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15090146(CITY OF (CUP1E1ZTINO IBUI LDING,PIERMIT ` -- BUILDING ADDRESS: G PERMIT NO: 15090146 19409 STEVENS CREEK BLVD CUPERTINO CA 95014 (316 20 112) Sand Hill Properties 10123 N. Wolfe Rd. OWNER'S NAME: Main Street Aggregator DATE, ISSUED: 01/26/2016 OW'NER'S PHONE: (650) 344 -1500 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor Sand Hill Properties Date —BLDG —ELECT _ PLIJMB MECH RE SIDENTIAL 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: SHERIFF SUBSTATION - STE # 150 (MAIN STREE'17FLEX 1 hereby affirm under penalty of perjury one of the following two declarations: 2) T.I. FOR (N) B OCCUPANCY (473 S.F.) r. 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 performance of the work for which this permit is issued. 2. 1 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 Sq. Ft Floor Area: Valuation: $15000.00 this permit is issued. APPLICANT CERTIFICA'T'ION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county APN Number: Occupancy Type. ordinances and state laws relating to building construction, and hereby 31620 112 authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and ED PERMIT IT IEXPIIRIES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN Il �® �� ®� PERMIT RMPERMIT ISSUANCE ®� granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal 180 DAYS P][2OM (LAST CALLED INSPECTION. Code, Section 9.18. Issued by: A. alva r!/f/bG'<.�/ Signature Date Date: 1 OWNER- BUILDE$ DECLARATION RE- ROOFS I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for r. 1, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered �l for sale (Sec.7044, Business & Professions Code) Signature of Applicant: I, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. I have and wil I maintain a Certificate of Consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the 2. 1. have and will maintain W'orker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. health & Safety Code, Section 25532(a) should I store or handle hazardous I certify that in the performance of the work for which this permit is issued, I material. Additionally, should 1 use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Cha r 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sect' n 2505; 255 3 n 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 Owner or authorized agent: be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRIJJC1 I IO LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Flame to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Address 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 ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. e, ti Cuperto Muni al 9. . Date 6 � Licensed Professional Signae ( CUPERTINO ❑ NEW CONSTRUC' CONSTRUCTION PERMIT APPUCQTION COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014 -3255 / (408) 777 -3228 ^ FAX (408) 777 -3333 ^ building olicupertino.org ('ION [—]ADDITION ALTERATION / T1 ❑ REVISION /DEFERRED ORIGINAL PERMIT # ADDRESS /7� ,� /� - -ZG- 2PROJECT OWNEWW PHO � � `�� ENIL n (� ST RE ADD SS � � C STAl'E, Z1P ®� FAX � � b�v CC" ('tt lG i� PHONE q,6 U�® dl v b I1 J STREF ' /rW1�Ij S / FAI& 7 ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT . ARCHITECT ❑ ENGINEER ❑1 DEVELOPER ❑ TENANT CONTRACT ,., e (�- LICEIN BER LICENSE Ty BUS. LIC # COMPA A E (M E -M IL / � /r/ '%� - F - P �V 0 STREET DRIESS CITY, SprJ,T$,(� r �e6 �� t&j P ONE' r U J ARCH[TECT[EN NAME LICENSE NUMBER /� l BUS. LIC COMPANYNAME {.(� E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK /I M�G� 479 Sl=. 'a D EXISTIN USE PROPOSED USE CONSTR GTW& TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR DEMO AREA AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: DETACH mom, -" — — []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES ' BEING ADDED? []NO ADDITION? ? iJ11 PRE - APPLICATION ES IF YES, PROVIDE COPY OF IS THE BLDG AN YES RECEI T AL VALUATION: [❑ PLANNING APPL# [ENO PLANNING APPROVAL LETTER / \, EICHLER HOME? NO _ �aaRtfO'act By my signature below, I certify to eac of e following: am the property owner or a I 0 pro er's behalf. I have read this application and the information I hav pro ded is corre I ave re the Description of Wor and verify rate. I agree to comply with all applicable local ordinances and state laws relating t uil c t cf n. a presentatives of Cupertino to enter the above - identified pro erty f r inspection urposes. Signature of Applicant/Agent: Date: I ION REQUIRED P PLAN CHECK ROUTING SLIP ❑ OVER- THE - COUNTER ❑ BUILDING PLAN REVIEW I New SFD or Multifamily dwel ngs: Ap 'ly for demolition permit for existing building(s). Demolition p it is re uired prior to issuance of building - permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR 1-1 SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_201 Ldoc revised 06121111 cCETY OF cCUP ERTENO FEE ESTIMATOR — B UI LDRNG D]I HRON ADDRESS: 19409 STEVENS CREEK BLVD DA'L'E: 09/22/2015 REVITWED 1BY: MELISSA APN :. 316 20 112 BP#: *VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 113 TI USE: PERMIT TYPE: WORK I SHERIFF SUBSTATION - STE # 150 MAIN STREET /FLEX 2 T.I. FOR N B OCCUPANCY 473 SCOPE IS. F.) OCCUPANCY TYPE: TYPE OF I LR AREA PC FEES PC FEE ID I BP FEES BP FEE ID CONSTR. s.L B (Tenant Improvements) II- B,111- B,IV,V -B 473 1 $2,107.52 IBTIPLNCK 1 $724.72 1BTIINSP TOTALS: I 473 I $2,107.52 I I $724.72 I J MECH, HOURLY 0 Yes (D No PLUMB, HOURLY 0 Yes (D No ELEC, HOURLY O Yes e I_I Heck P&nr Cheek 1'li mb. flan Check Ehre. Plan Check L ,Ieeh. I ermit Fee. Phtmb. Pmrrnil Fee: \ l let. 1'errnit Fee: Other ,Mcch.Insp, Olherl'lumb.lnsh. Other klee. h'tsp _L_ Afech. Insp. fix: Plumb. Insp. Fite: lilee,. Imp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc 1. These fees are hated on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. ]FEE ITEMS (Fee Resolution 11 -053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,107.52 Select a Misc Bldg /Structure or Element of a Building Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $724.72 Suppl. Insp. Fee:Q Reg. Q OT Q,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('onsiruction Tax: E] At hninistrative Fee: 0 Work Without Permit? 0 Yes (D No $Q.00 Advanced Planning_Fee: $0.00 Select a Non- Residential Building or Structure � d Travel Documentation Fears: Strong Motion Fee: IBSEISMICO $4.20 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2,837.44 $0.00 TOTAL FEE: $2,837.44 Revised: 07/02/2015