B-2016-2977 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2977
10380 PERIMETER RD CUPERTINO,CA 95014(316 20 092) SB C C INC
CAMPBELL,CA 95008
OWNER'S NAME: CUPERTINO PROPERTY DEVEL II LLC DATE ISSUED:01/09/2017
OWNER'S PHONE:408-343-1088 PHONE NO:(408)379-5500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#336974
Contractor S B C C INC Date 03/31/2018 X BLDG _ELECT _PLUMB
MECH RESIDENTIAL X COMMERCIAL
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. JOB DESCRIPTION:
TEMPORARY CONSTRUCTION TRAILER(HYATT HOUSE)(720 SQ
I hereby affirm under penalty of perjury one of the following two declarations: FT).
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.
12:• 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. Sq.Ft Floor Area: V.luation:$5000.00
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 APN Number: 0 cupancy Type:
and state laws relating to building construction,and hereby authorize 316 20 092 A 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 EXPI' I S IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 D YS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations p r the Cupertino Municipal Code,Section 9.18. 180 DAYS FRO _ST - _.. _ _ I I SPECTION.
f /—
Signature )\11\t,77-k---;09 Date 01/09/2017 Issued by:MELISSA v —
Date:01/09/2017
OWNER-BUILDER DECLARATION
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
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:01/09/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF CO RINGS 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. HAZARD US 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
s. 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 w.'th the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Section 25505,25533,and 255 4.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: __ _ d.
APPLICANT CERTIFICATION Date:01/09/2017 �'V
I certify that I have read this application and state that the above information is CONSTRUCTION LE G AGENCY
correct.I agree to comply with all city and county ordinances and state laws 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 Lender's 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. I understand my plans shall be used as public records.
Licensed
Signature Date 01/09/2017 Professional
f CONSTRUCTION PERMIT APPLICATION
i ' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
owyt.,ys, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildincicAcurertino.orq c. .- Z.01,6 plc
❑NEW CONSTRUCTION El ADDITION 0 ALTERATION/TI ❑ REVISION!DEFERRE a ORIGINAL PERMIT#15030181
PROJECT ADDRESS 10380 Perimeter Rd APN#
OWNER NAME KCR Development PHONE 408.343.1088 ''MAIL echan@kcrdevelopment.com
STREET ADDRESS 19820 Stevens Creek Blvd, Suite 200 CITY,STATE,ZIP Cupertino CA 950 4 FAX
CONTACT NAME Nandy Kumar PHONE 650.344.1500 '-MAIL nkumar@shcmllc.com
i
STREETADDRESS 2822 Sand Hill Rd, Suite 241 CITY,STATE,ZIP Menlo Park CA 94425 FAX
❑OWNER 0 OWNER-BUILDER IN OWNER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITE.T ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME Majid Tavakoli LICENSE NUMBER 336974 LICENSE 'E B BUS.LIC# 5655
COMPANY NAME South Bay Construction E-MAIL mtavakoli@sbci.com FAX
STREET ADDRESS 1711 Dell Ave CITY,STATE,ZIP Campbell CA 95088 PHONE 727.470.7255
ARCHITECT/ENGWBERNAME Stephanie Park LICENSE NUMBER - BUS.LIC#
COMPANY NAME GFA Architects E-MAIL spark@gfaarchitects.com FAX '
STREET ADDRESS 1130 Westwood Blvd CITY,STATE,ZR' Los Angeles CA 91024 PHONE 310.209.7520
---- --- DESCRIPTION OF WORK—-Installingjobsite-oftice-trailer: -- „- - "- i. -- - - - . _ ' .
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYP: 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 TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT DYES SECOND STORY OYES -
BEING ADDED? ONO ADDITION? ONO
PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES R$ •7 e- --.�••b .. T .yALU�ON..,
PLANNING APPL# []NO PLANNING APPROVAL Lin-Lek EICHLERHOME? Q.NO _;- -` C O ( )I
By my signature below,I certify to each of the following: I am the propertyowner or authoriz o act on the. operty owner's behalf. I have read this
application and the information I have pr.vided is correct. I have read the Description of Work and verify it is accura e. I agree to comply with all applicable local
ordinances and state laws relating o wild.:construction. I author',e repr )(wives of Cupertino to enter the ahoy identified property for inspection purposes.
Signature of AppIicant/Agent: i.A II,A>,' _ _ Ai. - Date: • -
SUPPLEMENTAL INA?'MA ION REQU ''D'IIIPLAN CHECK TY:E ;ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for p OVER-THE-COUNT DR ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. 0 EXPRESS 0 'PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD 0,PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project ❑ LARGE 0 EIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to .
MAJOR 0 SANITARY SEWER DISTRICT
submittal of Building Permit application.
0 ENVIRONMENTALREALTH
BldgApp 2011.doe revised 06/21/11
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