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14020064CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 12 RESULTS WAY CONTRACTOR: XL CONSTRUCTION PERMIT NO: 14020064 OWNER'S NAME: ECI TWO RESULTS LLC 851 BUCKEYE CT DATE ISSUED: 02/11/20 [4 OWN'ER'S PHONE: 4084901641 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] /� �f %U /� -1 APPLE- CONVERSION OF COLLABORATION ROOM INTO License Class'(.. Lie. 9 ` ( `� �/ 2 Contractor XL 4pn6 • Date r 1� PRIVATE OFFICES 176 SQ FT I hereby affirm that 1 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: 35720046.00 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 18 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 DAYS OM 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. Signature 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: 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS NIATERIALS 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. I 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 Munici al Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S ' ns 25505, 255 2553 Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent 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 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 1 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 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. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.org El NEW CONSTRUCTION ❑ ADDITION ✓❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # 12 Results Wad ZO O�/Cv QU OWNERNAMEPHONY /(G E-MAIL BVP Perimeter Square Retail LLC / GRTF esults !'r 110 �I STREET ADDRESS CITY, STATE, ZIP FAX 2 Results Way Cupertino, CA 95014 CONTACT NAME PHONE E-MAIL Darren Hall 408-240-6055 dhall@xlconstruction.com STREET ADDRESS CITY, STATE, ZIP FAX 851 Buckeye Ct Miltipas, CA 95035 408-240-6001 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Darren Hall LICENSE NUMBER 647480 LICENSE TYPE B -C8 BUS. LIC # 21836 COMPANY NAME XL Construction E-MAIL dhall@xlconstruction.com FAX 408-240-6001 STREET ADDRESS 851 Buckeye Ct CITY, STATE, ZIP PHONE 408-240-6000 ARCHITECT/ENGINEER NAME David Sabalvaro LICENSE NUMBER C-015925 BUS. LIC # COMPANY NAME E-MAIL FAX Studios Arch 415-398-3829 STREET ADDRESS CITY, STATE, ZIP PHONE 405 Howard Street Suite 588 San Francisco, CA 94105 415-3978-7575 DESCRIPTION OF WORK onversion of collaboration room into 2 private offices EXISTING UB PROPOSED USE CO11f. 6PE III # ST 1ES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG1 ANEW REA DEMO 176 AREA NET AREA 176 Of -rice 111'13 B 176 $100,000 BATHROOM REMODELAREA KITCHEN a REMODEL AREA OTHER �� REMODEL AREA PORCH AREA DELIS 9(j�A TOTA L,'�9(PORCH AREA GAQ[�W�R.EA: []ATTACH D^CH WA AWA N H �r//� _. .... -- # DwEj�t�tjf]�UNITS: IS A SECOND UNIT wi F&YES SECOND STORY 1�I//�+� BEINGpDEpT K/ff40 ADDITION. PRE -APPLICATION YES IF YES, PROVIDE COPY OF PLANNING APPL # El PLANNING APPROVAL LETTER IS THE BLDG AN YES EICHLER HOME? �NO RKE(VED ' Y, M,..,-�,•.+�,,,.�. „�,,_Z17-1 µ TOTAL V�iLU(q�T ON: 1 V� OOO By my signature below, I certify to each of the following: I am the property owner or authorized ag t to act on the pr�perty owner's behalf. I have read this application and the information I have provided is correct. I have read the De cription of Work and it is accurate. I/�a.�_ree comply with all applicable local ordinances and state laws relating tc ng construction I ® sent�i,�ertino to enCer the move:' eftopetforinspection purposes. ✓'l6.� Signature of Applicant/Agent: Date: SUPPLEMENT INFORMA ION REQLff RED PAN , I ROUTING s)L1I' VER-T"E ?1JNTI Ri' jLD1Nr,PLAN REVIEW 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 FXrREss El PLA1NMNGFLANREVIFW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 $TANAARD D" PVIRL1CWOP S form if any Hazardous Materials are being used as part of this project. fl LARrF �`3 DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. © �`��R � � sAN�'1rAIRYSI�WIERIpIST�Ic'� Q RNVrR(3kY141gTSTALETALTH BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 12 results way DATE: 02/11/2014 REVIEWED BY: MENDEZ PC FEE ID APN: Lo�+ ((� *VALUATION: $100,000 i�BP#: PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: $2,036.00 PENTAMATION 1B TI PERMIT TYPE: WORK apple- conversion of collaboration room into 2 private offices 176 sq ft SCOPE $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s f.) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 176 $2,036.00 IBTIPLNCK $571.00 IBTIINSP hrs $0.00 PME Plan Check: $0.00 Permit Fee: $571.00 Suppl. Insp. Fee:G Reg. OT0,0 hrs $0.00 Ll TOTALS: 176 $2,036.00 $571.00 MECH, HOURLY 0 Yes (F) No PLUMB, HOURLY 0 Yes 0 No ELEC, H01URLY ® Yes (2) No Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $571.00 Suppl. Insp. Fee:G Reg. OT0,0 hrs $0.00 Ll _L_ Lj PME Permit Fee: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt air- ! Thoco foot nro hacod an Jho nroliminary infnrmnlinn nvailahlo and nro nnh an octimnlo_ Cnntart Jho vont fnr addn'l infn_ FEE ITEMS (Fee Resolution 11-053 Eff 7%I;'I3) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,036.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $571.00 Suppl. Insp. Fee:G Reg. OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 E) Work Without Permit? C) Yes) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 t Stron_g. Motion Fee: IBSEISMICO $21.00 Select an Administrative Item 1 Bldg, Stds Commission Fee: IBCBSC $4.001 SUBTOTALS: $2,632.00 $0.00 TOTAL FEE; $2,632.00 Revised: 01/15/2014 .. . . ........ Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR f SUBCONTRACTOR LIST JOB ADDRESS: ), PERMIT # f. OWNER'S NAME: Tt,) o R. e,� TO 6< � 1 PHONE# GENERAL CONTRACTOR: X �? L BUSINESS LICENSE# Q z 6 ADDRESS: 2,51 /.4tC� ,Z, e"', / le61f-1 , ei 4 1 � CITY/ZIPCODE: el�ll *Our municipal code requires"all businesses working in the city to have a City of Cupertino busines's 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 Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing 0 .,A'44eating �Z 73,6o Insulation Landscaping Lathing Masonry I'Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile —0/ Owner / Contractor Sigl(iriure Date