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13090227CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10813 N WOLFE RD CONTRACTOR: MIDSTATE PERMIT NO: 13090227 CONSTRUCTION OWNER'S NAME: CUPERTINO VILLAGE LP 1180 HOLM RD DATE ISSUED: 02/26/2014 OWNER'S PHONE: 6507467503 PETALUMA, CA 95954 PHONE NO: (707) 762 -3200 d e- ENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] PHASE 1 -LEVEL 1 CONSTRUCT PARKING STRUCTURE _ License Class Lie. # C) � ' m s 34,876 SQFT np MON DEF #1 -ADA DETAILS AND SPEC'S FOR Contractor l �i S� Date ( -J ` CARPORTS ISSUED 10 -6 -14 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: 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: $1800000 4 erformance 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 APN Number: 31605056.10813 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIl�T 180 D ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D OM L LLED 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 com {�` 4 with all non -point source regulations per the Cupertino Municipal Code, ction 9.18. r Signat./ TIT Date A W RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read 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 I 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 I performance of the work for which this permit is issued. will maintain compliance with t perti Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se ions 5505 553 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized age Date: O r z� 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I 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 (Sec. 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. 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, ARCHITECT'S DECLARATION 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 108/3 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: -t"M N WOLFE RD CONTRACTOR: MIDSTATE PERMIT NO: 13090227 CONSTRUCTION OWNER'S NAME: CUPERTINO VILLAGE LP 1180 HOLM RD DATE ISSUED: 02/26/2014 OWNER'S PHONE: 6507467503 PETALUMA, CA 95954 PHONE NO: (707) 762 -3200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] License Class Lic. # r7''`' PHASE 1 -LEVEL ONE CONSTRUCT PARKING STRUCTURE 34,876 SQ FT as Contractor N \t�igT �" n'ate t - REVISION # 1 - RETAINING WALL I hereby affirm that I am licensed under the provisions of Chapter 9 DETAILS /CLARIFICATIONS AT NORTH SIDE OF PARKING (commencing with Scction 7000) of Division 3 of the Business & Professions STRUCTURE, RELOCATION OF UNDERGROUND Code and that my license is in full force and effect. UTILITIES AND LANDSCAPE DETAILS - 6/12/14 I hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $1800000 performance of the work for which this permit is issued. 11 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 APN Number Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D RMI ANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save DA INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, jud its, �7 costs, and expenses which may accrue against said City in conseque of the !i granting of this permit. Additionally, the applicant understands will comply sued b ate: with all non -point source regulations per the Cupertino Municipa 9.18. . RE- ROOFS: Signature ate 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. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I 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 have read 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 I 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 I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S 505, 255 , a d Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date,::f ' 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I 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 (Sec. 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. 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, ARCHITECT'S DECLARATION 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 g CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: — Oft69-N WOLFE RD CONTRACTOR: M STATE PERMIT NO: 13090227 CONSTRUCTION OWNER'S NAME: CUPERTINO VILLAGE LP 1180 HOLM RD DATE ISSUED: 02/26/2014 OWNER'S PHONE: 6507467503 PETALUMA, CA 95 54 PHONE NO: (707) 762 -3200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTIO • RESIDENTIAL COMMERCIAL E] PHASE 1- LEVEL ONE CONSTRUCT PARKING License Class Lic. # 0 8I 1 STRUCTURE 34,876 SQ FT Contractor µtD5TFtT rJ Date 2 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: 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 Are Valuation: $1800000 performance of the work for which this permit is issued. 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 APN Number: Occupancy Type: permit is issued. `D APPLICANT CERTIFICATION I certify that I have read this application, and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 80 DAYS OF P IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 AST LLED 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 - 24 Da granting of this permit. Additionally, the applicant understands and will comply e: with all non -point source regulations per the Cupertino Municipal Code, Section RE- ROOFS: 9.18. �� Signature Da ..(� All roofs shall be ins ected prior to any roofing material being installed. If a roof is installed without first inspection. obtaining an inspection, I agree to remove all new materials for ❑ OWNER- BUILDER DECLARATION Signature ofApplic .t: Date: I hereby affirm that I 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) LARDOUS I, as owner of the property, am exclusively contracting with licensed contractors to MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazo rdous 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 complianq with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additiono lly, 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 I performance of the work for which this permit is issued. will maintain compl'ance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety,, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized ". agent: ate: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that t iere 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 thi permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION L_ ender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plar s 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinancupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS � i� � p`O 7 Jlp ` �J APN Al PHONE OWNERNAME j/ E -MAIL L'� STREET ADDRESS , CITY, STATE, ZIP FAX CONTACT NAME P ONE -707 -3725 E -MAIL 732 1?4i STREET ADDRESS 1l80 Hoc- R-4 CITY, STATE, ZIP F.AX L7o7� 762 -07o& �r I un�R y ❑ OWNER ❑ OR'NER- BUILDER ❑ OWNERAGENT ❑ CONTRACTOR 'N.�ONTRACTORAGENT ❑ ARCHrmcT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME p\10G PrTE— Ca1JST .3cTlo[J LICENSE NUMBER LICENSE TYPE (D S�BtiSS BUS. LIC R COMPANY NAgM�E p- �f�" V-ff 1 iI -iCl� i :L�tC� E -MAIL �RT!�oe��� ;M � ATf CoaS e�llci oai -CoM F 61 W) W. Z- — o700 STREET ADDRESS ''9 1<1'� CITY, STATE, ZIP cy c� liGT �� 57 P 0) X07 1IQ LvM ! 7%1'3200 ARCHITECT /ENGINEER NAME LICENSE NUMBER BUS. LIC k ,1 R AT-,k G3"1 9Lt(0 COMPANY NAME PIKU— C7i1LP To E -MAIL MAR►- P �R�P.ci,VLPo! —m� ,CONS FAX 92�- Z2q -0 l(0 � STREET ADDRESS CITY, STATE, ZIP PHONE 9 Lf SSA 5 7- - 5-tS -Z(,- Z DESCRIPTION OF WORK AZA EXISTING USE PROPOSED USE CONSTR. TYPE m STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NF%V 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 # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? NO ADDITION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN TOTAL VALUATION: PLANNING APPLk ❑NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO ''. t -' ' By my signature below, I certify to each of the following: I am the property owner or authorized 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 Wor verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building I auth represent - npe e rtino to r the above -i entife property for inspection purposes. Signature of Appl icant/Agent: Date: 1� SUPPLEMENTAL INFORMATION REQUIRED , PLC CHEGKTYPE '. ,ROUTI1ti"I'IP ° New SFD or Multifamily d%vellings: Apply for demolition permit for w s © ❑ existing building(s). Demolition permit is required prior to issuance of buildings 0 \'ER THE- COUltTER k t BUILDING PLAN REL�i�V � r� r t permit for new building. ©EaPliESS z ❑ rLnNnI�GrLAn1�EVIE« { ' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTA7.n'Axv r` ❑ ruBLlewoRKS _ form if any Hazardous Materials are being used as part of this project i; ❑r$IREDEPT' I x,:RGEta�{ -z � z Copy of Planning Approval Letter or-Meeting, with Planning prior to ®�AlA70Ry ❑ submittal of Building Permit application. ? SAA1TATiI SE{iERDISTRICZa s��ENVIROIVH4EAT :4D.BEALTEi= .��.5��,��_,; B1dg4pp_2011.doc revised 06/21/11 r0, Co'*- CITY OF CUPERTINO MR/-A FEE ESTIMATOR — BUILDING DIVISION 19 ADDRESS:- 0889'N WOLFE RD DATE: 06/26/2014 REVIEWED BY: MELISSA APN: 316 05 052 BP #: 13090227 VALUATION: Iso rPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY USE: Commercial Building i PENTAMATION PERMIT TYPE: 1GENC0 WORK 6/26/14 - DEF # 1 - ADA DETAILS AIVD SPEC'S FOR CARPORTS SCOPE PME Plan Check: it1�u;;r. Plait Check. Plvanh. Floe Plan. k"'ech. Perini! Fee: rllnch. Gnp, Pic: Plainly, Pe.rmil Pee: ?nccr Plumb Irtsp. Phuitb. hislt. Tee:: Glee. Aerntil I ee:: odwr lslc >L', jnujt7, i. lec. Cnsp. Fee: 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 based on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -0 3 E . 7f /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $278.00 Deferred Submittal IDEFSUBM i 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. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C.on..1 nic t if,°N.Tax: 1 Llin l f) iS(rat i Vim' .I 0 E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure Q 0 Travel Docuntent;allar; Fist "s': Strong Motion Fee: $0.00 Select an Administrative Item .Bldg Stds Commission Fee: $0.00 fi SUBTOTALS:` $0.00 $278.00 TOTAL FEE: e $278.00 Revised: 10/01/2013 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 J�. (408) 777 -3228 • FAX (408) 777 -3333 - buildinn acunertino orn CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDTfION ❑ ALTERATION/ TI VISION DEFERRED ORIGINAL PERMIT # 130!14 Z • Z t t: IESS APN # - 4-086". Wolfe Road Cupertino, CA 95014 31605052 OWNER NAME PHONE E -MAIL Cupertino Village LP / Kimco Realt - Todd' Dewell 650 - 746 -7503 tdewell kimcorealty.com STREET ADDRESS CITY, STATE, ZIP FAX 15 South ate Avenue Suite 201 Daly City, CA 94015 650 - 756 -3390 CONTACT NAME Field Paoli Architects - Trish Beckman PHONE 415 - 788 -6606 E -MAIL aoli.com p kb @ field p STREET ADDRESS CITY, STATE, ZIP FAX 150 California St 7th Floor San Francisco CA 94111 415 -788 -6650 ❑ OWNER ❑ OWNER- BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT X ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # Patrick Tracy COMPANY NAME E -MAIL FAX Midstate Construction atrickt midstateconstruction.com 707 - 762 -0700 STREET ADDRESS CITY, STATE, ZIP PHONE 1180 Holm Road., Petaluma CA 94954 707 7762 -3200 - ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # Trish Beckman COMPANY NAME E -MAIL FAX Field Paoli Architects kb field aoli.com 415 - 789 -6650 STREET ADDRESS CITY, STATE, ZIP PHONE 150 California.Street 7th Floor San Francisco CA 94111 415 - 788 -6606 DESCRIPTION WORK ( `S` attached See attac_h�e1d� list of revision description. .- 1 d l lrI i✓1 L"ra-1� av — 1'l D r `�"VI Sl d e e-t ✓' W G '" � V► �[.t 2i� D cJY L J 1 S EXISTING USE PROPOSED USE CONSTR, TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK ARE A TOTAL DECK /PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES - BEINGADDED? ❑NO ADDITION? []NO PRE- APPLTCATION []YES TF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I ant the property owner or authorized agent ct o e property own e a read this application and the information I have provided i co' c' . to 'e read the Description of Work and verify it is h gree to comply with all applicable local ordinances and state laws relating to building cot str c' l tortze representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: 3.26.2014 SUPPLEMENTAL lNFO17 AI U IRED Q � P r- An,cxECl<c ►?1, RoU� GSLIr New SFD or Multifamily dwellings: Apply for demolition permit for ❑' A v s�` � — existing building(s). Demolition is required to issuance of building OVER TIIE•C�TINTER� �"� BUrLDBYCi PLANtRI�VIEw fi permit prior permit for new building. ,txp kE$S PiANNIi�(G PLAN RLVtEW Bldgs: Materials Disclosure ❑ _ Commercial Provide a completed Hazardous sIANDARb❑ I'ULYC WURY{ 3 g form if any Hazardous Materials are being used as part of this project. ❑. LARG�� ��� ©�„1+IRED�P'r �� � r of Planning Approval Letter or Meeting with Planning prior to a� s z� fl _Copy submittal of Building Permit application. �❑ 14XAJQA �� �'g"' t9 �ANITARi� $EWER UrSC,'T��� , ; .,,,, .'.�„ * � •.,,, _.wz,r .., �l�i� !IRfIN1N'�N'ItA>G'.�iEAL'I?H ,. r B1dgApp_2011.doc revised 06121111 MI CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 by (408) 777 -3228 • FAX (408) 777 -3333 • buildingCa?cupertino.org [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ngg�i q APN # 9;1& �l & ®r p . o OWNERNAME (� PHONE ww . 1C 03 E- MAIL� STREET ADDRESS _ `/ I%V i "'✓Gib l f��l� ✓ , 614-1 FAX I t o 1 CONTACT NAME_TVp PHO o STREET ADDRESS c^ gwL f Mr � n /^ ® FAX ` 1042 ❑ OWNER OWNER-BUILDER WNER AGENT CONTRACTOR 13 CONTRACTOR AGENT 13 ARCHITECT 13 ENGINER 11 DEVELOPER 13 TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER I d P7 C� BUS. LIC # CO NAME4b 1, E -MAIL r� 6"J/ -P R a 064 C 1/ LJp 4J�/ aI �G% �/� STREET ADDRESS r , g :e,o C�JIT �b CI�T -Y, S'TA1TEZIjP ���[,tf DESCRIPTION OF WORK 1 9 EXISTING USE I PROPOSED USE CONSTR. TYPE # STORIES ��pj©e � i ` p f1 �iri�oW p �L USE TYPE OCC. SQ.FT. VALUATION ($) AREA AREA NEW FLOOR AREA DEMO TOTAL AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE GARAGE AREA: DETACH ❑ ATTACH I J # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES -` BEING ADDED? ❑ NO ADDITION? ❑ NO PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN [3 YES „� S3Ys �, ti"A, _' TOTAL VALUATION: PLANNINGAPPL# NO PLANNING APPROVAL LETTER EICHLERHOME? NO re ss S,M 5- a k �� �''�S-_:f;c: 01fi.0 0 •ttp' ....% -; ♦f o,M :.(, b v 1s S 4 �/ By my signature below, I certify of the following: I am the property owner or authorize ent to act on the property owner's behalf. I have read this application and the informatio I pr ided 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 re i construction. I authorize representatives of Cupertino to enter the above-identified roperty for inspection purposes. Signature ofApplicant/Agent-. Date: c'C1�' / SUPPLEMENTAL INFORMATION REQUIRED � '101 �NewSFDorMultifamil � OVER HE COUNTER c ; ©f BUM- _ dwellings: Apply for demolition permit existing building(s). Demolition permit is required prior to issuance of buildings* s# z DINGPLANRESiEW 4 permit for new building. kK:y x t o .-a Li EXPRESS a grr,`xi t j t zr o > ANNINQ A7vREVti c Commercial Hazardous Materials b�' €'1 (3ttBI1PYvoRlcs_ Bldgs: Provide a completed Disclosure I { form if any Hazardous Materials are being used as part of this project. }$RD t p, n ��LARGE a �gFIREDEPTy Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_201 1. doc revised 06121111 'X0114 CITY OF CUPERTINO ON MY �i FEE FSTIMAT012 — BUILDING DIVISION ADDRESS: -PJ WOLFE RD DATE: 03/27/2014 REVIEWED BY: MELISSA I MISC ITEMS APN: 316 05 052 BP #: 13090227 "'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration /Addition/ Repair PRIMARY USE: Commercial Building $0.00 PENTAMATION PERMIT TYPE: 1 GENCO WORK 3/27/14 - REVISION # 1 - RETAINING WALL DETAILS /CLARIFICATIONS AT NORTH SIDE OF SCOPE PARKING STRUCTURE, RELOCATION OF UNDERGROUND UTILITIES AND LANDSCAPE fi:ch. Pi'u . ( "'heci: olher.Mexh' 112S"" ilfech' fns17. PiuitKh' Ph"Pit (, 1i'iaSc k P?aa,nb. Fee: 1' aD NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). l hese.fees are based on the preliminary information available and are only an estimate. Contact the Dept.lor addn'l info. FEE ITEMS (Fee Resolution 11 -053 Elf. 711113) FEE QTY/FEE I MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 ® hours Plan Check, Hourly $556.00 1STPLNCK Suppl. PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 - Pen-nit Fee: $0.00 Suppl. Insp. Fee:) Reg. O OT 0.0 hrs $0.00 PME Unit Fee: $0.00 Permit Fee: $0.00 /PME 7..ionn' nel 7 on. d. �6, x 1 chn;tti c trafi ve .T 'E'e 0 E) Work Without Pen-nit? Q Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure 0 :lit } r l t)r�c }� „r;r2tcrlir n .l a e t; Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS , $0.00 $556.00 TOTAY;FEE:" $556.00 Revised: 01/15/2014 [t M-7., CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: U A�9-N WOLFE RD DATE: 09/30/2013 REVIEWED BY: SYLVIA PC FEES APN: BP #: 13090227 *VALUATION: 1$1,800,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? 0 Yes (E) No PENTAMATION PERMIT TYPE: 1 S WORK PHASE 1 LEVEL ONE - CONSTRUCT NEW PARKING STRUCTURE 34,876 SQFT SCOPE $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID S -1 (Moderate - Hazard) II- B,111- B,IV,V B 0 $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee :Q Reg. 0 OT 0,0 hrs $0.00 �} PME Unit Fee: $0.00 PME Permit Fee: $0.00 I Construction Tax: IBCONSTAXC $0.00 Work Without Permit? 0 Yes Q No $0.00 TOTALS: 0 $0.00 ` . $0.00 1• T 4 , 7 W " s s ^% i . Prltrch. 111wi Check 1'! f'wb Plan Chock L'ler, Plcur. C'he>c;'r Perm:( t',:x>: t'LY:nat >. Perntir /'rr: h7e;`. Pee. Suppl. PC Fee: Q Reg. 0 OT Li hrs $0.00 PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e: Planning, Puhlic Works, Fire, Sanitary Sewer District, School District, etc.). Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept.for addn7 info. FEE ITEMS (Fee Resolution 11 -053 Eff 711113,) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 0 hours Plan Check,, Hourly $278.00 ISTPLNCK i Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee :Q Reg. 0 OT 0,0 hrs $0.00 �} PME Unit Fee: $0.00 PME Permit Fee: $0.00 I Construction Tax: IBCONSTAXC $0.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee.- $0.00 Select a Non - Residential Building or Structure 0 Trowel' ®OCE�PtTE'1 +Ildt7Qtt F'�Cnb': Strong Motion Fee: IBSEISMICO Select an Administrative Item Bldg Stds Commission Fee: IBCBSC SUaBTOTALS ' t X6-60 $278.00 TOTAL FEE:$ -®9 .Revised: 01/15/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408- 777 -3228 C O P E RT I N O Fax: 408 - 777 -3333 BCONTRACTOR / SUBCONTRACTOR LIST . JOB ADDRESS: F O d PERMIT # 3 b rt d ZZ--. OWNER'S NAME: d wve -A PHONE # 9$—Z> GENERAL CONTRACTOR: ZU & S ( s/-r, BUSINESS LICENSE # ADDRESS: 11,80 14GLA& CITY /ZIPCODE: 1 *Our municipal code requires all businesses 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 Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile �- 17-6. Owner %• Contr r Signature D to