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B-2016-2539 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2539 20745 STEVENS CREEK BLVD CUPERTINO,CA 95014(326 32 055) COLORADO WEST CONSTRUCTION INC TEMECULA,CA 92590 OWNER'S NAME: PCG CUPERTINO LLC DATE ISSUED:10/11/2016 OWNER'S PHONE:310-807-3370 PHONE NO:(951)5144942 LICENSED ONT A TOR'8 DECLARATION BUILDING PERMIT INFO: License Class B Lie.#908987 Contractor COLORADO WEST CONSTRUCTION INC Date 01/31/2018 X BLDG —ELECT _PLUMB _ I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH=RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirmT.I.-CONVERT(E)RESTROOM TO ACCESSIBLE FAMILY under penalty of perjury one of the following two declarations: RESTROOM(62 S.F.)-TARGET 1. 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 F performance of the work for which this permit is issued. a. 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. Sq.Ft Floor Area: Valuation:$8000.00 APPLICANT CERTIFICATION nfor ation is correct.I agree to d state that the above icomply - I certify that 1 have read this application an g p y w th all city and county ordinances. APN Number: ,' Occupancy Type: and state laws relating to building construction,and hereby authorize 326 32 055 A(Tenant Improvements),M(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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9,18. 180 DAYS F AT CAI B-INSPECTION. Signature's� Date 10/41/2016 Issued by: � Date: 10/11/206 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/11/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the a. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to 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 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: , APPLICANT CERTIFICATION Date:10/11/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal AR be used T'SDECLARATION Code,Section 9.18. I understand my plans shal1l1 be used as public records. Licensed Signature Date 10/11/2016 Professional �I TRUCTIAN PERMIT APP Ur IN (: ''MTY DEVELOPMENT DEPARTMENT=BUI, ORRE AVENUE•CUPERTINO, CA 95014,39,_, (408)777-3228- FAX(408)777-3333•CUPERTINO building(a�cupes :c a/(� 2 ❑NEW CONSTRUCTION ❑ ADDITION FZ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PEPJVIIT # �� PROJECT ADDRESS APN# s+9 OWNER NAME �PHOt�l E—MAIL n AI #4111y AL STREET ADDRESS CITY, STA ,ZIP FAX 133 P AO nirf CA 902Y5 CONTAW NAME PHONE E—MAIL STREET ADDRESS C ,STATE,ZIP FAX 1-36R &ST Ave I J seteAmc4r, 05VI �.OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME, 'B r ^ ^ a LICENSE NUMBER �� ql, " LICENSE TYPE BUS.LII#PV K l `1J t,3 `ti C3 j v COMPANY NAM �-s R E-MAILMAdo YOA CA A FAX( p^ 1��/d)� STREET CITY,STATE.ZIP i 9 �" /iy [ L PHONEQ6t `Gy9�1" ARCHITECT/ENGINEER NAME LICENSE NUMBER - f BUS.LIC# IN B COMPANY NAME E-MAIL FAX tK(s^X Afl .F'-Y a STREET ADDRESS CITY,STATE,ZIP P ONE MAO ►e � T v ✓tv A1C 0_1 -0 /5. $ R T ON.OF K - S L. H,✓ � t IN /4 G T. G,V E iUf TO F-4AvL IZESTr ov E4-0 A/ /V -itroa° elaa�rL 4�/v6 AL-r ehrroN d c_IGHT EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES - V USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA a . B.3/ AREA AREA NET AREA 47-wc 'V ji(7 yy V s��o,y BATHROOM (•, KITCHEN OTHER �'S REMODEL AREA4- C2 4 REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LIDETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY El YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN .❑ L VALUATION: PLANNINGAPPL# [-]NO PLANNING APPROVAL LETTER EICHLER HOME? =' -" ' �� By my signature below,I certify to each of the following: I am the property owner or authorized agent to act 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 v = It is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: �s'�si Date: SUPPLE AL INFORMA N RE UIRED Q Pf,roI CHkCkT E -:iiorlTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for - { ovER fixE couNTER D soILDING rLANvr1 W existing building(s). Demolition permit is required prior to issuance of building permit for new building. ElEXPREss PLA'NNTI G rLat�liEtnEw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q STANI}ARD."- _ 7<ruBLTc:uvoRx form if any Hazardous Materials are being used as part of this project. Q LARGE ET RIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to = �- submittal of Building Permit application. 'El MA �'SANITARYSEwEIiDISTItTC MWIRONMENTAL.IIEALTIT B1dgApp_2011.doc revised 06121111