B-2017-0300CITY OF-CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0300
16 RESULTS WAY CUPERTINO, CA 95014-5924 (357 20 041)
BARRON BUILDERS
INC
SANTA CLARA, CA
95054
OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET AL
DATE ISSUED: 02/23/2017
OWNER'S PHONE: 408-499-0223
PHONE NO: (650) 964-4493
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Ja Lic. #916366
Contractor BARRON BUILDERS INC Date 07/31/2017
X BLDG —ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH _ RESIDENTIAL X COMMERCLAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
APPLE (CAFE 1 ST FLR) REPLACE/ENLARGE (E) GAS LINE FROM 1
I hereby affirm under penalty of perjury one of the following two declarations:
1/2" TO 2" FOR EQUIPMENT REPLACEMENT
t. 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
�, z performance of the work for which this permit is issued.
V�e l 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: $15000.00
permit 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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
357 20 041
A (Tenant Improvements)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 1 -4I� PST TSSUANCE�OR_
Additionally, the applicant understands and will comply with all non -point
-5 --
source regulations per the Cupertino Municipal Code, Section 9.18.
18 AYS FROM -L INSPECTION.
SignatU Cre Date 02/23/2017
Issued by: LISSAl
Date: 02/23/2017.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (See.7044, Business & Professions Code).
Date: 02/23/2017
I hereby affirm under penalty of perjury 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
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code; for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
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 Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 255 , 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
,
be deemed revoked.
Owner or authorized agent:` /
APPLICANT CERTIFICATION
Date: 02/23/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
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 is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 02/23/2017
Professional
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
'S 110300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERT1140 (408) 777-3228 • FAX (408) 777-3333 • buildina(mcupertino.oEg MISC
PLUMBING FIMECHANICAL FJELECTRICAL MISCELLANEOUS
PROJECT ADDRESS
APN #
OWNERNAME n f �/� (� •
. t , -
PHONE L4 /
STREET ADDRESS
CITY, STATE, ZIP UmAi V, CA q,�Ul
FAX
CONTACT NAME ��j �f�
C
`VyyAM0
PHONE f, � ��I
E-MAILKf�i2tSMRLV�rrAn(�,tl/
t
STREET ADDRESS � � /'j/� f n, D&I�
tT
CITY, STATE,,zS�ft//''��/CIC#g
FAX
❑ OWNER ❑ OwNER-BUILDERI\�l/"/'❑3 owNERAGE d CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARemmer ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �}WJ ICENSE NUMBER LICENSE TYPE
COMPANY NAMErl EMAIL
//--�� ���yyy 9
STREET ADDRESS,;? � CITY, STATE, ZIP l /q 4fa / •/�� a OA
t ��({✓�J 1 �/' (�(�
BUS. LIC # �)
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
EMAH
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑SFDorDUPLEX ❑ MULTI -FAMILY
BUILDING: �O vIMERCIAAL
PROJECT INWH.DLAND ❑ YES
URBAN INTERFACE AREA arwoOOD
70CTIN JE❑YES
ZONE
ISTHEBLDGAN ® YES
EICHLER HOME? ®k("—
DESCRIPTION OF WORK
Ike fa Itkyl 41A.
TOTAL VALUATION: '� RECEIVED HY:
By my signature below, I certify to each of the following: I am the property owner or auemlo4ff on the property owner's 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 tocomplywith all applicable local
ordinances and state laws relating t�'c ' I au orize representatives of Cupertino to enter the above -identified
Signature of Applicant/Agent: Date: / p�mspection purposes.
SUPPL ORMATION R QUIRED
vs c aidry
�
� OYER'>'1HE-CiSilkv 1�ER.
�
L� EXPR�S
�
� STANI)ARI3
7rSR�
'CQ I4ltxaoli:; `
MEPMiscApp Z011.doe revised 06/21/11
� a
County of Santa Clara
Department of Environmental Health
Consumer Protection Division
1555 Berger Drive, Suite 300
San Jose, CA 95112-2716
(408)918-3400 FAX (408)258-5891
www.EHinfo.org
February 16, 2017
BARROM BUILDERS PROJECT NUMBER: SROSS3040
Attention: Karen Frierson PROJECT NAME: RW16
2346 CALLE DEL MUNDO PROJECT ADDRESS: 16 RESULT WY
SANTA CLARA CA 95054 CUPERTINO
Dear Ms. Frierson:
The drawings for the above noted remodeling project have been reviewed and approved by this department, subject
to the following conditions:
I. All existing equipment, facilities or finishes that will remain shall be evaluated and approved on a case-by-case
basis during on-site construction inspections. Equipment or finishes not found to be in compliance will not be
accepted.
2. All construction must be completed according to the approved plans. Contact our office for review and approval
for any changes to the approved drawings, including structural and/or equipment changes.
This approval shall expire by limitation and will become null and void if the construction, reconstruction, alteration, or
other work authorized by this approval is not_commenced within 180 days from the date of approval.
Please retain one copy of the approved drawings on the job site. A FOOD FACILITYCONSTRUCTION CARD has
been attached to the job copy and must be posted, with the other building permits. Present at least two (2) copies of
the drawings to your local building official for the required permit application and approval. Any change to the
drawings as a result of reviews by other jurisdictions must be brought to the attention of this
department as soon as possible to avoid construction delays.
Please be advised that you are responsible to contact this office to arrange a construction inspection before
rough plumbing signoff, installation of equipment, and upon completion of the project. You will also be asked to
submit a mechanical exhaust system performance test, if such a system is present, before we can
finalize the project. The original submittal fee(s) includes up to two (2) inspections. Additional fees may apply to
any further inspections or site visits. In the event the project is not ready for a scheduled inspection, please provide
at least 24 hours advance notice toavoid additional charges for canceled inspections/missed appointments. The Final
Inspection for the projectcannot take place until the balance for all Plan Check -related work is PAID
IN FULL. Failure to meet this%these requirement/s will result in the cancellation of the Final Inspection. Please note:
Rescheduling will be subject to availability.
All food handlers are'requir''ed to' in a food handler card within thirty (30) days of hire (with certain exceptions).
Contact this Department for more information.
If you have any further questions or would like to call for an inspection appointment, please contact the Department
at (408) 918-3471, between 8:0,0 a.m. and 5:00 p.m., Tuesday through Friday.
Very truly yours,
Fred Kieu, REHS
Senior Environmental Health Specialist
Plan Review and Construction Unit
Board of Supervisors: Cindy Chavez, Mike Wasserman, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith