13110117CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20300 STEVENS CREEK BLVD
CONTRACTOR: DEVCON
PERMIT NO: 13110117
CONSTRUCTION INC
OWNER'S NAME: SVF CUPERTINO CITY CENTER CORP
690 GIBRALTAR DR
DATE ISSUED: 11/18/2013
OWNER'S PHONE: 6505205483
MILPITAS, CA 95035
PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class_ Lic. # � /731
APPLE- 2ND FLOOR- GALAXY LAE 2- MOVE WALL TO
Contractor t�t� Date
MAKE
ROOM BIGGER 310 SQ lF Il'
hereby affirm that I 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.
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
Sq. Ft Floor Area:
Valuation: $100000
performance of the work for which this permit is issued.
1 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
APN Number: 36901019.00
Occupancy Type:
permit is issued.
....__. _ ..
APPLICANT CERTIFICATION
I 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 0 DAYS OF PERMIT ISSUANCE OR
building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY M LAST CALLED INSPECTRON.
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
Issued by: Date: 7
with all non-pWopLurce regulations per the Cu—pe mo Municipa I Code, Section
RE-ROOFS:
9.18.
f
Signal e C Date -
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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I 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).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. ➢ 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
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should I 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 of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti q 5505125533
Section 3700 of the Labor Code, for the performance of the work for which this
IV _ C�
Owner or authorized agent: Dater
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
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
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
ARCH➢TECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this 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
4-100. u(_
CUPERTINO
CONS"fRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 a FAX (408) 777-3333 • buildingt&cuoertino.oro
❑ NEW CONSTRUCTION ❑ ADDITION 2 ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS �O � ✓V � �
APN #
�1
OWNER NAME
Ape
PHONE /
'O�ZS -2,_3
E-MAIL
STREET ADDRESS
C Y, STATE, ZIP ••�
FAX
CONTACT NAME I �t %j
PHONE - c69
7
E-MAIL 1��
V
STREET ADDRESS��, I J L I ^ I
CITY, STATE, ZIP 5
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT I1CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC #
FAX
COMPANY NAME E-MAIL
STREET ADDRESS
C_ 1;Y, ST/\TE, ZIP a
PHONE y -9 B ls-1 0400
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE
CONSTR TYPE
1 # STORIES
USE
TYPE
OCC, SQ.FT.
VALUATION (i)
EXISTG
AREA
NEW FLOOR
AREA 30
DEMO
AREA
TOTAL
NET AREA
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH ARE
I GARAGE AREA: U DETACH
[]ATTACH
#DWELLINGUNITS
ISASECOND uirr ❑YES
BEING ADDED? ONO
SECONDSTORY ❑YES
ADDITION? ONO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
PLANNING APPL # []NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YEs
EICHLER HONIE? ❑ NO
REPEI . D Y:
-
TOTAL VALUATION:
S�
By my signature below, I certify to each of the following: I am the property owner or authori ed agent to act on the property 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 accurate. I agree to comply with all applicable local
ordinances and state laws relating t II g conswcti / _representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: f!J"tee Date:
SUPPLEMENTAL INFORMATION REQUIRED Q
'.., <. F CHECK TYPE.
ROUTING §LIP
AVER THF,7COUNTER
BUILDING PLANREVIENV, ,.
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.
0 'EXPRESS
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
0 .'STANDARD
P PUBLIC ` ORKS ..
fo_rm 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
submittal of Building Permit application.
0. MA.JdR
❑ SANITARYSEWER DISTRICT
ENVIRON117ENTAL HEALTH .
BldgApp_2011.doc revised 06/21/11
6U,1"
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20300 scb DATE: 11/18/2013 REVIEWED BY: mendez
APN: BP#:d *VALUATION: $100,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION
USE: PERMIT TYPE:
WORK a le- 2nd floor- galaxy lab 2- move wall to make room bigger 310 sq ft
SCOPE
1 B TI
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE IID
B (Tenant Improvements)
II-B,111-B,IV,V-B
310
$2,041.11
IBTIPLNCK
$637.37
IBTIINSP
Elec. Insp. Fee:
$637.37
Suppl. Insp. Fee -.0 Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consvri..rction Tar:
Administrative Fee:
Work Without Permit? 0 Yes (E) No
$0.00
TOTALS:
310
$2,041.11
1
$637.37
Strong Motion Fee: IBSEISMICO
MECH, HOURLY O Yes E) No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
)tech. Plan Check
PI•umb. Plan Check
Elec. Plan Check
Flech. Perwi! Pee:
Plumb. Permit f eL
Gk.c. Pi unit Fee:
Other illech. Insp.
Other Plumb Insp.Ll I
Other Elec. Insp.
Alec•h. Insp. I,ee
Phwnrb. lrrsp. Fee:
Elec. Insp. Fee:
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Di.ctriet. etr_ 1. These tees are hacad nn the nreliminary ininrmntinn avni/nhla and ara nnly an actinmta Cnntnet tho Dant tnr addn'/ inFn_
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,041.11
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: (F) Reg. Q OT
0,0 I
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$637.37
Suppl. Insp. Fee -.0 Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consvri..rction Tar:
Administrative Fee:
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select allon-Residential E)
Building or Structure 0
Tim,el Documenturiort Fires:
Strong Motion Fee: IBSEISMICO
$21.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$2,703.481
$0.00 TOTAL FEE:
1 $2,703.48
Revised: 10/01/2013
Cllf'f fl IN OO,
CONTRACTOR / SUBCONTRACTOR LEST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: PERMIT # 11 U 11
OWNER'S NAMEAvoic PHONE # �^
GENERAL CONTRACTOR: / BUSINESS LICENSE #
ADDRESS: �,�(� I!S A�('e '< zc t�r� CITY/ZIPCODE: �) ,(n 1d�i.3 , C i
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING (FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CU PIERTINO
BUSINESS LICENSE.
I am not easing any subcontractors:
Signature
(Tease check applicable subcontractors and complete the following information:
(Date
c�
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
c n 61 yn U
0� (A
Excavation
Fencing
V
Flooring / Carpeting
(,E— e
y
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
V
Painting / Wallpaper
2
Paving
Plastering
Plumbing
Roofing
Septic Tank
U
Sheet Metal
Sheet Rock
G M
l
Tile
Owner / Contractor Signature (Date