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15110183CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR: SC BUILDERS INC PERMIT NO: 15110183 OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 910 THOMPSON PL DATE ISSUED: 11/25/2015 OWNER'S PHONE: 4084721275 SUNNYVALE, CA 94085 PHONE NO: (408)328-0688 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] APPLE TENANT IMPROVEMENT ON FIRST FLOOR (2120 License Class Lic. # 141 ld((t' SQ Contractor CC. 1 iu1 L.VE'tZ i Date %I L-,' j I S FT). 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 Sq. Ft Floor Area: Valuation: $175000 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 APN Number: 36901027.00 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 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 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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 9.18. Signature Date 1 RE-ROOFS: 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 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 I, 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 MATERIALS 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. I 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 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 2550 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 1 /W)s 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION 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 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. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0cuaertino.oro f 6�1 l ve5 3 n NRW CONSTRI ICTION n ADDITION I v I ALTERATION / TI I I REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 20450 STEVENS CREEK BLVD. APN# 369-01-10a-q— OWNS AME HONE 408.472.1275 � �Jrr�i/Nd �/ ��vi<Rv E-MAIL matt_jorgensen@apple.com STREET ADD Siy CITY, STATE, CONTACT NAME )EFF RUSSELL PHONE 615.585.0277 E-MAIL jrussell@fca-arch.com STREETADDRESS 1361 BUSH STREET CITY,STATE, ZIP SF, CA 941109 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT IM ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME GREG BURDA LICENSENUMBER 767196 LICENSE TYPE B BUS. LIC# COMPANYNAME SC BUILDERS E-MAIL gburda@scbuildersinc.com FAX STREETADDRESS 910 THOMPSON PLACE CITY, STATE, ZIP SUNNYVALE, CA 94085 PHONE 408.328.0688 ARCHITECT/ENGINEERNAME CHILI LIN TSE-CHAN LICENSENUMBER C-012739 BUS. LIC 41 COMPANY NAME FONG & CHAN ARCHITECTS E-MAIL jrussell@fca-arch.com FAX STREETADDRESS 1361 BUSH STREET CITY, STATE, ZIP SFS CA 94109 PHONP. 415.931.8600 DESCRIPTION OF WORK RENOVATION OF EXISTING OFFICE SPACE EXISTING USE OFFICE PROPOSED USE OFFICE CONSTR. TYPE 1A #STORIES 8 USE TYPE OCC. SQ.FT. VALUATION (S) EXLSTG AREA 2,120 NEW FLOOR AREA 2,120 DEMO AREA 2,120 TOTAL NET AREA 2,120 OFFICE IA B 2,120 $175,000 BATHROOM KITCHEN OTHER REMODEL AREA N/A REMODEL AREA N/A REMODELAREA N/A PORCH AREA N/A DECK AREA N/A TOTAL DECK/PORCH AREA N/A GARAGE AREA: DETACH N/A ❑ATTACH # DWELLING UNITS: N/A IS A SECOND UNIT ❑ YES BEING ADDED? ®NO SECOND STORY ❑ YES ADDITION? ®NO PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF PLANNING APPL # ONO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? 2] NO RECEIVED J n / TOTAL VALUATION: l is ' Cco — By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the 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 verify 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 e--ide tified p perty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL ORMATION REQUIRED _ New SFD or Multi famil ellings: Apply for demolition permit forOVER-THE-COUNTER existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form 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. PLAN CHECK TYPE ROUTING SLIP ❑ EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ PUBLIC WORKS ip- FIRE DEPT ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO Il FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: 20450 Stevens Creek Blvd FLR AREA s.L DATE: 11/25/2015 REVIEWED BY: SeanAPN: imADDRESS: 60� O1 al- BP#: II-B,111-B,IV,V-B '"VALUATION: $175,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IBTIINSP $0.00 PENTAMATION 1 B TI PERMIT TYPE: WORK Apple tenant improvement on first floor 2120 sq ft). SCOPE Permit Fee: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.L PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 2,120 $2,262.22 IBTIPLNCK $1,971.17 IBTIINSP $0.00 PME Plan Check: $0.00 Permit Fee: $1,971.17 Suppl. Insp. Fee:Q Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 2,120 $2,262.22 $1,971.17 MECH, HOURLY 0 Yes (j) No PLUMB, HOURLY 0 Yes (j) No ELEC, HOURLY Q Yes (F) No =lec)z. Plan Chep:` -0i' a, I'14w f leck ""''Plan t, izecf: l fech. Permit Fixe: Pitonb. Permit Fee: Ele-% Pern.'h Fr:'E.. t?cher AA= ei?. Ir?sp. he r I'trrira> 1>;: ,E17— Wr l 4 c. Irrt _Ea 0.0 hrs $0.00 AUM 77tis estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the Dreliminary information available and are only an estimato_ Contart tho Wont far addn'I info_ FEE ITEMS (Fee Resolution 11-053 If' ' 1.73) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,262.22 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,971.17 Suppl. Insp. Fee:Q Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 onstruelion 7G1%': dinhiistrative f`c? % 0 0 Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Q Strong Motion Fee: IBSEISMICO $49.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $7.00 SUBTOTALS: $4,289.39 $0.00 TOTAL FEE: $4,289.39 Revised: 10/01/2015 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 La Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST *Our municipal code requites all businesses working in the city to have a City of Cupertin'o busi;ess license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUIPERTINO BUSINESS LICENSE. I am not using any subcontractors: -- -, .... . Signature Date Please check applicable subcontractors and complete the following information: ✓ ONTRACTOR BUSINESS NAME BUSINESS LICENSE # —.-V'Cabinets & Millwork WIN WIN RON Mfop UPC *Our municipal code requites all businesses working in the city to have a City of Cupertin'o busi;ess license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUIPERTINO BUSINESS LICENSE. I am not using any subcontractors: -- -, .... . Signature Date Please check applicable subcontractors and complete the following information: ✓ ONTRACTOR BUSINESS NAME BUSINESS LICENSE # —.-V'Cabinets & Millwork V C -To Cement Finishing V Electrical ---- -------- Excavation Fencing V" Flooring / Carpeting (Z 14ag Linoleum / Wood Glass / Glazing Heating VJ A LI-C—aS-- W Q LF::: Insulation Landscaping Lathing Masonry Painting/ Wallpaper C A/\j T -C-0 Paving Plastering Plumbing Roofing Septic Tank v,,'- Sheet Metal V III-J7n 1114. /A I &/A-' L Sheet Ro U Tile Owner/Contra or Signature Date