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13060104I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20300 STEVENS CREEK BLVD OWNER'S NAME: SVF CUPERTINO CITY CENTER CORP OWNER'S PHONE: 4083933929 L'r LICENSED CONTRACTOR'S DECLARATION License Class 8 Lic. # Contractor 44-Y-5: L -It Date_ 1 hereby affirm that 1 am licensed under the provisions of Ch pter 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: 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. APPLICANT CERTIFICATION 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, 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 rega ions er the Cupertino Municipal 'de, S coon 9.18. � � f Signature Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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. Date CONTRACTOR: DEVCON PERMIT NO: 13060104 CONSTRUCTION INC 690 GIBRALTAR DR DATE ISSUED: 06/12/2013 MILPITAS, CA 95035 PHONE NO: (408)942 -8200 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALID APPLE- 3RD FLOOR (E) WING- CONVERT OPEN SPACE INTO (2) OFFICES Sq. Ft Floor Area: I Valuation: $15000 APN Number: 36901019.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA F OM LAST CALLED INSPECTION. Issued by: Date: (fi 1.2. l3 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. Signature of Applicant: Date: 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 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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2$50.5, 2553,3, and 25534. �! Owner or authorized agent: Date: h 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 Ad ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO I/JI FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These Pees 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 Efl: 7111121 20300 SCB DATE: 0611212013 REVIEWED BY: MENDEZ PAADDRESS: APN: BP #: l3�% ;D�C% 'VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building 0.0 PENTAMATION PERMIT TYPE: 1GENC0 WORK APPLE- 3RD FLOOR- CONVERT OPEN SPACE INTO 2 OFFICES SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These Pees 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 Efl: 7111121 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? © Yes (D No $0.00 1 hours Plan Check, Hourly $133.00 ISTPLNCK Suppl. PC Fee: e) Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 -FT fir�i�ristrr err e irr: Q Work Without Permit? © Yes 0 No $0.00 Advanced Planning Fee: $0.00 ® hours Inspections $532.00 ISTINSP Inspection, Hourly E) xGr�,�l l ?o� trFK7,��iral�rxr� l�crc^: Strong Motion Fee: IBSEISMICO $3.15 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $4.15 $665.00 TOTAL FEE: $669.15 Revised: 04/29/2013 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 ' (408) 777 -3228 • FAX (408) 777 -3333 • buildingPcupertino.orq CUPERTINO 0U 1� ❑ NEW CONSTRUCTION ❑ ADDITION M ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS I APN # j iL� 1 Q 1 U 1 Ci .„ c c 54veA-�, 'IM„., re' %, %,,A.- ✓ OWNER NAME �"T- � �� PHONE - W E-MAIL 9 #°F 0"'f JO STREET ADDRESS � � ' CITY, STATE, ZIP 6&AX . CONTACT NAME �� „., �� PHONE E MA STREET ADDRESS ( '" CITY, STATE, ZIP AX „ ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT [?�-CONIRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME > �; LICENSE NUMBER LICENSE TYPE BUS. LIC # m el COMPANY NAME ,pro - ”" " " " " "m "�" E -MAIL �� c FAX STREET ADDRESS a I CITY TATE, ZIP ��.. PH NE w Y ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # , COMPANY NAME E -MAIL FAX &04 STREET ADDRESS " CITY, STAT P PHONE DESCRIPTION OF WORK }} EXISTIN IUSE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT, VALUATION ($) 0 e� EXISTG AREA �': °"'" "" NEW FLOOR AREA r ,�^'°"" DEMO �,,•�, AREA TOTAL p J NET AREA �,"'"....... BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY [] YES BEING ADDED? E3 No ADDITION? ❑ NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIV I3 f ". TOT VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO L By my signature below, I certify to each of the following: I am the property owner or authorized ag t to act on the property owner's behalf. I have read this the information provided I have provided Is correct I have read the Description of Work and erify it is accurate. I agree to comply with all applicable local la c S ruco relating g" Q+t ordinances and state laws to u ,ti" nY� I authorize representatives of Cupertino to enter the above identi ed property for inspection purposes. . ordinance of A A enlon Signature Date: g SUPPLEMENTAL RAC QUIRED., PLAN CHECK TYP ", ; ;i t, .� . RQifTINGST IF" New SFD or Multifamily dwelhn s :Apply for demolition permit for g — existing building(s). Demolition permit is required prior to issuance of building OVER THE - COUNTER ❑ >IUILDING PLAN REYLEW permit for new building. EXPRESS ❑ PTANiNGyLiNtRgyIE ',,��`," Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Li STANDARD ❑ rusLlcwoRrc ;, i t iii form If any Hazardous Materials are being used as part of this project. i� r %✓ ;; er %" ��i� �� , ❑ LARGE O FHtE DEPTr , /�! rd , � y Copy of Planning Approval Letter or Meeting with Planning prior to �,, ❑ MAJOR ❑ SANITARY5hWEIjDISTRICT submittal of Building Permit application. ❑ `ENVH2ONMENTAI EiEALTH ` i'" B1dgApp_201 Ldoe revised 06121111 . C6 I