1205009120400 STEVENS CREEK BLVD
12050091
CUPERTINO CITY CENTER
BUILDINGS
SCAN NED BOX #608
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR: GIDEL AND KOCAL PERMIT NO: 12050091
J OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 1574 DIVISION S[ I DATE ISSUED: 05/232012 1
OWNER'S PHONE: 4088730121 1 CAMPBELL„ CA 95008 j PHONE NO: (408) 370-0287
❑ LICENSED CONTRACTOR'S DECLARATION
License Class // Lic. A6& -3o
Contractor %l���f °!4� � 3_1 Datc_ '5'Z5' IZ
I hereby affirm that I am licensed under the provisions or Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I 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 performan=_aftlic work for which this
permit is issued.
APPLICANT CFRTI FICATION
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
❑ OWNER -BUILDER DECLARATION
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 (Sce.7044,
Business & Professions Code)
I, 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:
1 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 Penn it shall be deemed revoked
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 regulations per the Cupertino Municipal Code, Section
9.18.
Date
BUILDING PERMIT INFO: BLDG F ELECT r PLUMB f
MECH RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: CUPERTINO CITY CENTER - STI; 130 - COMMERCIAL.
TENANT IMPROVEMENT OF (2) EXISTING RESTROOMS (738
SQFT)
Sq. Ft Floor Area: Valuation: $150000
APN Number: 36901028.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
ED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
2 -
Issued bv: Date:
RE -ROOFS:
All roofs shall be inspected prior to any rooting material being installed. If a roof' is
installed without Post obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant
Date:
ALL ROOF COVERINGS "1'O BE CLASS "A" OR BETTER
IIAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Arca Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Ilealth & Safety Code, Sections 2.550.5, 25.533, and 2.5534.
Owncr or �cd g
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
ARCIIITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professiona
CURET
❑ NEW
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIV1SlON
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777/--3�22 FAM' 33 • b 'f+dii c ertino.or
4 ADDITION ALTERATION / TI ❑ REVISION / DEFERRED
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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PROPOSED USE CONSTR'
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USE
TYPE
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SQ -PT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO TOTAL
AREA NLTAREA
BATHROOM
KITCHEN
OTHER
REMODELAREA?,32
REMODELAREA
REMODELAREA
PORCH AREA
DE AREA
TOTAL DECKIPORCH AREA
I GARAGE AREA: DETACH
[]ATTACH
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# DWELLING UNITS:
ISA SECOND UINTT []YES
SECOND STORY
BEING ADDED? JO
ADDrrIONt O
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN LJYTS
RECEIVED Y: TOTAL VALUATION:
PLANNING APPL # ❑NO PLANNING APPROVAL LEITER
EICHLER HOME? NO24
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By my signature below, I certify to each of the following I am the property owner or authorized agent to act on the prpperty.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 accma.ta. 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.
Signatn a of Applicant/Agent Date:
SUPPLE AL INFORMATION REQUIRED
PLAN CHECK TYPE
ROOTING SLIP
❑ ov1 R -Ire comvTF.R
HUIIDINGPLANREVIEW
New SFD or Mul family 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
❑ PUSLICw0wo
_
form if any Hazardous Materials are being'used as part of this project
El LARGE
FM DEPT
_ Copy of Planning Approval Letter or Meeting With Planning prior to
El MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ M"TROtYMENTAL HEALTH.
11.doc revised 06/21/11
,#"YTZ7 !lT ��Ti9T YR��TfTAT//T
OCCUPANCY TYPE:
%_ILA A l9A �_UA A:JA®AIII Q\U
FEE ESTIMAT®R - BUIL,DING DIVISION
FIR AREA
SA
ADDRESS: 20400 Stevens Crk Rd DATE: 05/08/2092 REVIEWED BY: Sean
PC FEE ID
APN:
BP#: 0,57 17
'VALUATION: 1$150,000
*PERMIT TYPE: Building Permit
738
PIAN CHECK TYPE: Tenant Improvement
PRIMARY
Commercial Building
=1
PENTAMATION
113 TI
USE:
Suppl. Insp. Feer Reg. Q OT Q,Q hrs
$0.00
PERMIT TYPE:
PME Unit Fee:
$0.00
PME Permit Fee:
WORK
Tenant Improvement of 2 existing
restrooms 738 sq ft).
SCOPE
Administrative Fee:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FIR AREA
SA
PC ]FEES
PC FEE ID
BJP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
738
$1,936.00
1BTIPLNCK
$847.60
1BTIINSP
Elec. Imp. Fee:
Suppl. Insp. Feer Reg. Q OT Q,Q hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
Q
Q
Work Without Permit? ® Yes (2) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential Q
Building or Structure
Travel Documentation Fees:
TOTALS:
738
$1,936.00
Bldg Stds Commission Fee: IBCBSC
$847.60
SUBTOTALS:
MECH, HOURLY ® Yes (F) No
PLUMB, HOURLY Q Yes S No
ELEC, HOURLY Q Yes G No
IIech. Plan Check
Plumb. Plan Check
Elrc. I'lan (77Pc4
Alech. Pernsil Fee:
Plumb. Permit Fee:
Elec. Permil Fee:
Other Alech. Imp.
Other Plnmb lisp.
Other Elec. ]Asp. LJ
Afech. Insp. Fee:
Plumb. Insp. Fee:
Elec. Imp. Fee:
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 vreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,936.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: O Reg. Q OT
0.0 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$847.60
Suppl. Insp. Feer Reg. Q OT Q,Q hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
Q
Q
Work Without Permit? ® Yes (2) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential Q
Building or Structure
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICO
$31.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$6.00
SUBTOTALS:
$2,821.10
$0.00
TOTAL FEE:
$2,821.10
Revised: 04/0112012
r� n
CUPIER710 MOO
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 405-777-3225
Fax: 405-777-3333
(CONTRACT®IR / SUB COI NTRACTUR ILIISY
JOB ADDRESS:_ � F'��
SUBCONTRACTOR
PERMIT # �.
OWNER'S NAME:
Cabinets & Millwork
PHONE #
GENERAL CONTRACTOR
Cement Finishing
BUSINESS LICENSE #
ADDRESS: �� /'v e'
�,� o""o' -' ,>f z' �
CITY/ZIPCODE:. "/;_ ,.�;� - i`,,� ";�,
*Our municipal conte requires all businesses working in the city to have a City off Caupertino business license.
NO BUILDING ]FINAL OR-1FffNAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITE' OF CUP ERTI[NO
BU`SffNIESS LffCIENSIE.
ff am not unsung any subcontractors:
Signature Date
]Elease check applicable subcontractors and complete the fefloMng ii ormafloa:
V
SUBCONTRACTOR
BbSI MESS NAME
BUMNESS ESS UC1ENS>E #
Cabinets & Millwork
Cement Finishing
Electrical
i' TI
Excavation .
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpapers
Paving
Plastering
Plumbing
- -
C.�06-6
Roofing
Septic Tank.
Sheet Metal
Sheet Rock
`
C) 70
TileZ
�5 t
J �J(�
-'owner / ContractorSIlgnatuie
Date
6) PROMETHEUS
June 11, 2013
City of Cupertino
Building Department
10300 Torre Ave
Cupertino, CA 95014
RE: Permit # 12050091
We are most appreciative of the Building Departments flexibility regarding the permit mentioned above.
At this time we have fully executed contracts, completed submittals and materials order; unfortunately
we are experiencing lengthy leads times on the tile.
Aligning with the availability of tile, we have a projected start date of August 12, 2013, with completion
anticipated on or before October 1, 2013. With this in mind, we request, again, that you provide one
last extension on the permit noted above.
As always, we are more appreciative of your consideration.
ncerely,
Senior Portfolio Manager
20400 Stevens Creek Boulevard, Suite '30 1 Cupertino, CA 95014
T 40fU373.0121 I F 40R,873,012?
wwvv.(xomethc usreg. COM
April 19, 2013
City of Cupertino Building Department
10330 Torre Avenue
Cupertino, CA 95014
RE: Permit 012050091
Dear Pat:
We respectfully request the second and final extension of the aforementioned City of Cupertino Building
Permit, We apologize for the inconvenience on this matter. As of this date we have an approved and
funded budget as well as possession of fully executed contracts between Cupertino City Center
Buildings and our general contractor Gidel and Kocal, With these items in place we are, at long last,
prepared to move forward with this project and aggressively pursue its completion.
We fully understand that this is the last extension available for this permit.
Many thanks in advance for your assistance.
r~'
Sinc rely,
PR EUS
r w
Marni l:®pz
Senior Portfolio Manager