14060206LJ
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19925 STEVENS CREEK BLVD
CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 14060206
OWNER'S NAME: STEVENS CREEK 1NVRS LLC
1460 O'BRIEN DR DATE ISSUED: 11/14/2014
OWNER'S PHONE: 4084990223
MENLO PARK, CA 94025 PHONE NO: (650)701-1500
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
APPLE T.I. - RECONFIGURE INTERIOR TO CREATE (N)
License Classes Lic. 4 0
ESPRESSO BAR (2ND FLR)
Contractor DN T) COY\ tYV diCV1 Date 1 `
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.
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: $320000
performance of the work for which this permit is issued.
1 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.
APN Number: 31621089.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 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 F OM LAST CA D 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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
n
RE -ROOFS:
Signature Date I 1�i
All roofs shall be inspected prior to any roofing material being installed. If a roof is
41
installed without first obtaining an inspection, l agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
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
hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 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: I I I
permit is issued.
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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCH 1TECT'S DECLARATION
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
CITY OF CUPERTINO
FM__7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 19925 STEVENS CREEK BLVD
DATE: 06/30/2014
REVIEWED BY: MELISSA
APN: 31621089
BP#: 6a.,
°VALUATION: 1$320,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
227
PENTAMATION
PERMIT TYPE: 1A TA
WORK
APPLE T.I. - RECONFIGURE INTERIOR TO CREATE N ESPRESSO BAR
SCOPE
hrs
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
A (Tenant Improvements)
II-B,III-B,Iv,V-B
227
$2,366.00
IATIPLNCK
$575.00
]ATHNSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$575.00
Suppl. Insp. Fee:Q Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
227
$2,366.00
$0.00
$575.00
MECH, HOURLY 0 Yes Q No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY Q Yes Q No
NOTE: This 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 preliminary information available and are only an estimate. Contact the Dept.for addn'l info.
FEE ITEMS (l ee Resolution 11-053 E : 77:'131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,366.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: ) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$575.00
Suppl. Insp. Fee:Q Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
F7
0
G
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
Strom, Motion Fee:
IBSEISMICO
$67.20
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$13.00
SUBTOTALS:
1 $3,021.20
$0.00
TOTAL FEE:
1 $3,021.20
Revised: 04101/2014