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B-2016-3216CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3216 20400 STEVENS CREEK BLVD STE 150 CUPERTINO, CA 95014 (369 01028) WELLS CONSTRUCTION INC ROSEVILLE, CA 95678 OWNER'S NAME: CUPERTINO my CENTER BUILDINGS DATE ISSUED: 12/07/2016 OWNER'S PHONE: 408-330-1051 PHONE NO: (9167 788-4480 LICENSED CONT A TOR' DCLARATION BUILDING PERMIT INFO: License Class B Lic. #619655 Contractor WELLS CONSTRUCTION INCDate 05/31/2017 X BLDG _ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: STE 150, FIRST FLR ONLY; T.I. (1,381 S.F.) - HUAWEI I hereby affirm. under penalty of perjury one of the following two declarations: 1. 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. 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. Sq. Ft Floor Area: Valuation: $80000.00 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 APN Number: Occupancy type: and state laws relating to building construction, and hereby authorize 369 01 028 B (Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applica understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regul ti s per a Cupertino MunicipaSection 9.18. 180 DAYS FROM LAS .E SPECTION. f Signat s�Ztt Date 12/07/2016 Issued by: L OWNER -BUILDER DECLARATION Date: l2/07/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF�ROOF , following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 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: 12/07/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A” OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cutmo Municipal Code, Chapter 9.12 and Vons exemption,.I become subject to the Worker's Compensation provisions of the the Health & Safety Co 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized ag t: G/'���� ✓(.fi C APPLICANT CERTIFICATION Date: 12/07/2016 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 CONS�ZCTTON LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lendees Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 12/07/2016 Professional CONSTRUCTION PERM 11APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-.3255 (408) 777-3228 FAX (408) 777-3333 • building&cupertino.orgCUPFERTINO _ !J NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESSAPN L V&O 5` 4 'L f 3&/,ol ®4328 OWNER NAME k V PHONE - E-MAIL " STREET ADDRESS �/ I' �, 7 �y CTTY, }TATE, ZIP' FAX Zo Goo 5ie, e,3 t C� b L , ATE CONTACT NAMEPHONE It{, +0 fv GvvV JY�—aP i lS CC1K STREET ADDRESSYTJ _�_ CITY, STATE, ZIP , ^ 1.� f FAW_ ! p ,, 11 OWNER ❑ OWNER -`BUILDER ❑ OWNER AGENT, ❑ CONTRACTOR. ❑ CONTRACTOR AGENT ❑ ARCHITECT (❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMENSE 55 LICENSE TYPE BUS. LIC # w�,c,� N 7 COMPANY NAME E-MAIL FAX t,C e.S Lcs 5 cs L M t s cGs vJ.t �l 16 - ��ss STREET ADDRESS o CITY,STATE, ZIP PHONE 1 � r'7��Z� !16•�1�Fj`�'-t�-a ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS LIC # ti"'; 'CAt�e'49 "Vii Czly& :3 l SECOND STORY "YES COMPANY NAME ""/1/4l E-MAIL `` �1 � `:V S%iV 6, e-OYt t FAX C� i8 q16. 7 �jb i� 118 E STREET ADDRESS t:>410 V U CITY, STATE, ZIP 1 C PHONE .y �* / �''_9 �/' �`(- ( r� c G C7 °�� J J S?ESCRIPTIQNLOE WORK --- t., 54.0�F'(C1 - EXISTING USE PROPOSED USE USE CONS/JTR. TYPE # STORIES USE TYPE OCC. SQ.FT: VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL /}_ NET AREA �/� ' A l /� n ` VG !./ / e/ BATHROOM REMODELAREA KITCHEN REMODELAREA OTHER REMODELAREA By my signature below, I certify to each of the following: I am the property owner or authorized agent to tlRrn the property owner's behalf. I have read this - PORCH AREA DECK AREA TOTAL DECKNORCH AREA I GARAGE AREA: DETACH 'M ATTACH SUPPLEMENTAL INFORMATION REQUIRED y..' PLAN CHECK T SPE, _ �-',_ - # DWELLING UN FS: ISA SECOND UNIT ❑ YES SECOND STORY "YES BEING ADDED? NO ADDITION? ❑NO - PRE -APPLICATION [I YES IF YES,. PROVIDE COPY OF IS THE BLDG AN .- y -- - TO L VALUATI N: �o PLANNING APPL # E] NO PLANNING APPROVAL LETTER EICHLER HO N ""- /!Q V By my signature below, I certify to each of the following: I am the property owner or authorized agent to tlRrn 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 buuillddiinng con vction. I authorize representatives of Cupertino to enter the above -i entied property for inspection purposes. . Signature of Applicant/Agent: ate}-�(- E... Date: f SUPPLEMENTAL INFORMATION REQUIRED y..' PLAN CHECK T SPE, _ �-',_ =,. �: 'ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for ovER T DUNTER ET'DIM'DING PLAN REY1YS existing building(s). Demolition permit is required prior to issuance of building x permit for new building. �:✓ EXPRESS ti ANNIM, PLAN REV Ew Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 17,' STANDARD PT7BZIC 1VORIiS form if any Hazardous Materials are being used as part of this project."'' ❑. LARGE;`. -,. s © I3REDEPT, _ Copy of Planning Approval Letter or Meeting with Planning prior to 0 NrAaox p SANITARYSE\3ERllI5T$iCT submittal of Building Permit application. B1dgApp_2011.doc revised 06121111 i Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone 408-777-3228 C O P E RTI N O Fax. 408-777-3333 CONTRACTOR I SUBCONTRACTOR DIST Deur mumcjipai coae requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPE+CTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: ✓ JOB ADDRESS Q,n5 PERMIT # W l OWNER'S NAME: `t PHONE # GENERAL CONTRACTOR. iAj A BUSINESS LICENSE # i lea ADDRESS Lobo i4L A& skill- CA 1-)Z75CITY/ZIPCODE. 5tj)ttl-Z q. Deur mumcjipai coae requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPE+CTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing -Electrical ( tLi011 2 ; j Excavation Fencing Flooring/ Carpeting `)1%4 4AAIs M WW fit. A4 AN&I T Linoleum /Wood Glass / Glazing . Heating ri 5 Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile X77/ Owner / Contractor §69nature Date 9