B-2016-1419CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1419
19319 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 113)
S C BUILDERS INC
910 THOMPSON
PLACE SUNNYVALE,
CA 94085
OWNER'S NAME: MAIN STREET AGGREGATOR
DATE ISSUED: 05/13/2016
OWNER'S PHONE: 408-639-9322
PHONE NO: (408) 328-0688
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #767196
Contractor S C BUILDERS INC Date 08/31/2017
X BLDG ELECT PLUMB
— — —
MECH RESIDENTIAL X COMMERCL4,L
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.
JOB DESCRIPTION:
APPLE (OFFICE 2 AT MAIN ST) - CREATE (1) A-2 CAFE/NICE BAR
I hereby affirm under penalty of perjury one of the following two declarations:
(1,870 S.F.)
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.
z I have and will maintain Worker's Compensation Insurance, as provided for by
LV Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $100000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
316 20 113
3 16
A (Tenant Improvements)
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
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 applicant understands and will comply with all non -point
source regulations per th C pertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CAJAXD INSPECTION.
Z.
Signature Date 05/13/2016
Issued by: MEL AN S
Date: 05/13/2016
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
1. 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)
i. 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: 05/13/2016
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 hazardousmaterials 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 Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 2 05, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
�_r
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 05/13/2016
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I 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 05/13/2016
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-32,55
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • build! ng(a)cupertino.orp
❑ NFIV CONSTRUCTION ❑ ADDITION ALTERATION I TI ❑ REVISION / DEFERRED ORIGINAL PERMI #
PROSECT ADDRESS
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CONTRACTOR NAMEL
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LICENSE TYPE13.
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
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CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EYISTINGUSE
PROPOSEDUSE
CONSTR.TYPE
SSTORIES
USE TYPE I OCC. SQ,FT. VALUATION (S)
AREA
AREA
NEW
AREA
DEMO
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TOTAL
NET AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA GARAGEAREA: DETACH
H ATTACH
tl DWELLING UNITS:
IS A SECOND U\'IT YES
SECOND STORY LIYES
DELNO ADDED? NO
ADDITION?
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
ISTnEBLDGAN �-
TOT ATION:
PLANNINGAPPLIF []NO PLANNING APPROVAL LETTER
EtCHLER HOME7 r, �
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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 belra f. I have read this
By
application and the infonuation I have provided 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 to buil i>tg const ction. I authorize representatives of Cupertino to enter the above-ideutifr d property for inspection purposes.
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Signature ofApplicant/Agent. Date: �2 23
SUPPLEMENTAL INFORMATION REQUIRED
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New SFD or Multifamily dwellings: Apply for demolition permit forAM
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existing building(s). Demolition permit is required prior to issuance of building
QIiKi TSiE C9U\TER -r..
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BUILDING PL.An
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permit for new building.
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_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
1�: SraeDalxn
pUBSrIG 1i'oRifS
form if any Hazardous Materials are being used as part of this project.
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Copy ofPlanning Approval Letter or Meeting with Planning prior to
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SA,�IT4�t� SE\\'ER DI57RICT y:.
subnA• ttal of Building Permit application,
44120\R1fiNTAT'HEALTH
BldgApp_2011.doc revised 06/21/11
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-32SS
Telephone: 408-777-3228
CUPERTINO
Fax 408-777-3333
CONTRACTOR SUBCONTRACTOR LIST
JOB ADDRESS: ICJ,619
PERMIT # —,Lot
OWNER'S NAME: `PPLO I rur—
PHONE # ro,50, C�0(o
GENERAL CONTRACTOR: _Sr, SUCS WC
BUSINESS LICENSE# 'Z4J 10-7
LADDRESS; 910 VL
CITY/ZIPCODE: %gd4yALC- +% 9 5 -
Our municipal code requires all businesses working in the city to have a City, of Cupertino business license.
NO BUILDING FINAL
L OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
,Cabinets & Millwork
-3:5 i5-8
Cement Finishing
Electrical
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13 7 Z4
Excavation
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Fencing
Flooring / Carpeting
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Linoleum / Wood
Glass / Glazing
VJAL;,re4Z-S v,j ® L--fz'
0
HeatiA,g
j v v\
-7'1
Insulation
Landscaping
Lathing
Masonry
Painting /Wallpaper
Paving
Plastering
Plumbing
2(6 0 7 41
Roofing
Septic Tank
LADLi 0-7
Sheet Rock
M U
7-00
Tile
/ CWraetor Signature
Date
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