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B-2016-1732CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1732 20400 STEVENS CREEK BLVD CUPERTINO, CA 95014 (369 010 8) CODY/BROCK INC SAN CARLOS, CA 94070 , OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS DATE ISSUED: 04/11/2016 OWNER'S PHONE: PHONENO; (650) 591-0757 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #6, 971 Contractor CODY/BROCK INC Date 04/30/2018 X BLDG —ELECT —PLUMB MECI3 RESIDENTIAL X COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapte 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:, STE # 130 - (FIRST FLR, NORTHEAST WING) T.I. 2,786 S.F. I hereby affirm under penalty of perjury one of the following two declarations: (PROMETHEUS) 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 Lal: r Code, for the REVISION #1: REPLACE AND RELOCATE HEAT PUMP. ISSUED performance of the work for which this permit is issued. 0 6/8/16. -I have and will maintain Worker's Compensation Insurance, as provided for by -1 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $147000.00 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 APN Number: Occupancy Type: inspection purposes. (We) agree to save indemnify and keep harmless the 369 01 028 A (Tenant Improvements),B (Tenant Improvements) City of Cupertino against liabilities, judgments, costs, and exper ses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all r{on-point PERMIT EXPIRES IF WORK IS NOT STARTED source regulations per the Cupertino Municipal Code, Section 9 18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature Date s s 16 Issued by: SEAN HATCH OWNER -BUILDER DECLARATION Date: 04/11/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, as owner of the property, or my employees with wages as their sole RE -ROOFS: compensation, will do the work, and the structure is not in#ended or offered for 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 sale (Sec.7044, Business & Professions Code) I inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following threl declarations: Date: 6/8/16 t. 1 have and will maintain a Certificate of Consent to self -inure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER ,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 of th work for which this HAZARDOUS MATERIALS DISCLOSURE performance permit is issued. I have read the hazardous materials requirements under Chapter 6.95, of the s.- I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will shall not employ any person in any manner so as to becom subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of 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 Labor Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and be deemed revoked. the Health & Safety Code, Sections 25505, 25533, and 25534. APPLICANY CERTIFICATION I certify that I have read this application and state that the abovp information is Owner or authorized agent: correct. I agree to comply with all city and county ordinances and state laws Date: 6/8/16 relating to building construction, and hereby authorize represe tatives of this city CONSTRUCTION LENDING AGENCY to enter upon the above mentioned property for inspection purposes. '(We) agree I hereby affirm that there is a construction lending agency for the performance to save indemnify and keep harmless the City of Cupertino aga'nst liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the apI [!cant understands and will comply with all non -point source regulations per the C pertino Municipal Lender's Address Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 6/8116 Licensed CONSTRUCTIOP COMMUNITY DEVELOPM 10300 TORRE AVENUE C^U P E RT I N O (4088)) 777-3228 • FAX ((408 11 NF.W r.OWqTRTTCTTnW 1 I AnnTTTnN 11 AT PERMIT APPLI&TION :NTDEPARTMENT•BUIL1� UPERTIN•O,-CA 95014-3255 777-3333 • building(aD-cupertino.org 7F.RATTnN/TT RF.VTCTow/nF.FFRRF.n CiRTCUNAT.PRRMTT# PROJECT ADDRESS APN # ZncPOD 57rWP_f )3wC� Sy'T 1 3 Zy OWNERNAME I PHONE E-MAIL Cs✓'6 R-Tnv a CtTy dEtW.V,--re- 4b6 -5-73 - °t L1 M I o a ra e evs re • eGw STREET ADDRESS I CITY, STATE, ZIP FAX Zd r�O o S i� vt`�s �T �L $J�l� 3 0 Gcl� h nIa CONTACT NAME PHONE E-MAIL '7C7 631 . 32zy M a ocl e_voo � @ C o4 %mcr� STREET ADDRESS CITY, STATE, ZIP FAX to 'VWPD D,_,/ c�rry��s c.4 z �y�D 11 OWNER 13OWNER-BUILDER111eJ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARctirm T ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX COT) Y P-d2SIG LAle- STREET ADDRESS + CITY, STATE, ZIP `r'�o�d PHONE Cv 21®w73ft iwG S✓trE ��k.L)J �,g G Sa - Sir r - v s7 ARCHITECT/ENGINEER NAME i LICENSE NUMBER BUS. LIC # _50.';4�. -rrr'a COMPANY NAME - E-MAIL FAX Al�- STREET ADDRESS CITY, STATE, ZIP PHONE /7 MI/ ST /,.lD -N-v A i N V I- i— — C So - k-5, DESCRIPTION OF WORK c%Y-� o ni •Te �l `v►t�- G7'r�wt �ti'l.f'c�1 Nay cx.�. P� :S --it v, o vv� C �t li /�2 ,�✓ l i 1�2. G/vr.� _vC /pGdt e -r h�a..✓L�c ,r+c+ c/� � EXISTING USE PROPOSED USE CONSTR. TYPE # STORIIiS USE TYPE OCC. SQ.FT. VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KTTCHEN OTHER REMODEL AREA REMODELAREA REMODEIJ AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: U DETACH []ATTACH. I # DWELLING UNITS: _ IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES •' T T UATION: PLANNINGAPPL# [:]NO PLANNING APPROVAL LETTER EICHLERHOME? E] NO00 ✓ -• ` ` s> 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 and the information 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 b ding con%acftqn. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. 61 �G Signature of Applicant/Agent: 1. Date:or SUPPLEMENTAL INF TION REQUI� ED C IECK PI AN TYPE > £ ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER TIS -COUNTER ❑BUILDING PLAN REVIEW " existing building(s). Demolition permit is required prior to 'issuance of building permit for new building. EXPRESS ❑ 'PLANNING PLAN REVIEW • � r r � t � £ � £ z Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTAxDnRu ' $ ❑` PUBLIC woRtcs form if any Hazardous Materials are being used as part ofs' project. LARGE r r ❑ FIRE DEPT ; _ Copy of Planning Approval Letter or Meeting with Pl ing prior to e �. ' ❑ submittal of Building Permit application. MAJOR SANTPARYSEWER+DISTRICT „� .4 �• £•rim 'ENVIRONMENTAL HEALTH B1dgApp 2011.doc revised 06121111 ia-1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR:. PERMIT NO: B-2016-1732 20400 STEVENS CREED BLVD CUPERTINO, CA 95014 (369 01 028) CODYIBROCK. INC SAN CARLOS, CA 94070 OWNER'S NAME: CUPERTINO CITY CENTER BUIL.DINOS DATE ISSUED: 04/11/2016 OWNER'S PRONE: 408-873-0121 PHONE NO: (650) 591-0757 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #633971 Contractor CODY/BROCK INC Bate 04/3012018 y BLDG —ELECT _PLUMB — I hereby affirmMECH that I am licensed under the provisions of Chapter 9 (commenchng —— RESIDENTIAL X COMMERCIAL with with Section 7000) of Division 3 of the Business & Professions Code and that my license is in fall force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: STE # 130 - (FIRST FLR, NORTH/EAST WING) T.I. 2,786 S.F. (PROMETFIEUS) 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. J2 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: $147000.00 permit is issued. APPLICANT CEjrriFICATiON 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 ApN Number: 369 01 028 Occupancy p . y Type A (Tenant Improvements),B (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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point PERMIT EXPIRES IF WORD IS NOT STARTED WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 04/11/2016 Issued by: MFrISSA Date: 04/11/2016 OWNER -BUILDER DE T ARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. f, as owner of the property, am exclusively contracting with licensed contractors to eonsirr[ct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 2. I Live and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Corte, 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. a. 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 shalt be deemed revoked. APPLICANT C R7'1FI ATlON I certify that I have read this application and state that the above information is correct. t 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 0411112016 RE -ROOFS: 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 inspection. Signature of Applicant; ]late: 16 ALL ROOF COVE RXNGS TO BE CLASS "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 Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534, Owner or authorized agent: Date: 04/11/2016 CONSTRUCTION l 1 NDING AGENy 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 UL: : CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255' (408) 777-3228 • FAX (408) 777-3333 - building(cDcupertlno,orcl ❑ iaw CONSTRi1CTION El ADDITION ❑ ALTF_ J0N 1 TI ❑ REVISION 1 DFFF,?REJa ORIGThiAL PERMIT tt PRO7ECTADDRESS HiQ API, OW1,41ER NAK Pt10NE E-I�iAJL STREET ADDRESS _ CITY, STATE, ZIP a . I FAX C14 $ C144 • c , Aj- m G CONTACT NAME PHONE E -AML ( Go STREETADDRESS CITY, STATE, ZIP FAX ❑ OWNIF ❑ 01FJ'.ER•BUILDER i❑ OVINER AGENT yW-CONTRACTOR ❑cox-TIACCORAGENT ❑ ARCHITECT ❑ ENONTEER ❑ DEVELOPER ❑ TENAKT CONTRACTORRUIE LICENSEN IBER �-� �I LICENSE TYPE Bus. LIC COMPANY NAME / E-MAIL p FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHI=.T-NGWEERNAME [LICENSE NUMBER BUS. LIC r COMPANY NA114E �i � � E-hiAII. FAX STREET ADDRESS 7 -517 1f f CITY, STXTF, ZIP 'Zy�� � I PHOWE DESCRIPTIOA'OFAVORt % S7 =z_0'zr�y f EXISTIM USE PROPOSED USE CON RM. , TYPE r STORIES ! j �J Gr- L.!! ..r- USE I TYPE ! OCC. j SQ.FT. VALUATION (S) EXISTG ARE& 111.1..7r S7 ' NEWFLOOR I AREA - DEMO AREA TOTAL fir y N"ETARE.A ,Z 7/iy� O (De Cl! ...,.G. V +�J` `f�f% ( f CJQ ft BATHROOM KITCHEN OTHER RE\4ODEL AREA REMODELAREA REA40DEL_4REA POR=ARF4,ECKAREA TOT?.L DECK!PORCH AREA GAP AGE AREA' DETACH []ATTACH n DRrELLttaG UNITS; ISA SECOND UNIT ❑YES SECOND STORY YES BEnGADDED? []NO ADDITJON7 [INO I PRE APPLICATION [I YES IFYES, ES, PROVIDE COPY OF FLA -,n IMCAPPL.a []NO PLANNW'(3APPROVAL LETTER IS THE BLDG .AN © YES EICHLERHO1,4E2 ©'Y " =�•'�:�2$=�:x}g=airs-.:!` ` "' TOT.4i. V 4LL•ATION- ',•••_, _ _ I,;��F' _ ao Y By ❑zy signature below, I certify to each of the following: I ani the property owner or au rzed a4ent to act ant roperty 9w3 calf, i have read this application and die information I have provided is correct, I have read the Description of Work and verify it is acc c . agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatil•es of Cupertino to enter the above --identified propery for inspection purposes. Signature of ApplicantlAgent: is '✓" �J''✓"// Dafe; SUPPLEMENTAL INFORMATION REQUIRED SLIP r _ - t :OZi2 Ti E-COG\TEIt a a, .; �;,.LIL7G f ___ _ ,r5Iu c PLA\ RFy1 iE1i f I � r _ New SF7 or Multifamily d«ellines: Applyfor demolition permit for existing building(-). Demolition permit is required pilar to issuance of building permit for new building. e" `•: � Y. �I- a s i��P1,A_l\L\GTL i E�Rsss Y x r �� RE[ iE1i _ Commercial Bld?s: Provide a completed Hazardous Materials Disclosure WV ©sT \ZtaRD � �� e � r 1 Q r- fol.n if any Hazardous Materials are being used as pail Of this pro;et #. u� - .$ _UBLICVIORI.S � _ Copy of Plaiming Approval Letter or Wedna with PlannintrP rior to subiniiial of Building Permit application. :,I'sh•'I,Z�.�OR_i:4ps`-•'4 s :. �x]5A_\IT•4.Ft'L_SESi`IRbISI'k1CI �4 BldgApp_2011.doc r•eidsed 06121111 Building Department, City Of Cupertino 10300 Torre Avenue, Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-177-3333 CONTRACTOR SUBCONTRACTOR LIST - %-R ul tnull­_,pal vuuv 1 eqtuires an ousinesses worKing in the city to have, a City of Cupertino business license. NO BUILDING FINAL 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 JOB ADDRE S S: 20yoo (7/cve,�75 PERMIT #- BUSINESS NAME BUSINESS LICENSE OWNER'S NAME: PHONE# Cabinets & Millwork 1A GENERAL CONTRACTOR: Bmr�_ BUSINESS LICENSE# &_� , 3—;517:7/ Cement Finishing ADDRESS: 10.2,1 CITY/ZIPCODE: 'eP41070 %-R ul tnull­_,pal vuuv 1 eqtuires an ousinesses worKing in the city to have, a City of Cupertino business license. NO BUILDING FINAL 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 ISUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE Cabinets & Millwork 1A Cement Finishing Electrical Excavation Fencing I/ Flooring / Carpeting :nuFs Linoleum / Wood -Glass / Glazing AcLv cer N)CXpV"N"e Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile -Owner Signature—_ 0/21 0/I& Date