13110136CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20525 MARIANI AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 13110136
OWNER'S NAME: 20525 MARIANI DRIVE LP
851 BUCKEYE CT
DATE ISSUED- 11/20/2013
OWNER'S PHONE: 4085009908
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
13 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALE]
License Class � �, Lic. # 6q�qgo
APPLE— T.1 PREP ON IST FLOOR INTERIOR
oe
It 40/13
DEMOLITIONS
Contractor Dat,
IN PREPAREDNESS FOR PERMIT # 13090129
1 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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $15000
have and will maintain Worker's Compensation Insurance, as provided for by
'Section 3700 of the Labor Code, for the pe&rmance of the work for which this
APN Number: 32656001.20525
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 180 DAYS OF PERMIT ISSUANCE OR
to 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 LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
&. 2-a-1 3
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point ource regulations pe he Municipal Code, Section
9.18.
Signature Date
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.
❑ 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCL!QKRE
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. 1 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
or the performance of the work for which this
Section 3700 of the Labor Code, f
the Health & Safety Code, Sectio "505,255.53,And 25534.
1_71X —
Owner or authorized agent- - -1 Date:
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
'ION LENDING AGENCY
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
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 count), 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
ARCHITECT'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.
Signatu Date
CONSTRUCTION PERMIT APPLICATION 419
�\ J
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 0
NN
iiRRAVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(a-cupertino.oEg
CUPERTINO melr
M NEW CONsmucnoN Q ADDITION r-1 ALTERATION / TI n REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS Q 0 1 , -7'N',3
9 (2 57 coo I M go 5 -d -5 -
OWNER NAME
PHONE
qog Y00
E-MAJEL
0
STREET ADDRESS
CITY, STATE =1AX
A;P� cA q50( ff
CONTACT NAME
pe
PHONE Toy 69!q Sr,�4, F -MAIL
bnsr 'tAfo xkor%-S�UAII
STREET ADDRESSCITY,
'951 �Vd—!z 6
STATE, ZIP
95,c) 75-
FAX
0 OWNER 0 OWNER BUILDER ❑ OWNER AGENT t!�CONTRACTOR 13 CONTRACTOR AGENT n ARCHITECT OENGINEER 11 DEVELOPER ❑TENANT
CONTRACTOR NAME
L
E N=R
LICENSE TYPE
BUS. LIC #qa
COMPANYNAME X1- t d9ti5
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE Lips
Zg
ARCHTTECTIENGINEERNAME5.
LICHNSENUNIBER
BUS. LIC
COMPANY NAME
E-MAIL
STREET ADDRE46
CITY, STATE, ZIPPHONE
qo9At3823,)L
DESCRIPTION OF WORK
-Fo/- veram4- * (3p9pla9
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
-A �1
i
-hs
3
USE
TYPE
OCC.
VALUATION
FXISTG
AREA aAREA
NEW FLOOR
1D
DEMO
I AREA
d
TOTAL
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
OATTACH
# DWELLING UNITS:
IS A SECOND UNIT OYES
SECOND STORY OYES
I
REINGADDED? ONO
ADDITION? ONO
V
I
PRE -APPLICATION 0 YES IF YES, PROVIDE COPY OF
IS THE BLDG AN [:] YES
RECEIVE
TAL VALUATION:
PLANNING APPL # 0 NO PLANNING APPROVAL LETTER
EICHLERHOME? 0 NO
./L00-0
By my signature below, I certify to each of the following: I am the property owner or authorizegentact 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 cd verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to gconstruction I authorize representatives of Cupertino to enter the abov -iden property for inspection purposes.
AI,,,,d
Signature of Applicant(Age Date: I
SUPPLEMENTINFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
-0
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of buildinf'
--ErOR_ THE.COUNTXR
BUILD7]PXG PLAN REVIEW
permit for new building.
171 EXPRESS
11 PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
171 PUBLICWORXS
To—nn if any Hazardous Materials are being used as part of this project.
El
LARGE
FIRE DEPT
— Copy of Planning Approval Letter or Meeting with Planning prior to
171 MAJOR
11 SANITARY SEWER DISTRICT
submittal of Building Permit application.
I
I-] ENVIRONMENTAL HEALTH
BIdgApp_2011.doc revised 06121111
-, , ct}^-
I CITY OF CUPERTINO
FFF F1,9T1U1T4kr1a - BUILDILWOWM-0�8N
ADDRESS: 20525 mariani►REVIEWED
FEE
QTYA
BY: mendez
APN:
ON:
1$15,000�
*PERMIT TYPE: Building Permit
7
- ---
PLAN CHECK TYPE: Tenant Improvement
PRIMARYPENTAMATION
USE: Commercial Building
R 0
hrs
1TIPREP'i
PERMIT TYPE:
In
apple-tJ prep on 1stfloor interior demolitions in preparedness for permit# 13090129
$0.00
NOTE. This estimate does not include fees due to other Departments (i -a Planning, Fitolic worKs, rire, awwraryfewer vistrict, acnout
11—#.. Th— f — "'. har"I A" fho nroumi"ary i"formadn" available and are only an estimate Contact the Dept for addyl info.
FEE ITEMS Lee Resolution I
FEE
QTYA
MISC ITEMS
Plan Check Fee:
$0.00
= #
$405.001
Tenant Improvement Prep
ITIPREP I
Suppl. PC Fee: (F) Reg. 0 CIT
R 0
hrs
$0.00 1
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT:=hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consinuction Tax:
A(Jirin!'Streifive
0
E)
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Epee.$0.00
Select a Non -Residential
—1 Building or Structure
0
0
A
1 iynel Documentation If ees:
Strong Motion Fee: 1BSEISWCO
$3.15
Select an Administrative Item
Bldg Stds Commission Feer IBCBSC
$1.00
-SUBTOTAL$-.
$4.15
$405.00—
)9.15
Revised: 10/01/2013
ABBREVIATIONS
PROJECT SPECIFICATIONS
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