14020152-DPI
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20080 STEVENS CREEK BLVD
CONTRACTOR: JOHNSTONE
PERMIT NO: 14020152
MOYER, INC.
OWNER'S NAME: PREG BILTMORE
555 OLD COUNTY RD
DATE ISSUED: 07/01/2014
OWNER'S PHONE: 6509313457
SAN CARLOS, CA 94070
PHONE NO: (650) 570 -6161
❑ LICENSED CONTRACTOR'S DECLARATION
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BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. # \
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MECH RESIDENTIAL COMMERCIAL
Contractor E��y'�. N`�lil Date r /
I hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: MASTER SIGNAGE FOR RETAIL AND MFDWL UNITS TO
(commencing with Section 7000) of Division 3 of the Business & Professions
INCLUDE 10093, 10095 & 10097 S BLANEY AVE.
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: $30000
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 36903009.20080
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
PERMIT EXPIRES IF WORD IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIl�I 180 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 IDAY 1ZA T 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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
ROOFS:
Signature = Hate � �
All roofs shall be inspected prior to any ny roofing material being installed. If a roof is
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 1 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 haveread 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 1 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 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner a n�;� d - �- - -Date: M Q 1 Y
permit is issued.
or authorized --
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
r
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, l 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 (See. 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. 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9.18.
Signature Date
CUPER'nNo
NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICAT ON
COMMUNITY DEVELOPMENT DEPART =vEN'f • BUILDING DI ION
10300 TORRE AVENUE e CUPERTINO, CA 95014 -3255
(408) 777 -3228 FAX (408) 777 -3333 - building5cup ino.or 2 0� v M
F-1 ADDITION n A1.TFRATTON / Tl V F.VISION / DEFERRF.DJ ORIGTNAT. PERMIT ii
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STREET ADDRESS
CITY, STATE, ZIP .. _ & FA
C1 OWNER 1:1 OWNER- BUBAER V OWNER AGENT 11 CONTRACTOR ❑ CONTRACTOR AGENT 1:1 ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANTu
CONTRACTOR NA
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
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AL
LICEN
BUS. LIC #
COMPANY NAME
EMAIL
FAX
STREET ADDRESS,
CITY, STATE, ZIP
PHONE
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DESCRIPTION OF WORK
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
ATTACH
#DWELLINGUNITS:
ISA SECOND UNrr C] YES
SECONDSTORY ❑YES
BEING ADDED? JJNO
ADDITION? [3NO
PRE - APPLICATION [I YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES
4REQEIVED BY,,, -" JT ALIIATIrIAI-
`: C9,
PLANNING APPL # ❑ NO PLANNING AP OVAL LETTER
EICHLER HOME? ❑ NO
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e
By my signature below, I certify to ac
f e following: I am the property owner or authorized, agent to act on the property owner's behalf. I h ve read this
application and the information I h e
r d 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 relating t b
I i onstruction. 1 authorize representatives of Cupertino to enter the above dentifi p operty for inspection purposes.
Signature of Applicant/Agent:
Date:
SUPPLEMENT 0 ATION REQUIRED
PLAN CHECK TYPE
, IioUTMG,slur
❑ovEa -TIIE cotnvTER
BrI1LDINGPLANREVIEW
New SFD or Multifami dwellings: A ly for demolition permit for
existing building(s). Demolition s required prior to issuance of building
permit for new building.
❑ !EXPRESS
❑ "'PLANNINGPLANREVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTANnARD '.
❑ Pbu'LiC WORKS `
form if any Hazardous Materials are being used as part of this project.
El ,
'U LARGE
FIRE DEPT
_Copy of Planning Approval Letter or Meeting with:Planning prior to
k
0 MAaoli
d SANITARY sEWExbisTRrcT
submittal of Building Permit application.
❑ 'ENVIRONMENTALVHEALTH
BldgApp 2011.doc revised 06121111
CITY OF cCU]FIFRTffNO
FEE ESTIMATOR — BUff LDffNG DIVISION
ADDRESS: 10097 s blaney ave DATE: 02/20/2014 REVIEWED BY: mendez
APN: 1BP #: 13020151 `VALI1ATMN: 1$7,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT 'TYPE: d
WORK master si na a package for mfdwl
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. 'Planning, Public Works, Fire, Sanitary Sewer District, School
nictrict_ etc ). Thace fevc ary ha.ced nn thv nreliminary infnrmation availahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (1,-'ee Resolution 11 -053 ff 711/13
Xfecb. Plain ('&e ck
Phinth. Plan 1'hcol,
Lh1t P/cm
MCE;h. Permit Fe".
Pirnmh. permil7���c -:
1, 1, Armit1',•r
fn,v"
011"et' pfulnh IYi Sh.
0111.T ).;10 In.;17. EJ I
F,c'C."
11hiw;L hic17.
f' ic(. Imp. fco:
NOTE: This estimate does not include fees due to other Departments (i.e. 'Planning, Public Works, Fire, Sanitary Sewer District, School
nictrict_ etc ). Thace fevc ary ha.ced nn thv nreliminary infnrmation availahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (1,-'ee Resolution 11 -053 ff 711/13
FEE
QTY/FEE
ID ISC ITEMS
Plan Check Fee:
$0.00
0 #
$556.00
Deferred Submittal
IDEFSUBM
Suppl. PC Fee: E) Reg. Q OT NKI
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-E) Reg. C OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
E.orutruc'clurz TUN.*
1 `e�:
®I
E)
Work Without Permit? Q Yes E) No
$0.00
Advanced Planning
$0.00
Select a Non - Residential
Building or Structure
A
1 }cared 1)r�C:rrancrafrrticrn 1_, arc. >:
Strong, Motion Fee: IBSEISMICO
$1.58
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.58
$556.00
TOTAL FETE:
$558.58
Revised: 01115/2014
M
CT Y OF cCUP ER7 1NO
I!, ° FEE ]ESTIMATOR — WELDING DIVE ON
fi
AIDIDRESS: 10095 s blaney ave
DATE: 02/20/2014
REVIEWED BY: mendez
:.
APN:
BP #: 13020152
*VALUATION:
1$7,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
Select an Administrative Item
PENTAMATION
PERMIT TYPE: 1GEIVCOM
WORK
master si na a package for mfdwl
SCOPE
$556.00
fi
i'lan i
010('4
Eio . PIMP+ L'hc ck
r� & ><: ;'r. 1' ; r ?ail Fee'.
!'ir art h. Permit F,�e:
Ftar P� gnu
$0.00
01,1aer Phi nb !r:,"1r.
01hvr Elec 1,tsp.
;tech. ir»1z 1 r(r
P/11'1), 1ns1z
Select an Administrative Item
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These ees are based on the prelimina information available and are on! an estimate. Contact the De pt for addn'1 in o.
FEE ITEMS (Fee Resolution 11 -053 Ej" 7f /1,'13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0,00 2 # Deferred Submittal
Suppl. PC Fee: (2) Reg. ®OT Q,Q hrs $0.00 $556.00 IDEFSUBM
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. COT Q Q
hrs
$0.00
Work Without Permit? Q Yes (2) No
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Tru�rl 1.)Ex�ntrr��ntoar;o =i Fees:
t ti7rriiu� :1`�rr:
Strome Motion Fee: IBSEISMICO
,4C 11 ctr(tt; C r('(":
0
Work Without Permit? Q Yes (2) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential E)
Building or Structure 0
L
Tru�rl 1.)Ex�ntrr��ntoar;o =i Fees:
Strome Motion Fee: IBSEISMICO
$1.58
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.58
$556.00
TOTAL FEE-.
$558.58
Revised: 01/1512014
CITY OF cCUP EI[8' INO
FEE ESTIMATOR — BUILDING DIVIKON
ADDRESS: 20080 scb DATE: 0212012014 REVIEWED BY: mendez
APN: 1BP #: 13020151 VALUATION: 1$7,500
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY P]ENTAMATION
USE: PE Building P>ERMUTTYPE: 1GENCOM
d,
WORK master si na a acka a for new retails ace
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, unitary Sewer District, School
Aistrirt etc. i_ Thvse fees ore hated nn the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE IT)EIS'7[S (Fee Resolution 11 -053 Eff 711113)
l' .h. Plc;n C`rtr:k
Pravuhl r`'iar, Cref"A
1'lac. Plum Ch cck
.- tlecil. F'er•rtril �`.r.
P/mnE. i'e;•rni! h�c:
r`•,I�r•. F'er' %r;ir l�r;•.
Other 4ech. frisi >.
Other Plumb insp.
07her l;ler. 1rnu. Ll
A'Ioch' Insp. F1'er:
Pl "wh 14.'p. t`V •
1.77, -- imp. 1•: :c °;
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, unitary Sewer District, School
Aistrirt etc. i_ Thvse fees ore hated nn the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE IT)EIS'7[S (Fee Resolution 11 -053 Eff 711113)
FEE
QTY/FEE
MI1SC ITEMS
Plan Check Fee:
$0.00
#
$556.00
Deferred Submittal
1DEFsUBM
Suppl. PC Fee: (2) Reg. C OT Q,Q
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. COT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
�,CJIY..titb7lCiTlJli 1cVy.
r1l�l lirri;r;_i'uiivc° f' ±rr ::
E)
Work Without Permit? 0 Yes E) No
$0.00
Advanced Plannnink Fee.
$0.00
Select a Non - Residential
Building or Structure
E)
Q
d
iii ulc�/ IJe�rrunerrr�`u1�c�r7 Fees:
Strom,, Motion Fee: IBSEISMICO
$1.58
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUJIBTOTA]L8:
$2.58
$556.001
TOTAL FEE:
$558.58
Revised: 01/15/2014
0
e '
Cff',Y OF CUP EllBUND
FEE 7 M
ADDRESS: 10093 s blaney ave DATE: 02/20/2014 REVIEWED BY: mendez
APN: BP #: 13020153 *VALUATION: 1$7,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK master si na a package for mfdwl
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn I info.
FEE ITEMS (Fee Resolution 11 -053 EJ' 7/11131
b$,c h. Plan Chc° A
Plumb Mull ChccA
MISC ITEMS
Fl--h A!rrltil PPP
Phtrnh. fermi Vtv:
1 -!, ( peowl i x "( '
0111cf- Alech. Insp.
Other Plumh Ins(
PME Plan Check:
Alc(h Imp. V"C
P/lu,lh. h)sp. Fcc
On
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn I info.
FEE ITEMS (Fee Resolution 11 -053 EJ' 7/11131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
# Deferred Submittal
$556.00 IDEFSUBM
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. ®OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conn action I'Lix:
fld/ntl7l.Sll ";7IlDc'
Fee.,Q
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Ei
$0.00
Select a Non - Residential 0
Building or Structure 0
Trop el Doumnentuiinn Fees:
Strong Motion Fee: 1BSEISMICO
$1.58
Select
an Administrative Item
Bldg, Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$2.58
$556.00
TOTAL FEE:
$558.58
Revised: 01/15/2014