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B-2016-1755CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1755 10700 CLUB HOUSE IN CUPERTINO, CA 95014-3969 (356 05 003) S L M DEVELOPMENT INC BELMONT, CA 94002 OWNER'S NAME: AIKINS SONYA E TRUSTEE DATE ISSUED: 05/17/2016 OWNER'S PHONE: 415-945-9984 PHONE NO: (650) 288-7399 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. # 48 1898 Contractor S L M DEVELOPMENT INC Date 02/28/2018 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: (N) SERVICE COUNTER AT CAFE 150 SQ FT, UPGRADE INTERIOR I hereby affirm under penalty of perjury one of the following two declarations: FINISHES AND KITCHEN EQUIPMENT - DEEP CLIFF CLUBHOUSE 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 DEF#1 - TRASH ENCLOSURE jerformance of the work for which this permit is issued. 2I 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: $80000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 356 05 003 A(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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the a plicant�understands and will comply with all non-point source regulati . s per t�d. Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature -- - -Date 2 1 e Issued by: -Ayende Date: 05/17/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is s. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do, the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/5/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California 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 25532(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 Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the CypefiGm N'T}�nicipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Codo, Sections 7,5505 3,6533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall ' r be deemed revoked. Ofwner or authorized agent:. "Date:8/5/2016 ' APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CONSTRUCTN LENDING AGENCY correct. l agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (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 ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date/58 /2016 Professional . a G: ,.iPERTINO NEW CONSTRUCTION Vu CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 •building ,cupertino.orct I ❑ ADDITION n ALTERATTONITl 15;d RF.vrCT0N1T1EFPR11P1 OT?Tr;IMAT D>~DrsrmlF I PROJECT ADDRESS toqp�(� , K 1Jv ] APN# ✓ k�" C� R oo p OWNERNAME ,tI PHONE ` A15 'q+ q S-'q(+1fl E-MAIL STREETADDRESS CITY, STAT&,ZIP !' FAX CONTACT NAME -�^[� 1 � v J [ (f� PHONE E-MAIL STREETADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER 111 OWNPRAGENT ❑ CONTRACTOR 1:1 CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSENUMBER LICENSETYPE EUS. LIC# COMPANY NAME E-MATL FAX STREET ADDRESS CITY, STATE, ZIP PHONE 1 ARCHITECT/ENGINEER NAME 4 LICENSE NUMBER f' .. 5.52 q :� BUS. LIC Ii COMPANY NAME (�, _ t i t 'q _ � 1f� E-MAIL � .FAX C STREET ADDRESSjr'J�_ t `i L'" �plfth(�S/l �,, CI Y,1 ZIP /ll prJ fq PHONE y[�1 .1_jE�ly1' r ;4ey d(-/� DESCRIP'CIONOFWORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES - - V USE TYPE OCC, SQ.FT. (VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER - REMODELAREA. REMODEL AREA I REMODELAREA PORCHARBA DECK ARRA TOTAL DECKIPORCH. AREA GARAGE AREA: - DETACH ATTACH #D WELLING UNITS: WELLING ISASECONDUNIT E]YES SECONDSTORY- {]YES BEING ADDED? []NO ADDITIONZ []NO PRE -APPLICATION. ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN (] YES RET, : - - TOTAL VALUATION: PLANNING APDL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME't ANO ,ED.BY:, ::';�.,f,, By my Signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application anti the information I have provided is correct. I have read the Description of Work and vctify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building c nstiuction. I authorize resentatives of Cupertino to enter the above -id entified%property for inspection purposes. Signature of Applicant/Agent: Date: �� �✓ SUPPLEMENTAL INFORMATION REQUIRED ...:.p,PLAT�GFIECK TLPC, I�.OVEI;..THE-COUNTER "^ =' iA A.d BUH.,DINGPLANRL''Mw °--- New SFD or Multifamily dwellings: Apply for demolition permit for existhig building(s). Demolition permit is required prior to issuance of building permit for new building. C'EaPxEss �PLANNIxGPLnNREiIESv� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTAIrDAttv;;, :=:.:..:: D ruse to tivoRlis - _ form if any Hazardous Materials are being used as part of this project, i- U.. LIiRCG i FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to © ,s1Se1, OR © $ANiTARYSL:�LCIt.DISTW- subnxittal of Building Permit application. -- --- _ - - - -- - -.' NVSROMENTAlHEALTi(:=:?::=;:-s . Bldgslpp_2011.doe revised 06121111 lc{ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1755 10700 CLUB HOUSE LN CUPERTINO, CA 95014-3969 (356 05 003) S L M DEVELOPMENT OWNER'S NAME: AIKINS SONYA E TRUSTEE OWNER'S PHONE: 415-945-9984 LICENSED CONTRACTOR'S DECLARATION License Class B Lie. #84189 Contractor S L M DEVELOPMENT INC Date 02/28/2018 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: r. 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 l 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 a"enY un erstands and will comply with all non -point source regulati!pn§ per the upertino Municipal Code, Section 9.18. Signature Date15/ 7/2016 INC BELMONT, CA 94002 DATE ISSUED: 05/17/2016 PHONE NO: (650) 288-7399 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: (I) SERVICE COUNTER AT CAFE 150 SQ FT, UPGRADE INTERIOR FINISHES AND KITCHEN EQUIPMENT - DEEP CLIFF CLUBHOUSE Sq. Ft Floor Area: I Valuation: $80000.00 APN Number: Occupancy Type: 35605 1 A (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 05/17/2016 AQmkwh I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 5/17/2016 I hereby affirm under penalty of perjury one of the following three declarations: t. 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. 2. 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 5/17/2016 ALL "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 nicipal Code, Chapter 9.12 and the Health & Safety Code, S ons 205, 25533, and 25534. Owner or authorized agent: Date: 5/17/2016 CONSTRUCTION LENDING AGENCY 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT .BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255' CUPERTINO (408) 777-3228 • FAX (408) 777-3333 - buildingipcupertlno,org z u— ❑ NEW CONSTRUCTION ❑ ADDITION X ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERbET 4 PROJECT ADDRESS l0 0 0 oc l Se.- (-V" APN R o boJ OWNERNAME }J/�,.1 e, C Ii ft S d s 4p. PHONE+� Q�rj _ E-MAIL STREETADDRESS jfa, K01 1 I Io A CITY, STATE, ZIP l..n VI PHONE £-IvIAIL1 CONTACT NAME '1.'(4 .'( V( t STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ARCHITECT ❑ ENGINEER Q DEVELOPER Q TENANT CONTRACTOR NAME LICENSEWUNMER LICENSE TYPE BUS. LIC 9 COASPANY NAME E-MAIL FAX STREETADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME �n n �t / „ yp P - LICENSE NUMBER c_ 3 2- L f. (�l/V" BUS. LIC R � (,�,56� 1 ASP COANY NAME n t • �`+l /11., _ 1L j h . � E-A�.4IL '- �n l�� �T T 1 �/� i� ., (� S FAX STREET ADDRESS CITY, STATE, ZIP A 1 PHONE 1 Ll" t�G �1�-V �• , DESCRD'TION OF WORK c eXis� ISO •�iriis1w s a lZ►,� �.� �. EXISTING USE f'� _'L 1 PROPOSEp USE R • 2 CONSTR T1•PE : STORffS .�_ � 11 USE I TYPE OCC. SQ.FT. VALUAMN (S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA 150 I AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA , PORCH AREA DECK AREA TOTALDECI:TORCHAREA GARAGEAREA: LIDETACH ❑ ATTACH I DWELLING UNITS: is A sECOND Ln9T ❑ YES SECOND STORY ❑ YES 4 BEr.NGADDED? ❑NO ADDIDON7 ❑NO PtANi,naO vPI014 L R. []NOS Pt.:.h'NiNO APDE CPY OF PaO oAt LETTER ISTREBLDGAN 1CHLER HOME? NO .(�'a EI4. P BY M9f v ,�� TOTAL 1'.ALL� ATION; M 21. W. o c o O By my signature below, I certify to each of the following; I am the property owner c, authorized agent t act DA the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. 1 agree to comply with all applicable local Ordinances and state laws relating to building /co��shvction. I �tboriz� presentativeS Of Cupertino to enter the abovve-i en1fflpd property for inspection Purposes. Signature of ApplicantlAgent: � �7 _ �'7 Date: 411 VI A SUPPLEMENTAL INFORMATION REQUIRED pn o x ix>?c�ou\rER1{ x t>r i�c L4\ RE\ lER�Yi�tM, New SFD or Multifamily dwelling s: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildii 3 rtr f ,{ H '�- L �'i t st ?y p . 1 ��•a.r w tin pen jit far new building, -x �)E�1 EATItEs5 c SI 'tm�' ®pLA\:LSO PLXi AEA1E11� !� CommercialBldes: Provide a completed Hazardous?daterials Disclosure w[3 sr \� xD f ¢5 �..%11'Ar 5.r'3a t � PLSLICAiORl _ form if any Hazardous Materials are being used as part of this project. k ; stL LARGE,"- ¢ r kx }t "`•ter= 3-'^• v Meeting with P)annina prior to �y, y7 2'=.:/gi�'r�T h�yS" ^x•9o�s-r�3{^+.*.Ls pr iAJORn. 7 FIREDEPT'w �,,. �c�t '� �'J•--£�y `F4•'2 t �Es)LR�ISTRIC7 subni tial of Building Pepmit appiicatioor p�j r f \ST 4A] 2 l� '%.i .+x. ,:\•' -1..,._,.: t ,,:fir 01,E Bldg.4pp_3011.doc revised 06/31/11