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15110186CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 14 RESULTS WAY I CONTRACTOR: SC BUILDERS INC I PERMIT NO: 15110186 OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET OWNER'S PHONE: 4083968968 C� LICENSED CONTRACTOR'S DECLARATION License Class_ Lic.:# Contractor SC_Tj U Y. Date _ 1 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 pe ance of the work for :which this permit is issued. 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. APPLICANT CERTIFICATION I certify that 1 have read.this application and state that the above information is correct. 1 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 ma ccrue against said City in consequence of the granting of this permit: Ad ti ally, the applicant understands and will comply with all no - n urce eg atio per Cupertino Municipal Code, Section 9.18. Sign at Date ❑ / OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, 'andthe 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performance 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 permit is issued..,',, i. 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'ofCalifornia. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that 1 have read this, application and state that the above information is correct. l 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 iwhich 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 l: i Date 910 THOMPSON PL 1 DATE ISSUED: I1/25/2015 SUNNYVALE, CA 94085 1 PHONE NO: (408)328 -0688 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL NO (N) CONSTRUCTION - AS BUILT TO SHOW AS BUILT PARTITIONS & FURNITURE PLACEMENT, UPDATED OCCUPANCY COUNT TO REFLECT MAX PROJECTED OCCUPANCY Sq. Ft Floor Area: Valuation: $0 I APN Number: 35720041.14 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Date: ALL ROOF COVERINGS 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 de es which mt hazardous air contaminants as defined by the Bay Area 1' pee.eint District I will maintain compliance wit u ertin un' Cohapter 9.12 and the Health & Safety Code, ctions 25 05 5533, d 2553 Owner or authorized Date:— 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional ,s C CUPERTINO CONSTRUCTION PERMIT APPLICATION CONIdiUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 • buildino( cunerino.orq X NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION / TI REVISION / DEFERRED ORIGR\?AL PERMIT 4 151019 PROJECT FDDPESS �j)[ ` \w I IN R t� n ✓ / BT 01ANERNP.IVM $vK f `m -k-ty SVAye a6 PHONE MAIL 4��_ ✓ �� -!/ 1�(J �uv± STREErPDDRESSgIO JvVi PL. CITY, STAN V& 11 1 05 I FAX CONTACT NAME 11 j \ � I � 1 y�„ I PH01 i ®!/ _ n � - � 12 E N.AII avid davi4t� hi ate • !� STREET ADDRESS s1% Thy k Vv� St loo CITY, STA7 ' ZIP 17- FAX a '44 • SxK CA FJ (n 0 01ll-a 11 O1WN7?,- BUILBFR ❑ VWN' R AGFiv r ❑ COh 1P.ACTOR ❑ CONTRACTOR AGTT 19 /-Y CLSTECT ❑ ENGWIZER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME o1 % LICENSEN`UWBER LICENSE TYPE SUS.LIC -1 D -1 `� 1,• COIv?P NY NAME <E '?>Vk1Ak & v. c7lJ e' E -WJdL • s 'h�bOW(F c�uildw5ini•c� FAx STREET ADDRESS (j I O -j'(_ S O I4 PI CITY�U n�ZIPV 940 15 P Ooe O rj t � 0( CJ _ ARCIIITECT/ENGIIN'_EIERNAMP LICENSF NUN.SER BUS. LIC 4 COMPANY N.A1.CE E -MAIL FAX STREET ADDRESS I CITY, STATE; ZIP PHONE DESCRIPTION OF WOP.K New AS LJ JO A.S 3 v TAIR:noO v ..P t-AC- i UeD.A78i c3cC -y C.d v1J ( Ta M OA- E7ISTDJGUSE PROPOSED USE CONSTR. TYPE ' ISTORIES I USE TYPE CCC. SQ.FT. VALUATION (S) FX7CTG N`W FLOOR DEMO TOTAL AREA AREA AREA NET AREA '- BATHROOM KITCHE?d 0 i r�R REMODEL.ARE.A REMODEL AREA RF AODEL.AREA PORCH AREA DECK AREA TOTALDECIUPORCH AREA G.= .RA.GE AREA: DETACH ❑ ATTACH DWELLIN G UN-1 IS: IS A SECOND UNIT ❑ YES SECOND STORY OYES BELNGADDED? ONO ADDITION? E]NO PRE-APPLICATION []YES IF YES, P - _ IS THE BLDG AN }^rS °Rt,C]' YED�1 _ A - .: TOTAL VALUATION. -O PLANNINGAPPL9 []NO P 'G APPROVAL LE j_ EI RHOME? [:]NO V By my signature bel , I certify to each of the fc!lo inz- I am e property o\vner or authorized agent to act o e property owner's behalf. I have read this application and the nformation I have provided is rr t. I h , ea the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinarces and state aws relating to building co, tru ti on utho '_e representatives of Cupertino to enter the above - identified proprerr�yy r��yas� ction purposes, E Signature of Applicant ent Date: %fLs SUPPLEMENTAL OR- MATION REQUIRED y - oUri csLrP = ' I-- – [l o«R New SFD or Multifamily d ellings:.Apply for demolition permit for existing buildinQ(s). Demolit' n pemit is required prior to issuance of building rscoL tTSx — 3 BLIID�cPL RFVIECi permit for new building. Fx�ss m© PL 4 �ALNGPLAFE {7EF; _ Commercial Blda Provide a completed Hazardous Materials Disclosure Wp �4RD =� Y _ ,i ALB c�oxxs s form if any Hazardous Materials are being used as part of this project. Ya _ Copy of Planning Approval Letter or Meeting with Planning prior to .M470R £- - – S.�iT�R1S'ER�ISrRICT submittal of Buildir; Permit application. �� _,. � _ _ M1� z;*+��oNn✓,Et,T4I.�AIra Bldg4pp_2011.doc revised 06121/11 TAI WE CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 14 Results way DATE: 11/25/2015 REVIEWED BY: Phuong Plan Check Fee: Hourly Only? Yes No APN: 357 20 041 BP #: *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: $0.00 PENTAMATION 1GENCOM PERMIT TYPE: WORK No N construction - As built - To show as built partitions & furniture placement, updated occupancy SCOPE count to reflect max projected occupancy z, NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School mistr ci, etc.). [ nese fees are Dasea on the preliminary information available ana are only an estimate. Contact the Uept for addn'l into. FEE ITEMS (Fee Resolution 11 -053 &L 711113) FEE QTY /FEE I MISC ITEMS Plan Check Fee: Hourly Only? Yes No $0.00 1 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. OT O.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Kix: T-T if762iYtti'11 aZli?'C'''c 0 Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee; $0.00 Select allon- Residential E) Building or Structure 0 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 'SUBTOTALS $0.00 $143.00 TpTAL FEE $143.00 Revised: 10/01/2015 771 FIRE n SANTA CLARLk 14700 Wimchesei Blvd., Los Gatos, CA 950 30-1818 (4 08) 378 -4010 (phone) R ( 408) 373-9342 ?L4N CL'ZcCK No. PLAN REVIEW CONBIE E S = lIsccrE o WORK: � AA .� ccr,U r ilo. I `, _ ") 't _ I — ,-.i— _ '. _ 1-,, ., — _( _1,. r, , . . /,r, 1 n ri . . 1 :1Silil�!17�= pilnl; lei p.- !';re�12^iN �;' "stG;:!S��!Z11 G�!i! CiiiG�',�i!ECGS�ci)',r SllbiTlii3 5ES Oi �ia1h'li1C$ _ t cDphC____L k is =S i0 me SeTit_ C1cia CGUniy 1'li e Dept, iGr approVZl prlOr i0 Zltei iri ;y. L Lt C 901,E " 11 po:iions Gi a ebu 1din' sr!a)I CE h'ithir) %G F:Ei of a i ie xii l_LISi, l,cVir!� a - ili7liM1]i!, i at ?i:a o7. �- k:10 -BC, CrC 905 Com,!%n 7r i_--I COokkn— nulpr -n-mt shall be provided With a Class b1Elir. E;�;iing'.lish 100atEd w:-- iil rc:t of t17° ClLlur:!er!i !d l t t}!0 Yaul Gi cXiti!ayel. CFC 90_4 doors shall be;eadiy opEnab1E iTOrl the, egtSs s 16E t10_t Special CnOii'1°d�-e or eff t & Shall no,, i @Gulre t i E h t g7zs7ln', tight Di-!Chiiig or -LW ;Sting OF the wrist t0 Opera,.,, ty ope-ated IGCking devices ais ei!! ii_3d vrhen ; vadily distii:�uishable as locked UNLOC:C.D VkIFIEN BUILDING IS OCCUPIED, C B C 1005.1.8 ,4 ✓n3 O f egrf- sS Sha11 be IlhuminF Pd at 311 tirreS With 90 rni',ute back L'N wlh:Eie 2 Or ii:OrE EKits eTE eouired. CBC 10063 its Shz1I be marked by illuminated exit si=ns. Sins ShLII be i 1)1-' M:j in at ed at _•1'i ti -_ s and have 0. m in_.es of e ne;gency backup pou'ei. CB 1011 Contractor shall field Vern~ the, intwgrity Of ExlSt'Tlcl,rct°d CO 15 ruC}il0iraS: TCIi and r_stOF'.OF T.'j,ZLr cS n °C°sscr,. I- Lr7L;Ons in retEd'li'al1s�CEilings shall be protECtild by listf/ i i ra(°d eS_ °.i?b11cs �Oai!ipf•i., d00rs, ca!ulhlnc, ilre stopping, etC,) CFC -03 cow A� T lint shall provi^ a - , = k aY 0c ,: F:it !rl the bilr'ir!v .;!oi E. 7c ac a �� l_�y , y C . S boy. CrC 1406 1 This pla:l Check do.-s notrermii the !uSe, stordzP, or disc- rising Gi hazzrd0us materials, OD= rai10;?s or Tenant Shall provide a completed HNfIS to the r ";re depzr!;::cnt`s hazardous r:!at_,-i?!_ sp -Cia.!ist =or re'v'` ' %nd Corinm=_n` A CLOSL.IIE PERMIT is r e°opu!red prior to temninaj!r!� the. SiGra�e Or ii' rdOLS TiZiei!? c at a per-rIi d :torc2.', izCllii��. �'_701iii0n OI c::y C. ryIstc, ra_;c Zr °3 ti, -M f?i = zidGi]S TiZicr'iz - t be arprovcd prior t0 Obtaln.in a• q CLOSURE EPR Is PITNLZT. � d`r/ 0 y i0 isSi), building Sl,';jvCt 0 C•O i 2PC.= i -,b ip�i � rl�i7 a�0i %C Jl n l3 S S= =' s N_, D= gIP. =Y LI ju Y-N 6aa l,'Al,I., D- ra.CiLl Tf LGC TIGt! 4\70 WtaLWC-ZA-4 tcs AL__.rLcs r!?cs H'Ws, ^L =s Gctcs. !4cn.2 S =_r =_nc, i:;o- .. -`ill, crd _. - CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: ZQ P Sv PERMIT # (� OWNER'S NAME: y4e 1 PHONE # p GENERAL CONTRA TOR: BUSINESS LICENSE # (j ADDRESS: ' CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTI O WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL BCO RACTORS OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors. Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date 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 Owner / Contractor Signature Date U) 0 z D ui co IX -i uj UJ cL m a. I 'ON gql ym, 4 R R'5 w, OK a� - N �40 iii 3 0 H BRI O GWIL0190 04! U4v 20 1 �nTWF V 0 r , M E F A rw V \7) 1 Lp aH l ,0 —g W gP ME, 'MIHO H M"'s —.Ml. 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