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B-2016-1266 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1266 20400 STEVENS CREEKBLVD CUPERTINO,CA 95014(369 01 028) (GIDRL&KOCAL CONSTRUCTION CO INC) CAMPBELL,CA 95008 OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS DATE ISSUED:01/27/2016 OWNER'S PHONE:408-873-0121 PRONE NO:401-370-0210 LICENSED CONTRA TOR'S DECT RATION BUILDING PERMIT INFO: License Class l3 Lio.*IMO 0 Contractor(GIDEL&KOCAL CONSTRUCTION CO INC)Date 01/27/2016 X BLDG _ELECT PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing"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: AEMETIS-INSTALL(N)GLASS DOOR IN(E)OPENING I hereby affirm under penalty of perjury one of the following two declarations: a, -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. \+' 2. 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: Vali ation:$10000,00 APPLICANT CERTIFICATION I certify that l have read this application and state that the above information is correct.I agree to comply with all city and county AP Number: Occupancy'Pype: ordinances and state laws relating to building construction,and hereby 369 01 028 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 PERMIT EXPIRE IF WORK IS NOT STARTED expenses which may a. crue agalnst said Cty in nequands of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LA ,. ova-INSPECTION. Code,.Section 9.1 . Issued by:AL S �_ — 7.5 Signature Date 01127/2016 Date:01/27/2016 OWNER-BUILDERDECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all now materials for 1. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec,7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:01/27/2016 contractors to construct the project(Sce.7044,Business&Professions Code). • I hereby affirm under penalty dtperjury 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 HAZARDOLS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&SafetyCode,Section 25532 a should I store or handle hazardous this permit is issued. ( ) s. I certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area AirQuality Management District I Worker's Compensation laws of California, If,after making thiscertificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: fiP J be deemed revoked, Date:01/27/2016 APPLICANT CERTIFICATION CONSTR;CTTON LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit s Issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 01/27/2016 . --� ' PERMIT APPLICATION ~�`�"�~=" "�~°~" °"~~.. , ! CDMMUN�YDE\DELOPMENTDEPARTMENT^8U�O�GDK/�|*N iv- 1O3UUlTURREAVENUE^CUPER�No.CAQ5O14�255 B �� ~�----~� (4V8)777~%Z18^FAX(408)777�333,&uUV�p0ruper n�orq CUPERTINO ~ ~- 1 C3 t6 - x 2* 6 CONSTRUCTION 0 ��u��rurw/o [ nEvz�oN/Ds:sRna^ ORIGINAL x _ - 'ROJscr^oD«o« _ rwxwSTEVENS rxoocupD Mm APm* 369*i-1DR ~~� OWNER NAME PROMETHEUS REAL nmzTECROUP 'oM' ^m-873-01:1 EMAILMLOPP2(4PROMITPI IBITSRE0 COM STREETADDRESSo�nonmcmum�uummm r�� ZIPoormm��o^�m� FAX , , CONTACT NAME xvoma +auL � LILIAN -108-370,0110u^�ox -108-370-108-370,0110^ ~ -----_------ — STREET ADDRESS'nmrisuE,sTxcm, . CITY.STATE.or CAMPBELL,o^so08 FAX Q ^�y�'� On��m 0 DEVELOPER �r�� Omm� Oo�� O �m�A�� u�cmn��m umy�^�^��' -__-__-- ' _�' _ ___ _ -__-_-_---_-_ ______�__- _-______ CONTRACTOR mxms LANCE OIDELLICENSE NUMBER LICENSE z 403050 a COMPANY NAME. E-MAIL FAX mDEL mnoc^LCONSTRUCTION,INC ~--=------- – STREET ADDRESS 514E)IVISION STREET CITY,STATE,ZIP o^m�*o^c^,nw ru«mn^� »r*«�^ _ ARCHITECDENGINEER NAME LICENSE NUMBER EUS.I IL , . / ^ coaP^mrnmmu &mwL 13^X STREET ADDRESS CITY,STATE,ZIP PHONE ____' DESCRIPTION OF WORK INSTALL AGLASS DOOR^zTENANT LOBBY,SUITE 700 __, � --� xr �-nr�, �~ / x�� ' _.~\~ ' • �~=G=° PROPOSED��- CONSTR. USE OFFICE EXIST° NEW FLOOR DEMO IOTA I, 1111111111111111. ARRA so AREA 0 AREA 0 NET AREA 50 BATHROOM KITCHEN OTHER REMODEL AREA °~~.~~~.~~ REMODEL AREA PORCH AREA 1 DECK AREA TOTAL~~~~~~`~~E~ GARAGE AREA: Et---, -i,DWELLING UNITS: IS A SECOND UNIT El YES SECOND STORY 0 YES BEING ADDED? 0 NO ADDITION? 0 NO ,didiallippl"----*-11111Pr. OYES IP YES, OF STIP:BLDG—N 0 YES��m^,� MANNING APPL# ONO PLANNING APPROVAL LErrtlt EICELER DOME? . ______� tiles . By my signature below,1 cell*to each of the following: I am the paipmly owner or authonzed agent ,,,act o,..otr7 'open),owner's beilialf,liiI bye r7 application and the infornaation I have provided is correct. I have read the Description of Work and veri, •""ace rat.. I agi‘ei.,to Lomp y wi, ,a app i(cal local , ove dr:imbed rty for inhpection purposes. . ordinances and state laws relating~ *ling construction._-- a—tho � ' | � ' v � - � Date: . `~ � Sixv^ �oc»p�o�mxm�t ue� - / New SED or IVIultifamily dwellings: Apply for demolition permit for fiC-PiElliWiearallial.rNtiO:ka:3.:qi--1714g7nritilt ftafIE:14-Mr4-t.+2;15 Commercial Bldg& Provide a completed Hazardous Materials Disclosure VLAU:f.-0410.iti- ,,,I.:P:Wig..1'Ac.:1,3f..0:141-03%.4:...WESIAS02:::i form.any Hazardous Materials being used as- art of this project. gariiiiaNigERtgariii 0:1140:020--AggS-Z-Rag . submittal Copy of Building Permit application. ~ ~ * ~~- °~=�^ '_~^________-_-_� BldwIpp_201.doc revised 06/21/11 ,