Loading...
15050164WON CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19600 VALLCO PKWY CONTRACTOR: Wo PERMIT NO: 15050164 OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC no DATE ISSUED: 11/10/2015 OWNER'S PHONE: 4087773081 /1<I "(5) PHONE NO ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMER IAL 1 ICOOL - T.I. TO BUILD OUT SHELL FOR NEW 'B' OCCUPANCY License Class Lic. # RESTAUARANT WITH NEW KITCHEN & EQUIPMENT, ADD 1 ADA RESTROOM AND DINING & SERVICE AREAS Contractor Date I her affirm tha ense under the provisions f CI apter 9 (comenci ection 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: $75000 performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 31620108.19600 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 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for i ection purposes. (We) agree to save 180 INSPE TI N. indemnify and keep harmless the City upertino against liabilities, judgments, costs, and expenses which may ac a ainst said City in consequence of the !j;S=LAST 'll Issued by: te: granting of this permit. Additio ly a applicant understands and comply with all non -point a re at' pertino M Code, S tion 9.18. RE -ROOFS: Signature Date 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 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, Ch ter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store o n e hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or d ces ich emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air ality anagement Distri I performance of the work for which this permit is issued. I will maintain compliance with the Cu rtino M icip Code, Chapter 9.12 nd I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sec 2550 2553 Section 3700 of the Labor Code, for the performance of the work fpr 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 f 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 in ormation is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of th s city to enter upon the above mentioned property for inspection purposes. (We) E gree to save indemnify and keep harmless the City of Cupertino against liabiliti s, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequ nce 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 r A CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPM�NT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE •UPERTINO, CA 95014-3255 CUPERTIf+It> (408) 777-3228 • FAX (408)I777-3333 • building(Mcupertino.or4 150)f 16 ❑ NEW CONSTRI ICTION ❑ ADDITION 54 -ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS , / , I �j 0 v� / O /1 APN #316 I (.� ��y \ 1016 0.•J O e LC � V /7 '( (/ 6 0 0 / , C b (/ (5 OWNER NAME G P ONE �' i EE -MAIL STREET ADDRESA" A�FJO i9Q7feJ 5/1t5�h-N%TAl CITY, STATE, ZIP II/�Q` ` l_r1/�� FAX 40 (_���i(i()I 1'w_• CONTACT NAME E416v.AESIGN51te%y0VCSM PHONE E-MAIL_ STREET ADDRESS CITY, ATE, ZIP „ <3 � FAX ->X- -/ ff2/ 3T'11-6 -e , 5c r� ❑ OWNER 11OWNER-BUILDER 11 OWNER AGENT ❑ CONTRACTOR 11CONTRACTOR AGENT ,0 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANI CONTRACTOR NAME ICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE __7 ARC NAME (CENSE NUMBER BUS. LIC # J I GJ COMPANY NAMEr., _ A14 IAI �- 'R W4 E-MAIL ?l✓. p S /G Siip DDI CJM FAX Sig '4Z - 21 STREET ADDRESyS, r 6'(A /1 CI STATE, ZIP PHONE / DESCRIPTION OF WORK n A r EN % 6 e,, M_ { ]cr A -j s LZ 6&aipvvo EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES A f` 4,,<,4N V / USE TYPE OCC. SQ.Er. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA V11-1 I' (/ OZ 0 /' /, 17 U U j BATHROOM KITCHEN OTHER -- REMODEL AREA REMODEL AREA I r - REMODEL AREA --- PORCH AREA DECK AREA TOTAL DLCKIPORCH AREA GARAGE AREA: DETACH H ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY OYES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES -RECEIVED BY: '< TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 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 building construction. 1 authorize representatives of Cupertino to enter the above -identified pro erty for inspection purposes. Signature of Applicant/Agent: , �_ ___ Date: �j 'y SUPPLEMENTAL INFORMATION REQUI RED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required 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 j ❑ submittal of Building Permit application. rytA,loR SANITARY SEWER DtsTRtcr ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 VA � CITY OF CUPERTINO I/VI FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 19600 VALLCO PKWY STE 100 DATE: 05/27/2015 REVIEWED BY: PAUL Ila APN: 316 20 108 BP#: `VALUATION: $75,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAMATION 1 B TI PERMIT TYPE: WORK ICOOL - T.I. TO BUILD OUT SHELL FOR NEW'B' OCCUPANCY RESTAUARANT WITH NEW SCOPE I KITCHEN & EQUIPMENT,ADD 1 ADA RESTROOM AND DINING & SERVICE AREAS OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 820 $2,128.56 IBTIPLNCK $998.16 IBTIINSP $0.00 PME Plan Check: $0.00 Permit Fee: $998.16 Suppl. Insp. Fee:O Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 820 $2,128.56 Consti,uctlon I ax: $998.16 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY Q Yes 0 No ELEC, HOURLY 0 Yes 0 No Afech. Plan ChecA Phfin& Plan Check 1, lec. Plan Check ,. Plumb. Permit Fe' / ; Permit Fee, Chher ;llech. Insp- her Plumb Insp. v/ier Llec. Insi 11ech. Insp. 1 1 ju s p. Fc, $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt_ otr )_ Thoce foot aro ha.ced an the nreliminary information available and are onlv an estimate. Contact the Dent for addh7 info. FEE ITEMS (Fee Resolution 11-053 Efl' 171:13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,128.56 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $998.16 Suppl. Insp. Fee:O Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consti,uctlon I ax: ldrnini.strcative Fee: 0 0 Work Without Permit? © Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i 1'rat,el Uocume nicuion 1'cre8, Strong Motion Fee: 1BSEISMICO $21.00 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $3.001 SUBTOTALS: $3,150.72 $0.00 TOTAL FEE: 1 $3,150.72 Revised: 05/07/2015 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 4if ® G PERMIT # 0 f7 OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: - CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertin6 business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRAC OR HAVE OBTAINED A CITY OF UPE INO BUSINESS LICENSE. I am not using any subcontractors: C Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork © j (� �- �j, -vl Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry J Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank v Sheet Metal Sheet Rock Tile co�—wl z�. Date