Loading...
B-2016-2616CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2616 10845 N WOLFE RD CUPERTINO, CA 95014-0614 (316 05 052) N T GENERAL CONSTRUCTION COMPANY SUNNYVALE, CA 94087 OWNER'S NAME: CUPERTINO VILLAGE LP I I DATE ISSUED: 11/10/2016 I I OWNER'S PHONE: 408-202-4866 I I PHONE NO: (408) 623-2297 I LICENSED CONTRACTOR'S DECLARATION License Class H Lic. #706999 Contractor N T GENERAL CONSTRUCTION COMPANY Date 05/31/2017 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. 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. 1fiJ✓ 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. APPLICANT CERTIFICATION 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 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. Additionally,. the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 11.10.16 BUILDING PERMIT INFO: X BLDG —ELECT _PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: 1 ST FLR; T.I.-CHANGE OCCUPANCY RETAIL TO OFFICE (M/B) (925 S.F.) LONGEVITY SPA Ft Floor Area: I Valuation: $80000.00 APN Number: Occupancy Type: 316 05 052 1 A (Tenant Improvements),B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: SEAN HATCH 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 i. I, 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: 11. .1 I hereby affirm under penalty of perjury one of the following three declarations: i. 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. z. 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. 3. 1 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 11.10.16 11 A 1i 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 9.12and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Sectio 255Z255;and 25534. Owner or authorized agent: - r Date: 11.10.16 CONSTRUCTION LENDING AGENCY 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 Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed CUPERT[NOr R NEW CnNSTRt I["i'Tt7N CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT, BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buking(a)cuaertlno.oro I. I ATr IT)TTIOW I I AT TPP ATiri-m iTi F DrXTICM-m fr, LLIDDCri nD TO- MAT nrnx.rrm u PROJECT ADDRESS ' APN # " vfi O\E'ER NAME ''�J j � �/ hYl • f S f l i ltd ClYt,7' "' PHONE09 STREETADDRESS �. (%J }may , T C1Yy ATE ZIP� ( FAX CONTACT NAME � FH NE +7� E-MAILO i0VtgOAWA f4ht - STREET SS 1���+ •� 'l//aVV V{J WY CITY, ATE, ZIP n V FAX ❑ OVINEP ❑. OWNER -BUILDER OWN£RAGnzT CONTRACTOR ❑ CoNTRAC OR AGENT ' ARCTTIT£CT 'Gl ENOII.TEER El DEVELOPER. TENANT CONTRACTOR NAME e; - S1 1 Y IU2 EA'UMBER LICENSETYPE BUS•LICJ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, .ZIP PHONE ARCHITE; x 1N 7y LICENSE NUMB BUS. LIC 9 . COMPANY A4E E M� j j til FAX $, /� ii ' 1J�+ (S/J S A_ CIT ,3 ATPZ,J�Ijp C (iA J PNOIS2 V C: iJ � DESCRIPTION OF WORK jJP�(/"J E. TING USE :PROPOSED USE CONSTR TYPESTORIES ✓, IV tFLO✓OR 1� USE TYPE OCC. SQ.FT. VAI,t3ATI0N (b} E7CISTC DEMO TOTAL AREA ARE ARE A AREA NEI' � �� BATHROOLI - KITCHEN _ OTHER REMODELAREA RBMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK.'PORCN AREA GARAGE AREA: CIDETACH - - - []ATTACH 1DVIELLINGUMTS: ISASECONDUNIT []YL -S SECONDSPORY []YES - - BEING ADDED? MNO ADDITION? [:]NO PRE -APPLICATION []YES IF TES, PROVIDE COPYOF IS THE BLDG AN. ❑YES ERE.GENEIIBY .- r TO VALUATION YLAN'NINGAPPLn I]NO PLANINIRGAPPROVALLETTER EICHLERHOME? LINO , .: ="""" _ - P:>...,-,.:::• -�- By my signature below, I certify to each of the following: Ie pTSpe own o uthorized agent to act on the property owner's behalf. ba e read this application and the information I have provided is core -e i'have read the cription of Work and verify It is accurate, I agree to comply with -all applicable local ' ordinances and state laws relating to building S..pistration. I aur r resentatives of Cupertino to enter the above atifieproperty for inspection purposes. SignatureofApplicantlAgent: Date; ' SUPP ENTAL TIQN REQUIRED r`" P`- "^%=='A LANCHECKTSFC_._... .. : ;. r. y. ROfrrIRGSLIP,,, `- New S or Multifarnily dwellings: Apply for demolition permit for p R TIrl Caui,TEx r �IIDLLDI�G PLA?• RE\7E1i existir uiiding{s). Demolition permit is required prior to issuance of building for building. ov> * 1] rr F: pE ]it new EAPRESS rLA't-ZInGrLAn'ii);�'tEn= Commercial Bidgs Provide a completed Hazardous Materials Disclosure _ form if any Hazardous A4aterials are being used as part of this project. ©LAxcE DEPT 4 _ Copy of Planning Approval Letter or Meeting with Planning prior to �fl- D21JOIt r © S N1I ARY'�EXITRDISTRICT submittal of Building Peniut application. r- t , �'- - •1.❑..EA'VIROR'l1 SEi.TAi'HLALTII: ,__f"* Bldggpp_2011.doo revised 06121111 e FILE Fly -��� 41 TEST AND BALANCE R'e'-,.PO Rq LONGEVITY ACCUPUNCTURE 101#01,101M M CUPERTINO CA 95014 CIJENT- NT GENEARAL CONSTRUCTION CO. PROJ.ECT NO. 104 3 DATE: 24.201.7 'FECHUAN: DAVE PINE 4,0827 CAPA DRIVE.', FREMONT, CA 94539 '31.113,2-703240 FAX877-478-2908 FLOW HOOD AIR OUTLET TEST REPORT PROJECT: LONGEVITY ACCUPUNCTURE SYSTEM: AC -1 AREA OUTLET ———— DESIGN mil ask PAGE • �■�