15080181CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 14 RESULTS WAY CONTRACTOR: SC BUILDERS INC PERMIT NO: 15080181
OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET 910 THOMPSON PL DATE ISSUED: 08/25/2015
OWNER'S PHONE: 4083968968 SUNNYVALE, CA 94085 PHONE NO: (408)328 -0688
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
APPLE - 14 RESULTS WAY - ADD (2) (N) A/C UNITS ON
License Class Lic. #__2 q d� ROOF, ADD (N) HEAT PUMP ON FIRST FLOOR AND ADD
Contractor SC' ` v� 1 �� TS Date EAT PUMP ON FIRST FLOOR
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.
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: $86500
I 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: 35720041.14 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 WITIIIN 180 DAYS ®F 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 180 D YS FROM LAST CALLED INSPECT ON.
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. Aildilikally, the applicant understands and will comply Issued by v / Date: vv//r'vv
with all non -point sou e r Cupertino Municipal Code, Section
9.18.
A 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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 MA'T'ERIALS 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. 1 will
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
1 have and will maintain a Certificate of Consent to self- insure for Worker's material. Additionally, should I use equipment o vices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Are i ality Management District II
performance of the work for which this permit is issued. will maintain compliance wi a 5 ' o C 1 Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, ections 55 , 2 , nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this �S
permit is issued.
Owner or authorized agent: Date:
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 of exemption, I CONST UCTION 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 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 1 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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION 15ISl ,
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE ° CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 • buildinq(c�cupertino.orcl
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS y M WIRY
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❑ OWNER OWNER - BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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DES CRIPTIONOFWORK
EXISTING USE
PROPOSED USE CONSTR
TYPE
I STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER'
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNTTS�
±TOTAL
ND UNIT ❑ YES
SECOND STORY ❑YES
DED? ❑NO
ADDITION? []NO
PRE- APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
1 IVEDBY -
':r
TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER
EICHLERHONIF? ❑NO
By my signature below, I certify to each oft following: I am the property owner or authori d agent to act on the property owner's behalf. I have read this
application and the information I have prow' ed is correct. kfave ;re the D ription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' ng construction a nze re ntatives of Cupertino to enter the above -i entified r erty for inslp0ion purposes.
g
Signature of Applicant/Agent: Date:
SUPPLEME TAL INFORMATION REQUIRED
„4�i5 PLas crcK'TiE
., . ,ROUrrzvc
New SFD or Multifamily dwellings: Apply for demolition permit for
fiF
OVER THE- COUNTER
r
� BUII.DING PLAN REVIERy
existing building(s). Demolition permit is required prior to issuance of building
�, �
°
permit for new buildinb
a `
❑ EXPRESS `' Y
" °:
❑ PLANNING PLAN REVIEW
L
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ sTa� DARn <� a
❑ i woxxs
_
form if any Hazardous Materials are being used as part of this project.
❑I
'WPit
❑
Copy of Planning Approval Letter or Meeting with Planning prior to
LARGE r `" a�
"
FIRE DEPTHY a.
'sAriTARY
❑MAaox tt
❑ SEWERDiSTRJCT
submittal of Building Permit application.
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❑::.EIVYIRONMENTAL HEALTH -_.,. z ,
BldgApp_2011.doc revised 06121111
0TY OF cCU? ERTffNO
FEE ]ESUI\Y1IATOR — ]BUMINNG ]Dff Vff ,9ffON
ADDRESS: 14 RESULTS WAY DATE: 08/25/2015 IREVIEWED BY: PAUL
APN: BP #: 15080181 *VALUATION: 1$86,500
"PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building PENTAMATIION FURfN /AC
SSE: PERMIT TYPE:
WORK APPLE - ADD 2 NEW A/C UNITS ON ROOF ADD NEW HEAT PUMP ON FIRST FLOOR
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
A/C Units ( >10K cfm)
1 MCAIRHAN
4
#
$572
Perm* Fee:
Suppl. Insp Fee
PME Unit Fee:
$572.00
PME Permit Fee:
$48.00
Construction ax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes No
$0.00
TOTALS:
o,
Travel Documentation Fee: ITRAVDOC
$572.00
Strong Motion Fee: 1 BSEISMICO
a 4* ,x
Mech. Plan Check 0.0 hrs $0.00 Plurnb. flan Check Elec. Plaii Check
Mech. Permit Fee: IMPERMIT I'lumb. Peranil Fee: Elm Permit Fee:
Other Mech. Insp. II 0.0 II hrs I $48.00 II Other Pluraab /;ash. II 1 1I otlier Elec. lay.
Mech. Insp. F'ee: Plaarnb. Iaup. I{ee: 1I Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
MtricL etc 1. These fees are hated an the nreliminary intarmatinn availahle and are nnly an estimate. Cnntaet the Bent for addn11 infa.
]FEE ITEMS (Fee Resolution 11 -053 Ef 7/1/13
FEE
QTY/FEE
MISC ITEMS
Flan (7he>ck Fee:
SrppL PC fee
PME Plan Check:
$0.00
Perm* Fee:
Suppl. Insp Fee
PME Unit Fee:
$572.00
PME Permit Fee:
$48.00
Construction ax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fees:
o,
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1 BSEISMICO
$24.22
1.0 hrs Inspections
$143.00 ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$4.00
l
_ .;
. n..
$741.22
$143.0 0
�I ALF EE,
$884I
Revised: 07/02/2015