13120159CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD
CONTRACTOR: GIDEL AND KOCAL
PERMIT NO: 13120159
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS
574 DIVISION ST
DATE ISSUED: 12/19/2013
OWNER'S PHONE: 4088730121
CAMPBELL, CA 95008
PHONE NO: (408) 370-0287
i( LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
FLOORS 3 & 4, UPGRADE ALL RESTROOM FACILITIES ( 4
License Class Lic. k �. '�
TOTAL, 2 ON EACH FLR) FOR ADA COMPLIANCE
Contractor ��..°�°m�, �,:" Date
I 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.
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
Sq. Ft Floor Area:
Valuation: $150000
performance of the work for which this permit is issued.
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: 36901028.00
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 comply with all city and county ordinances and state laws relating
WITHIN 180 DAY faF� ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
t
„M,.
upon the above mentioned property for inspection purposes, (We) agree to save
180 DAYS -F" LLED 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
--771
granting of this permit. Additionally, the applicant understands and will comply „��
ssue a e:'""
with all non -point source regulations per the Cupertino Municipal Code,_„
-
9.18.
Signature Date '2 , Prj7
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
�Q
Signature of Applicant: Date:
1 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
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 (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
l 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 1 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
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
g Date:
Owner or authorized agent: " ` " D „m""
permit is issued,
,
1 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, 1
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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",,
a
CUPERTINO
F-INFZW CON.qTR I I(-
noN
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(akupertino.org
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❑ OWNER ❑ OWNER -BUILDER 0 OWNER AGENT ACONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANT
CONTRACTOR NAI
LICENSE NUMBER
LICENSE7
e�PE
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESSwq
CITY SATE, J
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ARCHITECTAEN,QOTEER N 1
LICENSE NUMBER ,
BUS. LIC N
COMPANY NAME"'
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DESCRIPTION OF WORK
7
57
EXISTING U
PROPOSFR USE CONSIR,
TYPE
I STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
c",
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL ARE
PORCH AREA .
DECK AREA
TOTAL DECK/PORCH ARE
GARAGE AREA: []DETACH
0 ATTACH
I
9 DWELLING UNITS:
IS A SECOND UNIT El YES
SECOND STORY [] YES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
IS THE BLDG AN
TOTAL VALUATION:
PLANNING APPL # [] NO PLANNING APPROVAL LEITER
EICHLER HOME?
t
By my signature below, I certify to each of the following: I am the property owner Or authorized agent to1ct on M!ropeTer's behalf. I have read this
c 0
application and the information I have provided is correct. I have read the Description of Work and verify it is cur agree to comply with all applicable local
-identified
-eriftstr4ction, I authorize representatives of Cupertino to -enter tK -,d ,property for inspection purposes.
ordinances and state laws relating to building�ve entrfedt,,,
Signature ofApplicant/Agent: Date: ----------------
SUPPLEMENTAL INFORMATION REQUIRED
A
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(sy. Demolition permit is required prior to issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp 2011. doe revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
1AADDRESS:
20400 STEVENS CREEK BLVD
DATE: 12/19/2013
REVIEWED BY: MELISSA
PC FEE ID
APN: 369 01 028
BP#:
"VALUATION: 1$150,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1BTIPLNCK
PENTAMATION 1 B TI
PERMIT TYPE: 14
WORK
FLOORS 3 & 4 UPGRADE ALL RESTROOM FACILITIES 4 TOTAL 2 ON EACH FLR FOR ADA
SCOPE
COMPLIANCE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
S.L
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,111-B,IV,V-B
738
$2,061.55
1BTIPLNCK
$902.85
IBTIINSP
Permit Fee:
$902.85
Suppl. Insp. Fee:O Reg. 0 OT
10701
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
°onsfr action T�o
Jd) lGiYistratNe Fec:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
738
$2,06155
i'x �rEa�� C.7ac�t,r�ol llt rtirrlf l°'ccs_
$902.85
Strong Motion Fee: IBSEISMICO
1Ce'
F1((?IJRLY
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,061.55
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT0.0
Olf7b.'!' V,'ch. Ib79Y.r
Li
C.(/wP '1'97('( 1r7S17,Ll
I'r,erfz Mt P. 1,v"c'
hsp.
ln,q), [ ce-
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution II -053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,061.55
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT0.0
1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$902.85
Suppl. Insp. Fee:O Reg. 0 OT
10701
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
°onsfr action T�o
Jd) lGiYistratNe Fec:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure
i'x �rEa�� C.7ac�t,r�ol llt rtirrlf l°'ccs_
Strong Motion Fee: IBSEISMICO
$31.50
Select an Administrative Item
BldgStds Commission Fee: IBCBSC
$6.00
%, � ;,i7►A,:,
$3, 001.90
$0.00 ,� ; ,, E
$3,001.90
Revised: 10/01/2013
Uuilding Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR SUBCONTRACTOR LIST
JOBADDRESS:
PERMIT # 1?jZ()t-!',j 13 2
OWNER'S NAME: . . . .... . . .... . ..
PHONE#
GENERAL CONTRACTOR. ,,,,'/,,-4,,,BUSINESS
LICENSE #
ADDRESS: s,
CITY/ZIPCODE:
*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 CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
00,
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
- - -------
Masonry
—
— - - - -
Painting / Wallpaper
Paving
.................
-- ------- . ...... .
Plastering
Plumbing
Roofing
1461"Z, "�,17/Nnf
3 "65
Septic Tank,
Sheet Metal
--- - ---------
Sheet bock
2ei'0 70
Tile
00,
Owner / Contractor Signature
Date
CUPERTINO �
CONTRACTOR / SU
CONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS , .
PERMIT # 2OLSS W14
OWNER'S NAME: a°N , °`
BUSINESS LICENSE #
PHONE #
GENERACCONTRACTOR
"
BUSINESS i,ICENSE #
ADDRESS:
Cement Finishing
CITYIZIPCODE:
Electrical
Excavation
*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 CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
t,
10
'I"11/"Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
t,
10
'I"11/"Owner / Contractor Signature
Date