14020018CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20450 STEVENS CREEK BLVD
CONTRACTOR: GIDEL AND KOCAL
PERMIT NO: 14020018
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS
574 DIVISION ST
DATE ISSUED: 02/04/2014
OWNER'S PHONE: 4088730121
CAMPBELL, CA 95008
PHONE NO: (408) 370-0287
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL 11
License Class /7'03105Z-) Lia #
2ND FLOOR- SUITE 200- COMM. T.1 TO INCLUDE
INTERIOR REMODEL
Contractor elvz
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.
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: $82000
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: 36901027.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 DAYS 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 F OM LAST CALLED INSP CTION.
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-poi ure u a ons per the Cupertino Municipal Code, Section
RE-ROOFS:
`"
Signatu - Date 2 /
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, l 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
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 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. 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 C rpertin u icipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti 5505 5 , and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent- .---�-�' Date:
I certify that in the performance of the work for which this permit is issued, 1 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
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
CUPEFITiNO
NRW Ct7NSTRITCTIt7N
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408))777-3228 • FAX (408) 777-3333 • building(LDcupertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME rl y^
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LICENSE TYPE
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DESCRIPTION OF WORK
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ZIP'
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLo6r
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK ARELIBS
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
ASECOND UNIT ❑YES
SECOND STORY ❑YES
ING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑YES I'YES, PROVIDE COPY OF
PLANNING APPL # 0 N PLANNING APPROVAL LETTER
IS THE BLDG AN ❑YES
EICHLERHOME? ❑NO
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TOTAL VALUATION:
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By my signature below, I certify to each of the f wing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have ovide I rrect I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws relatin- ding ruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofApplicant/Agen. 1Date:
.
RE
TAL FORMATION REQUIRED
SUPPLEMEN IN Q
_ New SI~D or Multifamily dwellings: Apply for demolition permit for
existing building(s).Demolition permit is required prior to issuance of building permit for new budding.
Commercial. Bldgs: Provide a completed Hazardous Materials Disclosure
form ifany 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 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 20450 SCB suite 200
DATE: 02/04/2014
REVIEWED BY: Mendez
1.VAPERMIT
APN:
BP#: ��
VALUATION: $82,000
TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
IBTIPLNCK
PENTAMATION
PERMIT TYPE: 16 TA
WORK
2nd floor- suite 200- comm. U to include interior remodel
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.t.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,111-B,IV,V-B
1,290
$2,087.10
IBTIPLNCK
$1,234.70
1BTHNSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,234.70
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
1,290
$2,087.10
$1,234.70
0 Yes E) No
r
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 areliininary information available and are only an estimate. Contact the Debt for addn'1 info.
FEE ITEMS (Fee Resohilion 11-053 Eff 7%1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes E) No
$2,087.10
0 hours
$0.00
Plan Check, Hourly
Suppl. PC Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,234.70
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
0
Work Without Permit? C) Yes (F) No
$0.00
Advanced Planning?Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
A
Strong Motion Fee: IBSEISMICO
$17.22
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTO FALS
$3,343.02
$0.00
TOTAL FEE:
$3,343.02
Revised: 01/15/2014
CUPER.TINO
PURPOSE
HAZARDOUS MATERIALS CHECKLIST
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(Z�cupertino.org
To minimize possible delays that would result for the Fire Department plan review, please complete the
following checklist to determine if an additional level of Hazardous Materials plan review will be
required.
MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING?
PLEASE MARK YOUR ANSWER WITH AN `X' IN THE YES OR NO BOX ON THE SIDE
BELOW.
YES
NO
1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases,
hazardous materials, etc.
2. Battery back-up rooms or racks.
3. Propane tanks.
4. Gasoline stations with underground tanks.
5. Installation or replacement above ground or underground storage of liquid petroleum
products, liquefied petroleum gases, compressed natural gas, explosives or other
regulated hazardous materials.
6. Gas rooms for dentist, doctors or veterinarians.
7. Generators with back-up diesel or other fuels.
8. Large refrigeration systems.
9. Fuel cell systems.
-
10. Commercial pool systems.
11. Chemical Storage areas.
12. Flammable liquid storage.
13. Compressed Gases.
14. Dry cleaners.
15. Print Shops.
16. Auto Repair and Auto Body Shops.
17. Research and Development.
For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa
Clara County Fire Department, at (408) 378-4010.
HasMa1 201 /.doc revised 03/07111
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
*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 Date
Please check applicable subcontractors and complete the following information:
V
JOB ADDRESS: 2oy p caeF 844N PERMIT # 1-101.061
BUSINESS LICENSE #
OWNER'S NAME: Cu-?erlp�oo L, -r. Cex{e, PHONE # O$i 3 -10 -0 -Z -8 -
Cabinets & Millwork
GENERAL CONTRACTOR AJC BUSINESS LICENSE # Z a
ADDRESS: 51ti 1>v;5ic3 S—%, CA G LL r4 CITY/ZIPCODE: 1?S'00
*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 Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing `
Flooring / Carpeting G '!
Linoleum / Wood
Glass / Glazing o G
`�t'ci 0 L1Li
Heating t91516W
Insulation
% 7C
Landscaping
Lathing
Masonry
Painting / Wallpaper /� ja , per, A,I'i',,k�,N
-1 S -LI
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal t (z—
.277
Sheet Rock
Tile
Owner / Contractor Signature
Date