permit is issued, 1 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
CON�TRUCTION 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!LERTLF CATION
Leader's Address
I certify that I have read this application and state that the above information is
correct 1 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 DECLAflATION
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
Signature._ Date__
CONSTRUCTION PERMIT APPLICATION
COMMiUN7 Y DEVELOPMtENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildimoCaj),cu ettlng.org
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VALUATION (S)
EXISTU
MEW FLOOR TOTAL
.AREA
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AREA I AREA I ME-7 AREA
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IS A SECOND UNIT ®Y BE S
SECOND STORY Cj1�S
BEING ADDED? n '0
ADDITION? [3Mo
PT\Z-;UPLTC.A,TjON ED -.S IFF PR.0%Vz COPY OF
PLANNINGAPPL-� EDNO PLANWMhG AP??1Ov,4.L LETrE?
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is THE BLDG AN YES
EICHLER HOMF? ".0
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TOTAT VALUATION:
—
By my SIR,-, a-, u-'e below, I C,-rL;4 to each of the f'o I I ow`�
ing: Ism the property m1mer or authorised agent to act or th e property owners behalf. I have recd this
application, and the information I have provided: is Cor.—C et: Jhaves read the Description of Wtork-andverilfy it, is accurate. I
ordinances and state laws relating to building n5,,)--,._c"1 wnL F. i rrese ntalivtscl Cupertino to enter the above - identified Property for inspection proposes.
SignatL reofApplkant/Agent: Date, WOV Al
SUPPLE? N1 E? 77AL INFORMATIO-N 77"QuIRF-1)
N2w SFD or Milltifaznily dF� ,--'Iings: Apply for de m nm
olition oeit for
te
C-xisting builciin.cr(s). De.-molition pennit is required prior to 1*Ssu''a--nc-. of bul'idin a,
for, new building.
permnit
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 75
'bif
any Hazardous Materials are being used as part of this project.
Cony of Planning AD nova Letter or planIling prior 0
P i rt
u bn-Mpl of Building Pe. nit application,
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revised 06121111
USE: L;ommerciai uncling in - BQ zone? - 0 Yes (j) No 1GENCOM
PERMIT TYPE:
='Apple T1 to add (4) security doors.
jVOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Divtriet- ptr-)- Thow foot ano hawd on tho nrofinnnare ;nfnrnwytMn awlilahlo and aro ""lip "" Ovam"tV CA—f—f f1h, 71—f f— —U.11 i. i;,
FEE ITEMS (Fee Resolution 1.1-Q53 Eff. Z/1113
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No
$0.00
= hours
$286.001
Plan Check, Hourly
isTPLNCK I
Suppl. PC Fee: (D Reg. 0 OT
1, 0.0 1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes (E) No
$0.00
Suppl. Insp. Fee. ®- Reg. 0 OT
0 0 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: jBcomsTA-vc
$0.00
0
0
Mork Without Permit? 0 Yes (E) No
$0.00
Advanced Pjqnnjp&fee:
$0.00
3 hours
$429.00
Inspections
ISTINSP TInspection, Hourly
G)
0
7 ,nzve,l Documentaftonfi es:
Stron,2 Motion Fee: IBSEISMICO
$26.60
Select an Administrative Item
B!dL, Stds Commission Fee: IBCBSC
$4.00
Z'B
$30.60
$715.00
00
$ 7� i.60
Revised: 10/01/2015