B-2016-1167CITY OF CUPERTINO. BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1167
19459 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112)
L B COMMERCIAL
CONSTRUCTION INC
SUNNYVALE, CA
94085
OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC
DATE ISSUED: 05/13/2016
OWNER'S PHONE:
PHONE NO: (408) 844-8299
i ICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GLAZING Lic. #B
Contractor L B COMMERCIAL CONSTRUCTION INC Date 10/31/2016
X BLDG _ELECT _PLUMB
MECH RESIDENTIAL X COMMERCIAL
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:
T.I. for 85 degree bakery (2,484 S.F.); Main Street
I hereby affirm under penalty of perjury one of the following two declarations:
2. 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.
ll 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
Sq. Ft Floor Area:
Valuation: $350000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
316 20 112
316
A (Tenant Improvements),B (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 the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/13/2016
Issued by: SEAN HATCH
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:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
installed without fust 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: 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
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.
HAZARDOUS MATERIALS DISCLOSURE
2. 1 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
s. 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 25_1%4, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 05/13/2016
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDI G 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
10 CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
CWPERTINt] (408) 777-3228 • FAX (408) 777-3333 • building okupertino.org
❑NEwCON5'IRCICTION ❑ ADDITION (ZALTERATION/TI ❑ REVISION/DEFERRED
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CONTRACTOR NAME
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DESCRIPTION OF WORK
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ISASECOTDUNITLJ YES
SECOND STORY []YES
DEINOADDED7 []NO
ADDI77ON7 ❑NO
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TOTAL VALUATION:
By my sigmdure below, I certify to each of the following: I ant the property owner ar authorized agent c act on the prop wnees behalf. I have read this
escription of work and verify it is accurate. I agree to comply with all applicable local
application and the information I have provided is correct, ha+ED
ordinances and state larvs relating to bui consh otion. I aesentatives of Cupertino to enter (lie abovo-identified ropeny for inspection purposes.
Signature ofApplieant/Agent: Date:SUPPLEM
ALWFORMA NRLNew
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RurrDH.Grt�LL� rtt l� et\
SFD or Multifamily dwellings: Appl fordemlit for
existingbuilding(s). Demolition pennitisrequired priortoissuance ofbuddmg
permit for now building,
pi: FxPREss
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Co1llmercial Bldgs: Provide a completed Hazardous Materials Disclosure
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form if any Hazardous Materials are being used as pact of this project.
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submittal of Building Permit application.
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RldgApp 2011.doc revised 06121/11
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CITY OF CUPERTINO
FEE �STIMATOR- BUILDING DIVISION
ADDRES5: 19459 Stevens Creek Blvd DAT�: 01I12I2016 REVIEWED BY: Phuong
� APN: 316 20 112 BP#: *VALUATION: $350,000
*Pt,RMITTYPE: BUlldlllg P2fi711t PLANCHGCI{TYPE: TEtt8flf 111lpPOVBYll0llf
PRIMARY CommercialBuilding PENTAMATION 1BTI
� USE: PERMIT TYPE:
WORIc TI for 85 de ree baker - Main Street
SCOP�
OCCUPANCY TYPE: TYPE OF FLR ARLA pC R��S PC FEE ID BP r�ES BP FEE ID
- - CONSTR. s.f.)
B (Tenant Improvements) II-A,III-A,V-A 2,622 $2,917.96 IB'L'IPLNCK $2,965.68 IBTIINSP
TOTALS: 2,622 $2,917 96 , $2,965.68
MECH,HOUI2LY, � Yes ' � No 1?T.UN�$,HOURLY ' Q Y.os,,Q No ��,�C'i H`OT7RLY°� � Yes ,.��Ns-
�fe•cFr. Pl:rn f'fl�tk I'lat,r;b. Z'!ma Cfte(�x £lce.I'i�ar:t tio-a: �
!tfecfa. "?srrnit hze: J'J�dr1�.i�'ar�mi(i�ce: tifec..Natani�t���r::
(hke,A�faett. h,». Ochzr Pitnrib Ircp_ Uri!er E;t�z�.arts�z
hleeft.frr.sp. `r�=c: /'K��4uiti. 7ns{z F<rc: F:tac.,'racp./",e:
NOTE:Tlais estimate does not include fees due[o oUter Departments(d.e.Plnnning,PuLlic Worhs,Tire,Snnitnry Sewer District,Scliool
Dastrict,efe . TJrese ees are bnsed on Ute relimdnar dn ormnllon avni[able and are onl me es8mnte. Contticf the De�t for addn'1 in o.
F��ITLMS (Fee Res�lution 17_0�3 I�:7/!/,13 FEE QTY/PE� MISC ITEMS
Plan Check Fee: $2,917.96 Select a Misc Bldg/Structure
Suppl. PC Pee: � Reg. � OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $O.DO
Permit Pee: $2,965.68
SuppL Insp. Fee:� Reg. � OT p,p lirs $0.00
PM�Unit P'ee: $0.00
PME Permit Pee: $0.00
� (.`nrrs•trrtc�ricnTar:
�4drrrrtti:sirCtRt'e, I'eP: �
Work Wit6out Permit7 � Yes � N'o $0.00 �
Advaneed Planning4,Fee: $0.00 Select a Non-Residential �
I;�a��e(Z>n<���rr��rtar9t7n��cs: BttildingorStructure �
e
Sti_on�Motion Fee; 1eSE�SrvnCo $98.00 Select an Administrative Item
Bld�Stds Comuiission Fee: 1UCasC $14.00
SUBTOTALS:; $5,995.64 $0.00 TOTALF��: $5,995.64
Revised: 10/01/2015
Building Department
Ci Of Cupertino
10300 Torre Avenue
Cupertino, C 95014-3255
Telephone:408-777-3228
C U P RT i N p pax: 08-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS:, 7 ERIIT # •: E r (((�
SUBCONTRACTOR
OWNER'S NAME:),j PH NE #l -
BUSINESS LICIENSE
GENERAL CONTRACT R: 60415 � a BU INESS LICENSE #
ADDRESS: 30 lkW EXJV o CA.' CITVZIPCODE: Ll
*Our municipal code requires all businessk working in the city to have a City of Cupertino business 1
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTTON(S) NVILL BE SCHEDULED
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF
BUSYNESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
TETE
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SUBCONTRACTOR
BUSYNESS NAME
BUSINESS LICIENSE
#
Cabinets & Millwork
Cement Pinishing
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Electrical
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Excavation
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Fencing
Flooring / Carpeting
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Linoleum / 'Wood
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Glass / Glazing
'Heating
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Insulation
Landscaping
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Lathing
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Masonry
Painting / Wallpaper
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Paving
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Plastering
Plumbing
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Roofing
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Septic Tank
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Sheet Metal
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Sheet Rock
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"Tile
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