B-2016-3156CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3156
10815 N WOLFE RD STE 105 CUPERTINO, CA 95014 (316 05 056) ALLIED
CONSTRUCTION
BUILDERS INC
OWNER'S NAME: CUPERTINO VILLAGE LP
OWNER'S PHONE: 310-279-0088
III 11"All-141 %W -11k,111 11Vs to14 V 09
License Class a Lic. #q,$;IM
Contractor ALLIED CONSTRUCTION BUILDERS INC Date 09/30/2017
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:
L 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 ofthe work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
erection 3700 of the Labor Code, for the performance of the work for which this
e- pe�nm#is issued.
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
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, costs, and expenses which
may accrue against said City in consequence of the 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.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 1, 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)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
[ hereby affirm under penalty of perjury one of the following three 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.
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.
3. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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, costs, and expenses which may accrue against said City in
consequence of the 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 2/15/2017
MOUNTAIN VIEW, CA
94043
DATE ISSUED: 02/15/2017
NO: (408) 440-6168
PERMIT INFO:
BLDG —ELECT —PLUMB
MECH _ RESIDENTIAL X COWYIERCIAL
JOB DESCRIPTION:
UNIT 105; T.I.- DINING AREAAND COOKING EQUIPMENT (1150
S.E.) - GOGIGO
Sq. Ft Floor Area: ( Valuation: $60000.00
APN Number: Occupancy Type:
316 05 056 1 A (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Ab4 —A ey nde
RF RQOFC
All roofs shall ba 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.
Signature of Applicant:,
Date: 2/15/2017
TO BE
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
/)
Ow=ner or authorized agent°7-'���"`�
Date: 2/15/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCUMCT'S DECLAARAIM
I understand my plans shall be used as public records.
Licensed
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 96014-3255 B
CUPERTINO
(408) 777-3228 - FAX (408) 777-3333 - buildingp—cupertino.org
DMWCONSTRUCTION MADDI-1710N ��TERATMN/n F� RF-VlSl0N/DFFFRRP.T) 0RT6TXAT.PRRM1Tfi
PROJECT ADDRESS i0v s �0," wo (At 105
Ap", ,?)I U -
OWNERNAME �j, "
PRONE 3t 0
STREET ADDRESS
/1) Ida
CITY, STATE, ZIP0 1
FAX
CONTACT NAMSPHONE
(E-MAIL j
--�'t6Or-Z-1
e-eob
'
U
STREEIADDRE
s7o Ave-
CITY, STATE, ZIP
sopl"�- 105"
6 (W
0 OWNER 0 OWNM-13VILDER 11 OWNBRAOFNT 171 CONTRACTOR El CONTRACTOR AGENT 171 ARCHITECT 1771 ENGINEER 1:1 DEVELOPER 1:1 TENANT
CONTRACTOR NAMEm
ftp
LICENSE TYPE
Bus. LIC 294?v
E. %
COMPANY E.
'DCA--'&,& 6 kis,
F -MAH, -N I
FAX
STREET ADDRESS
CITY, STATE, ZIP I
P14ONB
i. 711
ARCHITECTISNGIWFF.RNAMB f J
11CBNSENUMBER r
E�42-5
BUS. 111C 6
COMPANY NAME
E-MAIL
FAX
STREETADDRESS
CITY, STATE, ZIP
P"C"VO (o 6 7S
DESCRIPTION OF -WORK
ul
EXISTING"'
-IUSE
z- I17
PROPOSED USEA.ONSTR.
-DEMO
TYPE
-o
#STORMS
I
TYPE
OCC.
SQ.Fr.
VALUATION
EXISM
AREA 2�04,j
NEW FLOOR
1 AREA —
AREA o
TOTAL
NETAJWA;�96 7
BATHROOM KITCHEN
MIODM,AREA REMODELAREA
OTHER
RFMODFLAREA
PORCH AREA
I DECK AREA
I TOTAL DECWORCII AREA
GARAGE AREA: EIDETACH
n ATTACH
4 DWELLING UNr17S:
ISA SECOND UNIT Cl YES
SECOND STORY OYES
RIONGADDEM? I0
ADDITION? 1wN0
PRE -APPLICATION DYES IF YES, PROVIDE COPY OF
PLANNINOAIIPL# R" PLANNING APPROVAL LFTrER
ISTHEBLDGAN [] YES
EICIIIAM ROMP? NO
L VALUATION:
'0� By my signature below, I certify to each oftho following: I alli the properly OWnor or authorized a 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 j1n9ldjp_g construction. I authorize representatives of Cupertino to enter the above-idqntified prop-av for inspection purposes.
bate-
Signature ofApplicantfAgent:
SUPPLEMENTAJ!�19FORMA-nol\T REQUIRED
CKTYPE,
-5 _0 -
b
Nen SF) or Multifamily dwellings. Apply for demolition permit for
exi•sting building(s). Demolition permit is required prior to issuance ofbui 1 119
----- -----
P exmit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials DisolosIlTe
E;
?b—nn ifany Nazardous Materials arebeing used aspartofthis pi-Qjoct.
k..
:;4
J.,
Copy of lanning Approval Letter or Meeting with Planning prior to
iubmittal of Building Permit application,
IV
BldgApp_2011.(Iocrevised 06121111
rnvxvv',� 5*Aevice*
CITY OF CUPERTINO
Finance Department • 10300 Torre Avenue • Cupertino, CA 95014 • (408) 777 - 3221
BUSINESS LICENSE CERTIFICATE
CONTRACTOR
ACE PLUMBING _
1616 FOXWORTHY AVE
SAN JOSE, CA 95118
PLEASE DETACH THE BELOW LICENSE CERTIFICATE AND PLACE IN A CONSPICUOUS PLACE ON BUSINESS PREMISES
This license has been paid and issued in accordance with the Cupertino Municipal Code, for the specified business location. For questions
or further assistance, please see our website at www.cupertino.orQ or call the City Cupertino Business License Clerk at (408) 777-3221.
LICENSEE NAME: ACE PLUMBING
BUSINESS NAME: ACE PLUMBING
BUSINESS ADDRESS: 1616 FOXWORTHY AVE
SAN JOSE, CA 95118
BUSINESS PHONE: (_408) 605-9754
BUSINESS EMAIL:
LEGAL STATUS: SOLE PROPRIETOR
FEDERAL TAX ID:
421555100
STATE TAX ID:
4818723
LICENSE NUMBER:
403091
EFFECTIVE DATES:
-4/3/2017 to 4/2/2018
TOTAL PAID
$137.00
CUT ALONG DOTTED LINE
---------------------------------------------------------------
CITY •OF CUPERTINO
BUSINESS LICENSE CERTIFICATE
NOT TRANSFERABLE
CUPERTINO
CONTRACTOR LICENSE
BUSINESS LICENSE #403091
ACE PLUMBING
1616 FOXWORTHY AVE
SAN JOSE, CA 95118
EFFECTIVE DATE: 4/3/2017 EXPIRATION DATE: 4/2/2018
THIS LICENSE IS ISSUED. IN ACCORDANCE WITH CHAPTER 5.04 OF THE CUPERTINO MUNICIPAL CODE AND DOES NOT SANTION ANY BUSINESS ACTIVITY OR USE OF PERMISES WHICH ARE IN VIOLATION
OF FEDERAL, STATE, OR LOCAL LAWS. THIS. LICENSE IS ISSUED WITHOUT VERIFICATION THAT THE LICENSEE IS SUBJECT TO OR EXEMPT FROM LICENSING BY THE STATE OF CALIFORNINA.
DIRECTOR OF ADMINISTRATIVE SERVICES
BUSINESS LICENSE MUST BE DISPLAYED IN A CONSPICUOUS PLACE ON THE PREMISES OR VEHICLE
l Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone 408-777-3228
CONTRA
Fax: 408-777-3333
JOB ADDRESS:
4- Fax:
/ SUBCONTRACTOR LIST
lG��' .
OWNER'S NAME: ®P�
n® or PERMIT #-. ®lV-�
GENERAL CONTRACTOR: PHONE #'�7
4�fie% INESS LICENSE #
ADDRESS::t "4
`f- � e, v% CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(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:
Please check applicable
i
Owner / Contractor Signature
Signature =
and complete the following information:
Date