14090196CITE' OF CUP ERTINO BUILDING PERMIT
BUILDING ADDRESS: 10411 BUBB RD
CONTRACTOR: SC BUILDERS INC
PERMIT NO: 14090196
OWNER'S NAME: M WEST PROPCO 11 LLC
910 THOMPSON PL
DATE ISSUED: 12/03/2014
OWNER'S PHONE: 4084503854
SUNNYVALE, CA 94085
PHONE NO: (408)328 -0688
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
SITE IMPROVEMENT TO ADD LANDSCAPING AND
License Class # -1(b'? 1C( (@
MODIFY
Contractor C� 1,
1e3JG', Date I}
ACCESSIBLE PATH OF TRAVEL.
.aL.�.ttL.T3�S
1 hereby affirm that 1 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 have and will maintain a certificate of consent to self - insure for Worker's
Compensation, as provided for by Section 3700 ofthe Labor Code, for the
Sq. Ft Floor Area:
Valuation: $75000
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 ofthe Labor Code, for the performance ofthe work for which this
APN Number: 35720010.10411
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN ®�+ PERMIT jl�.��AN�E' ®I(<;
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
1801DAYS F M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
�2,
granting of this permit. Additional) . he applicant understands and will comply
Issued by: Date:
with all non -point source regulatio s per Cupertino Municipal Code, Section
9.18.
Signature Date�� f �t
RE- ROOFS:
All roofs shall be inspected prior to any rooting material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
❑ OWNER- BUILDER DECLARATION
Signature of Applicant: Date:
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 have read the hazardous materials requirements under Chapter 6.95 ofthe
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
1 have and will maintain a Certificate of Consent to self- insure for Worker's
material. Additionally, should 1 use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance ofthe work for which this permit is issued.
will maintain compliance with the Cupertino Mullicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Se tions 2 5, an 25534.
Section 3700 ofthe Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date: i�
1 certify that in the performance ofthe work for which this permit is issued, l 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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. -
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
1 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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting ofthis permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
r- UPERTIN®
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE > CUPERTINO, CA 95014 -3255
(408) 777 -3228 > FAX (408) 777 -3333 • building )cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION EE1 ALTERATION/T1 ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10411 Bubb Road
APN #357 -20 -010
OWNERNAMEMWest Propoco II, LLC
PHONE 408-450-3854
F7MA7L
STREETADDREss3351 Olcott Street
CITY, STATE, ZIP Santa Clara, CA 95054
FAX
CONTACT NAME Bryan Carrera
PHONE408.727.6665
E- MAILbcarrera @kierwright.com
STREET ADORE
Scott Boulevard
CITY.
CITY, STATE, ZIPSanta Clara, CA 95054
FAx408.727.5641
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT N ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Greg B u rda
LICENSE NUMBER 767196
LICENSE TYPE B
BUS. LIC 124074
COMPANY NAME SC Builders Inc
EMAILgburda @scbuildersinc.com
FAX
STREET ADDRESS 910 Thompson Place
CITY, STATE, zrPSunnyvale, CA 94085
P "4,480- 328 -0688
ARCH ITECT/ENGINEER NAME Mark Knudsen
LICENSE NUMBER 75828
BUS. LIC #
COMPANY NAME Kier & Wright
E-MAIL mknudsen@kierwright. Corn
FAx408.727.5641
STREETADDRESS3350 Scott Boulevard
CITY, STATE, ZIP Santa Clara, CA 95054
P "°`408.727.6665
DESCRIPTION OF WORK
See cover sheet.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODELAREA REMODEL AREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
#DWELLING UNITS:
IS A SECOND UNIT OYES
SECOND STORY OYES
BEING ADDED? NO
ADDITION? [J NO
PRE- APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES
RECEIV BY-
VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
^ /
7AL
$75,000
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information 1 have provided is correct. 1 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 construction. 1 authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Si g natureofA pp Iicant/A g ent: Greg Burda y , September 29, 2014 Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTINGSLIP
❑
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OVER - THE - COUNTER
BUILDING PLAN REVIEW
permit for new building.
EXPRESS
71
1-A PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
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
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_20l l.doc revised 06121111
F"'r-'M CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
10411 Bubb Road
DATE: 09/29/2014
REVIEWED BY: Sean
MISC ITEMS
APN:
BP #:
`VALUATION: $75,000
~PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY
USE: Commercial Building
hrs
PENTAMATION
PERMIT TYPE: 1GENC0 i
WORK
Site improvement to add landscaping and modify accessible path of travel.
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -0.53 G . 7/1:131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? ® Yes (F) No
$0.00
1 hours Plan Check, Hourly
$143.00 ISTPLNCK
Suppl. PC Fee: Q Reg. ® OT 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee-.0 Reg. Q OT 10.0-1
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tca:
Fee:
p
E)
Work Without Permit? Yes 0 No
$0.00
Advanced. Planning Fee:
$0.00
0 hours Inspections
$429.00 ISTINSP Inspection, Hourly
Q
0'A
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICO
$21.00
1
Select an Administrative Item
Bldg Stds Commission Tee: IBCBSC
$3.001
SUBTOTALS:
$24.00
$572.00
TOTAL FEE:
1
$596.00
08/20/2014
717 '
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CONTRACTOR / SUBCONTRACTOR LIST
B uiRding Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 - 777 -3333
JOB ADDRESS:
SUBCONTRACTOR
BUSINESS NAME
PERMIT # 14C)9D 19 f)
OWNER'S NAME:
Cabinets & Millwork
PHONE # 1409 SZj7o65k
GENERAL CONTRACT M:
-jG
BUSINESS LICENSE #
ADDRESS:
CITY /ZIPCODE:
*Our municipal code requires all babsinesses working in the city to have a City of Cupertino "bunsiuness license.
NO BUILDING (FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UN'T'IL THE
GENERAL CONTRACTOR AND ALL SUBCON'T'RAC'T'ORS HAVE OBTAINED A CI'T'Y OF CUPIER'T'INO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
lHease check appllicabRe subcontractors and cornpllete the ToRlowing information:
(Date
d
9619!�z
Owner / Contractor Signature
//6.16
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
C 1�
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
9619!�z
Owner / Contractor Signature
//6.16
Date
T wa�l6 J
N05002a ;a-
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