15020127CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20090 STEVENS CREEK BLVD
CONTRACTOR: TM577rPBE
PERMIT NO: 15020127
ED
OWNER'S NAME. PREG BILTMORF
DATE ISSUED: 02/19/2015
OWNER'S PHONE: 9259693900
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
SUITE 106 -INSTALL UNDER StAbt PLUMBING FOR
�C_>
License Class—§76 J! Lie. #
FUTURE
Con tractor - I k1- Date— Z4 5-
FRESH PIX PERMIT # (14120017)
1 hereby I,. 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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $10000
1 have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36903009.20080
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 inspection purposes. (We) agree to save
181 DAYr LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
against said City in consequence of the
costs, and expenses which may accrue
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
RE-ROOFS:
being installed. if a roof is
9.18. 4f
1r
Signat re Date _Z 1 q
All roofs shall be inspected prior to any roofing material
at ri s for
in It m e a]
installed without first obtaining an inspection, I agree to re ove a new
inspection.
13 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 die 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
HAZARDQU_S MATERIALS D15CLOSURE
construct the project (See.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. Iwill
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, Sections 25505,25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:,
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
!CQNSTRUCTION LENDING
Compensation laws of California. If, after making this certificate of exemption, I
_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.
worWs for which this permit is issued (Sec. 3097, Civ C,)
]Lender's Nam
APPLICANT CERTIFICATION
Lender's Addres
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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�
Signatur Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY, DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TO•RE AVENUE - CUPERTINO, CA 95014-3255 B.
(408) 777-3228 - FAX (408) 777-3333 - build�n_q cupertino.o
CUPERTINO I M
NEW CONSTRUCTION EIADDITION "fl ALTERATION/ TI [] REVISION I' DEFERRED ., ORIGINAL PERMIT #
PROJECT ADDRESS awso
44
OWNER NAME
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STREET ADDRESS
CITY, STATE, ZIP
FAX
COIQrrACT NAME
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
0 owi,,ER ❑ owNFR.B=Ep, ❑ OWNER AGENT 13 CONTRACTOR 13 CONTRACTOR AGEN7 Q ARCHITECT ❑ ENGINEER 0 DEVELOPER TENANT
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LICENSE TYPE
BUS. LIC
OMPANY NAME
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E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
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ARCI-11TECT/FNGENEER NAME
LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, M
PHONE
DESCRIPTION OF WORK
77)
EXISTNG USE PROPOSED USE CONSTR. TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG _T
NEW FLOOR
DEMO
TOTAL
AREA
I AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DFCKIPORCH AREA
GARAGE AREA: DETACH
ATTACH
9 DWELLING UNITS:
iSAsEcoN5)uNrr
STORY []YES
BEING ADDED? NO
ADDITION? rJNO
PRE-APPLICATION 171 YES IF YES, PROVIDE COPY OF IS THE BLDG AN_ ❑YES
PLANNING APPROVAL LETTER PICHLER HONIE? [j?"O
PLAMTN3NGAPPLi5 rJN0
By iny signature below, I certify to each of the foil ,Pwing: I am the property owner or authorized agent to act on the property oxvner's behalf. I have read this
application and the information I have provided" co 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 s clio I uth2e. representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Agent: Date: 2-1 r V/r7
SUPPLEMENTAL INFORMAT)��` Q
N:OBM*-
R -CR
Oi ER THE C TE �&Z-�X,M,,',
demolition r
New SFD or Multifamily d,"7ellings: Apply permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Tor—in if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
M3
BldgApp_,201 1. doc revised 06121111
Zut
FEE ESTIMATOR - BUILDING DIVISION
11 WADDRESS: 20080 scb suite 106 1 DATE: 02/19/2016 1 REVIEWED BY: Mendez
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY Civil/ Religious activities PE TAMATION IGENCOM
USE: Commercial Building in BQ zone?, _ 0 Yes (E) No PERMIT TYPE:
WORK i Suite 106 -install under slab plumbing for future fresh pix per
SCOPE
14ech' hap, Fee:
llhwlh Plan Check
F,11114'mb� Permit Fee:
District,E� �.These&ees are based on the prelinfinary
FEE ITEMS (Fee Resolution 11-051f� . �7111132
Plan Check Fee: Hourly Only? 0 Yes e, No
PME Plan Check:
Permit Fee: Hourly Only? 0 Yes (E) No
PME Unit Fee:
PME Permit Fee:
Construction Tax: IBCONSTAXC
Administrative F'ee:
Work Without Permit? 0 Yes 0 No
Advanced_Plannin Fee:
Strong Motion Fee: IBSEISMICO
Bid, Stds Commission Fee. IBCBSC
U U
Elec, Check
ation available and are on1v an estimat4 Contact the D
FEE QTY/FEE MISC ITEMS
1 .00 1 ] hours Plan Check, Hourly
:::$0.00 $143.00TISTPLNCK
d0000
$0.00 Select a Non-Residential E)
]== Building or Structure 0
$2.80 Inspections
I Inspection, Hourly
$1.00 $286.001 ISTINSP
$3.80 $429.00['�Z' $432.80]