15010106CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19620 STEVENS CREEK BLVD CONTRACTOR: SMI CONSTRUCTION PERMIT NO: 15010106
INC
OWNER'S NAME: EVERSHINE VI, LP 1595 MONTAGUE AVE I DATE ISSUED: 04/23/2015 1
OWNER'S PHONE: 4089301275 1 SAN LEANDRO, CA 94577 1 PHONE NO: (510)351 -3288
❑ LICENSED CONTRACTOR'S DECLARATION
License Class__ Lic. # 31 WBusiness& /
Contract Date i I hereby affirm that I am licensed u nder the prov(commencing with Section 7000) of Division 3 of tons
Code and that my license is in full force and effect.
affirm under penalty of perjury one of the following two declarations:
I ill maintain a certificate of consent to self - insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
erformance of the work for which this permit is issued.
hove 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.
s%, APPLICANT CERTIFICATION
I certify that I have read this application an ate that the above information is
correct. I agree to comply with all city county ordinances and state laws relating
to building construction, and hereby fhorize representatives of this city to enter
upon the above mentioned prope d-r! inspection purposes. (We) agree to save
indemnify and keep harm/io ity of Cupertino against liabilities, judgments,
costs, and expenses which rue ' mst s id City in consequence of the
granting of this permit. Ay e appli ant understa nds and will comply
with all non -point source per the Cupertino Municipal Code, Section
9.18. d I ,
JOB DESCRIPTION: RESIDENTIAL [J COMMERCIAL F]
SUITE 180 - SUPER CUE - TENANT IMPROVEMENT (1300
SQ FT).
Sq. Ft Floor Area: I Valuation: $16000
APN Number: 36906010.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 18Q ERMIT ISSUANCE OR
180 +RO CALLED INSPECT ON. -
i�
DA, - Z�
J RE- ROOFS:
All roofs shall be 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.
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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 (See. 7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & 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
permit is issued.
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
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Munici al Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) shoul store or handle hazardous
material. Additionally, should I use equip .ces which emit hazardous
air contaminants as defined by the Bay Ar Air Qua ty Management District I
will maintain compliance with the Cuper a' "-o
Code, Chapter 9.12 and
the Health & Safety Code. Sections 25 .255 and 254.
Owner or authorized agent:
Date:
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
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
V�
CONSTRUCTION PERMIT APPLICATION O
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O\
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 jam,
(408) 777 -3228 • FAX (408) 777 -3333 - building(a)cugertino.org
❑ NEW CONSTRUCTION ❑ ADDITION
ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
APN
6
l'�6 2 o S•Fc���S c:re�:.k P1��
OWNERNAME V ! �Lp
PHONE
Noz, )
E -MAIL
I�nt1Xr�Go Ld.-,
/
0- Z'1 '5
e�tdu
STREET ADDRESS P, (
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CITY, STATE, ZIP 1 FAX
CK .C( /Il�u C%4•
CONTACT NAME
�- ,.,� ;r, ✓r
PHONE
jio � ! °( -�! 'i j
E -MAIL
L� ..L.�t.'1•ar�:�n �. �b'�LI i►.u�r -�
STREET ADDRESS
<ys p,,�„rA e•e '7.y
CITY, STATE, ZIP
3�� Leur7�ro CA- -7q57'7
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT Q'CONIRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
£S31lEG
LICENSE TYPE
BUS. LIC #
7- 51
er ,
qZ
COMPANY NAME -r
S wl L Lo•� to G'Ft �n C
E -MAIL
�MT C(j!I% 1 L' TICJ�JU j� AFIOJ.[.B
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
595
Le�,O ro C.A' 9'(5 -7-7
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
�e - •�f'id.i� Q,.✓ C' �l[[� v'+ =,.L4' � � ,5�•na l f�v - -�� elcckr�u,�// (Q�c.7'+<n.
({,, JJ
hrr 10Ur
EXISTING USE
PROPOSED USE CONSTR_
TYPE
# STORIES
�C1r�wr- ^k
iZ&S�ak✓ ^n
5
j
USE
TYPE
OCC.
SQ.FT.
VALUATION(£)
EXISTG
„v(j.S'F
NEW FLOOR
AREA _�
DEMO
AREA -i 107-f
TOTAL
NET AREA [3,)o jT
,TL
R&,TL
R&
16 oup -vv
BATHROOM
KITCHEN
OTHER
'
REMODELAREA 'ri'
REMODELAREA r S f
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
�---
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
_
BEING ADDED? ❑TIO
ADDITION? r0
t
PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
EIVED BY- "
TAL VALUATION:
PLANNING APPL# []NO PLANNING APPROVAL LETTER
EICHLERHOME? �NNO
-
•
�
OOD.oU
By my signature below, I certify to each of the following: I am the property owner or authorized age o act o e er s behal . 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 appTi-0ible local
ordinances and State laws relating to building construction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: Date: i? O Z of 5
SUPPLEMENT ORMATION REQUIRED
Q
PLAN CHECK TYPE, -
ROUTING SLIP
El 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
❑ STANDARD
❑ , PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project
'
❑
_ Copy of Planning Approval Letter or Meeting with Planning prior to
LARGE
.'❑ MAJOR
FIRE DEPT�
❑. SANITARYSEVVERDISTRICT '
submittal of Building Permit application.
� �•-
❑,,.ENVIRONMENTALHEALTH :!
II.doc revised 06121111
C UPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 950143255
(408) 777 -3228 o FAX (408) 777 -3333 o buildina{a cupertino.org
n NF. W CONSTRUCTION n ADDITION n AI.TE,RATION I TI ❑ REVISION J DEFERRED ORIGINAL PERMIT # 15010106
PROIECT ADDRESS 19620 Stevens Creek Blvd Suite 180 Am 3 36 �1 -06-0/0
OWNER ""IF KCR Development
PHONE 408- 343 -1088
F-MAJI,
STREET ADDRESS 19620 Stevens Creek. Blvd Suite 200
CITY, sTATE.ZIPCupertino, CA 95014 F`
c0NTACT NAME Benjamin Ly
PHONE 510- 919 -4353 E-MAIL miconstructionusa yahoo.com
IT ADDRESS 595 Montague St
CrM STATE, ZIP San Leandro, CA 94577
FAX 510 - 351 -7910
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER ACENr ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEvELoPER. ❑ TENANT
CONCRACTORNAME Can Ly
LICENSE NUMBER 8831166
LICENSE TYPE B
BUS. LIC #
C0MPAN"NAMESMI Construction, Inc
E- M `ILsmiconstructionusa @yahoo.com
FAX 510 - 351 -7910
STREE'rADDRESS 595 Montague St
c", sTATE,z1P San Leandro, CA 94577
PHOIIE510 -351 -3288
ARCHITECT/ENGINEERNAt�¢ Raymond Situ
LICENSEN'UMBER 8831166
BUS.LICp
COMPANY NAME S M I Construction, Inc
E-MAIL smiconstructionusa @yahoo.com
FAX 510- 351 -7910
STREET ADDRESS 595 Montague St
CITY, STATE, ZIP San Leandro, CA 94577 1
PHONE 510 -351 -3288
DESCRIPTION OFwORK Replace plumbing and electrical fixtures. Re -paint and repair walls as needed.
EXISTING USE
Restaurant
PROPOSED USE CONSTR.
Restaurant
TYPE
B
I # STORIFS
1
use
TYPE
t]CC.
SQ.F r.
VALUATION (S)
PJOSTG
AREA 1,300 sf
NEw FLOOR
+ 1,300 sf
DE"0
AEt 0 sf
TOTAL
NET AREA 1,300 sf
Restaurant
1B
B
1,300 sf
$15,000.00
BATHROOM
REMODEL AREA 55 sf
KITCHEN
REMODEL AREA 590 sf
OTHER
REMODEL: AREA
PORLH AREA
DECK AREA
TOTAL DECKTORCH AREA
I GARAGE AREA DETACH
❑ ATTACH
# DWELLING UNITS:
1S A SF.(.'OND LTV1T C) YES
BEING ADDED? NO
®
SECOND STORY ❑YES
ADDITION? ®NO
PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # ® NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EIC ILER HOME? ® NO .
RECEIVED BY:, -
- -: _: , •:.
TOTAL VALUATION:
.. $15,000.00
By my signature below, I certify to each of the following: .I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: _ Date: 3/13/71
SUPPLEMENTAL IMRMATION REQUIRED
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
it for new building.
_ Commercial Bldgs:.P.rovide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project`iAxG$
_ Copy of Planning Approval Letter or Meeting with Planning prior to
subtnittal of Building Permit application.
PLAN CHECK TYPE
ROLTPiNG 9ISP''
❑ ovER iH ccsurR
C4�s?
O' ST
�;,
❑ `oR
ev
❑ ELII[ DING PLATT ltrvtEty
rLANlvrxt; PLAN L2EVIEw
Q• PViUC woRxs
❑ x>ia$ DFPr
❑ sArnTARV nLSrrucx
❑ RNVIRORfirEY1TAt HEALTH
BldgApp 2011.doc revised 06121111
F"_ft CITE' OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 19620 STEVENS CREEK BLVD
DATE: 01120/2015
REVIEWED BY: MELISSA
PC FEE ID
APN: 369 06 012
BP #:
- VALUATION: 1$16,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
IBTIPLNCK
PENTAMATION
PERMIT TYPE: 1 B T�
WORK
SUPER CUE - T.I. TO REPLACE PLUMBING AND ELECTRICAL FIXTURES
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
pc FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
11- 13,111- B,IV,V -B
1,300
$2,149.60
IBTIPLNCK
$1,271.60
IBTIINSP
t.lec. Insp, Fee:
$0.00
Permit Fee:
$1,271.60
Suppl. Insp. Fee:Q Reg. Q OT 0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
1,300
$21149.60
$1,271.60
MECH, HOURLY 0 Yes Q No
PLUMB, HOURLY Q Yes E) No
ELEC, HOURLY Q Yes Q No
;, t'..: C ,
l ;',rrul> , "lotr (;rrr• +;
Glee. Plaza C•1u�cl�
%, ,;'� '
l'lu,�;b P,•r-mu %���E:
F,IE�r. F,�rntit 1•e��'
Li
0 ;hvr Phanh l;7sr
Odle) 1.1(q. Insp, Lj
l,r.+l I ee
PJrouh. fuse. Cue-
t.lec. Insp, Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). 7hese.fees are based on the preliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Cff.• 711113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$2,149.60
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,271.60
Suppl. Insp. Fee:Q Reg. Q OT 0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
o;'' I'
0
0
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning .Fee:
$0.00
Select a Non- Residential
Building or Structure
E)
0
Stron2 Motion Fee: IBSEISMICO
$4.48
Select an Administrative Item
Bldg_ Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$3,426.68
$0.00
TOTAL FEE:
$3,426.68
Revised: 01/06/2015
'IV
CUPFR I�JOO
(CONTRACTOR / SUBCONTRACTOR ILffST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408-777-3333
*Our anunnic -p I coals req�unires ali businesses working in the to have a City off Cuflpertino business license.' s
NO BUILDING FINAL OR FINAL OCC�UPANC SPIECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CQ NTRACTOR AND ALL SUBC RS HAVE OBTAINED EID A CITY OF CUPERTINO
BUSINESS LICENSE. I am not using army su bcontractors: Ar
Signature 4ate
Please check applicable subcontractors And complete the following information:
d
t
]BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
-y _ ,►��_� ,. .- -�..: �r f,,� _
• D ..rte,: ����., �,__�_ raj
*Our anunnic -p I coals req�unires ali businesses working in the to have a City off Cuflpertino business license.' s
NO BUILDING FINAL OR FINAL OCC�UPANC SPIECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CQ NTRACTOR AND ALL SUBC RS HAVE OBTAINED EID A CITY OF CUPERTINO
BUSINESS LICENSE. I am not using army su bcontractors: Ar
Signature 4ate
Please check applicable subcontractors And complete the following information:
d
SU13CONTRACTOR
]BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
2. 1
/Date