14090046CITY OF CU PlERTINO BUILDING 1P]ERIN]T
1411LDING ADDRESS: 20111 SPL'VENS CREEK 13LVD I CONTRACTOR >4 PERMIT NO: 14090046
03NF,R'SNAME: TRANS - CON "INBN1ALREALIS "A "I IN VS I /�� (I 4- &1),1 DATE ISSUED: 09 /09/2014
OWNER'S PlION'F,: 4087300808 I , PtioNE No:
❑ LICENSED CONTRACTOR'S DECLARATION
License class C .ic. X
Contractor class
r- p e6fs. Date /
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Codc and that my license is in full force and effect.
BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB F-
r
MECH n RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: RI:MOVI:CARPHI'& INS' fALL 'I'ILI;A "I'•I'l-ii3EX "1'ERIOR
I3ALCONY.1-1I1GRADE ALI. DOOR THRESI (OLDS TO COMPLY
W /A DA
I herchy affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to sell' - insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performancc olthc work for which this permit is issued.
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 Sq. Ft Floor Area: Valuation: $35000
permit is issued.
APPI,ICAN 1' CER "I'IFICA7'ION
I ccrtily 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 ol'Cupertino against liabilitics,judgmenls,
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 t� Cupertino Municipal Code, Section
9.18.
Signature 414 f Date
❑ OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's I..icense Law for one of
the following two reasons:
I. as owner of the properly, 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,
13usincss & Professions Code)
L as owner of the properly. am exclusively contracting with licensed contractors to
construct the project (Sec.7044, 1usiness & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
performance of the work for which this permit is issued.
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
permn is issued.
1 ccrtifv 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 ccriilicate of exemption, I
become subject to the Worker's Compensation provisions oi'the Labor Code, I most
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I ccrtily 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 stale laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned properly 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
Willi all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature
Date
APN Number: 31623026.00 1 Occupancy "Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 O YS 1D NSP EOTION.
o �
Issued by: Date:
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a root' is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature ol'Applicanc Dale:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Llcalth & Safety Code, Sections 2.5505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Nlunicipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) should 1 store or handle hazardous material.
Additionally, should 1 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
Ilealth & Safety Code, Sections 25505, 25533, and 25534.
Owner o horircd a 0 4 ,%
t. Date. T-1 6G 1
CONSTRUCTION LENDING AGENCY
I hereby aft inm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
bender's Name
Lender's Address
ARCLIITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professiona
CCUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255
(408) 777 -3228 ^ FAX (408) 777 -3333 ^ build ingl a)cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION / DEFERRED
ORIGINAL PERMIT #
PROIECT ADDRESS ?10 ��� � � Nve�
APN # ^3 p
I
OWNER NAME �ngV�1
PHONE4a_ JiJ ®l ,Do
I4ZIIPP
E -MAIL
STREET ADDRESS io . � A An
CITY, STATE, /9 ti yA 0 � Q '9 ems
yv�'1 ` iE-MAIL. ��'(�l�ult�'
FAX
CONTACT NAME °,P�,�'1yy �UVt
,9
PHONE
�'I®
4t G) A lay' atD%4-
STREET ADDRESS �g'�.�®j®
CITY, STATE, ZIP �A
FAX
❑ OWNER 11 OWNER-BUILDER 11 OWNER AGENT 13 CONTRACTOR 13 CONTRACTOR AGENT IR ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME � U ry � 1 �
(J
LICENSE NUMBER
LICENSE TYPE
BUS. LIC # 3 [7 1703
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME �rA.l�
LICENSE NUMBER C —
BUS. LIC#514
COMPANY NAME o n /,�_ - P °Q- q
V 60
E-MAIL ° �IAz�p V��. _A s
FAX
STREET ADDRESS f _ _• Za�G•�
tnl
CITY, STATE,VZIIP C /a�� f
(/VA 1
PHONE
DESCRIPTION OF WORK
1 t o.1l +o a,,)[ A P A-
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
l
BATHROOM
REMODELAREA
KITCHEN
REMODELAREA
OTHER
REMODELAREA
�1 "" �•�� ''SS��
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES
BEING ADDED? []NO
ADDITION? NO
PRPAPPLICATION []YES IF YES, PROVIDE COPY OF
ISTHE BLDG AN YES
RE EIVE BY:
TOTAL VALUATION:
PLANNINGAPPL# []NO PLANNING APPROVAL LETTER
EICHLER HOME? 0 N
®�®
By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf 1 have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to building co stnrction. I au prize representatives of Cupertino to enter the above- identified property for inspection purposes.
Signature of Applicant/Agent: Date: q f I l
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER- THE - COUNTER
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doe revised 06121111
F"—, W CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 20111 stevens creek blvd
DATE: 09/09/2014
REVIEWED BY: larrys
PC FEE ID
APN:
BP#:
VALUATION: 1$35,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
Other Vec. lnsp. Ll
PENTAMATION
PERMIT TYPE: B TA
WORD
remove car et and install tile at the exterior balcony.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II- 6,111- 6,IV,V -B
:?�1::'r i i, rn i`+l •
$0.00
Other Vec. lnsp. Ll
$0.00
l'llllll" . hisp, /ve-
1.1h;(. Insf ,. Fee.
Permit Fee: Hourly Only? ()Yes (F) No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Ll
TOTALS:
0
$0.00
$0.00
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY 0 Yes Q No
PG�ir(71,',
01110 l'luu('ht "'.4
Ele(% Flan Check
1) •Tlllil F c"
Plunsh. P %r„:;r l'r,r
Flec Perntir Fee
:?�1::'r i i, rn i`+l •
0i"Ier 1,111apb ln.tl'
Other Vec. lnsp. Ll
4r!li. hop 1,'r:
l'llllll" . hisp, /ve-
1.1h;(. Insf ,. Fee.
NOTE: This estimate does not include fees due to of /ter 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 (&e Resolution 11 -053 Ef. 711113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes) No
$0.00
F__27 hours Plan Check, Hourly
$286.00 ISTPLNCK
Suppl. PC Fee: E) Reg. 0 OT 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ()Yes (F) No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Ll
0
0
Work Without Permit? ® Yes (D No
$0.00
Advanced Planning Fee:
$0.00
hours Inspections
$286.00 ISTINSP Inspection, Hourly
G
0oceri;rewatio;q I�ce s:
Stron. Motion Fee: 1BSEISMIC0
$9.80
Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$11.80
$572.00
TOTAL FEE:
T
$583.80
Revised: 0812012014
CUPERTINO
UNREASONABLE HARDSHIP EXEMPTION FORM
COMMUNITY DEVELOPMENT DEPARTMEN U ft: 1W AV
ALBERT SALVADOR, P.E., C.B.O., BLIILDIN O I ,�
10300 TORRE AVENUE • CUPERTINO, CA 95 4 -3 55 U T
(408) 777 -3228 ° FAX (408) 777 -3333 ° building(a cupertino.orq
For Tenant Improvements where the Cost of Construction does not exceed $139,934.00
SITE ADDRESS
d 20110
APN
BP#
CITY
ZIP �� l�$
TOTAL CONSTRUCTION COST Ag $ .... ® .......................
�l�.I...
DESCRIPTION OF WORK: acq p&tU v car e-+ oLt � Rao, lord m VJ 04
L(� -F) 5, -
The following is a list of costs to provide access features in order to comply 100% with the current State Title -24 Disable Access Standards.(AII
costs to be documented by actual bids or other information accepted by the Building Official.)
Accessible Features
Complies with
If not, list required upgrades in order for
Cost to make feature
Description of access features to be provided:
current standardsq
features to fully
comply?
fully
accessible?
1. Path of travel to accessible entrance.
$
2. Cost of providing a primary entrance. (Including but
not limited to, thresholds, landings, door hardware,
'Ire
max. door pull, etc.
3. Cost of providing the primary path of travel to the
r;1 —eWD r
V% s 40 b-t-
specific area of alteration, structural repair, or
$
,OOP OLWD
addition.
4. Cost of providing accessible restroom facilities.
$
5. Cost of providing an accessible drinking fountain. (If
BY
required or if a drinking fountain is provided.)
6. Cost of providing accessible public telephones (if
$
provided)
7. Cost of providing other accessible features, including
c6ov wr g
$
,31mo
but not limited to, parking, storage, alarms etc.
10 CO ,�
VJJ 62A
TOTAL COST
AF ACCESS FEATURES (Bj:
$
Lo 31 Do
Has the same tenant performed work in the
same tenants ace within the last three ears?
� -7-
Calculate (B / A) x 100 °I°
y/
Description of access features to be provided:
Vve W11 119va4e all doa- tNKsk bW 6ki .rza -y- eIevaict, wo&t 9 he
TOTAL COST OF
PROPOSED UPGRADE
$ 3 X/°
i 00
PERCENTAGE (20% minimum
expenditure is required)
°
ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify that the above n ted information is true and correct. t�
Name (print): ln.o� Si�glLnature: Date: -u /9 I/
Firm address: 20U)Q 'C A&-,S Gfe�e �� 1 �® Title: Pl rV- d P!�L B Phone: - °' ®s' 10 I
Y� ° -- FOR DEPARTMENT USE ONLY
❑ The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 11348.2.1.
❑ The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR -Title 24
(Regulation for the Accommodation of the Disabled) pursuant to 2010 CBC Section 1134B.2.1.
COMMENTS:
Building Official Designee (print): �° "�e�� -� 59 � rs�tu1: —( A--::: Date:
2012.doc revised 10Y17113