14020054CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 14 RESULTS WAY
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 14020054
OWNER'S NAME: ECI TWO RESULTS LLC
851 BUCKEYE CT
DATE ISSUED: 03/06/2014
OWNER'S PHONE: 4082406000
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
LICENSED CONTRACTOR'S DE LARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
r7V/� Q
k O
APPLE T.I. (1000S.F.) TO EXPAND (E) COMPUTER LAB.
License Classy_ Lic. # v/ O
ADD CORRIDOR FOR RESTROOM ACCESS
`
/
Contractor �f Dateff-(
1 hereby affirm that I am licensed under the provisions of hapter 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: $200000
pe ormance of the work for which this permit is issued.
a will maintain Worker's Compensation Insurance, as provided for by
_and
on 3700 of the Labor Code, for the performance of the work for which this
APN Number: 35720041.14
Occupancy Type:
it is issued.
APPLICANT CERTIFICATION
1 certify that 1 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 DA ' AST LED 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
ssu
with all non -point source regulations per;he Cupertino Municipal Code, Section
9.18.
f
RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If roof is
installed without first obtaining an inspection, l agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant Date:
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).
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 tinder 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 th pertiuo Munic' C C r 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
for
the Health & Safety Code, Sec " 5,25533 4. ,
�j
Section 3700 of the Labor Code, the performance of the work for which this
Owner or authorized agent: Date:
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. 1 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
1 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�7
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION /I N
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 l 11 V
(408) 777-3228 • FAX (408) 777-3333 • build ing(a-cupertino.orcl
❑ NEW CONSTRUCTION ❑ ADDITION ✓❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
7APN #
14 Results Wax
OWNER NAME L
BVP Perimeter Square Retail LLC l GREF Results
P N / _
E-MAIL
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 ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
Darren Hall
647480
B -C8
21836
COMPANY NAME
E-MAIL
FAX
XL Construction
dhall@xlconstruction.com
408-240-6001
STREET ADDRESS
CITY, STATE, ZIP
PHONE
851 Buckeye Ct
A C'FtITE T: E
34;
LICENSE NUMBER C 16 9PIS
BUS. LIC #
D
COMPANY N
E-MAIL
w a�
STREET
�i{.(f�j �V
CI ,ST�
� �M�
P7�7 -/I ��
�r 7 •. V
/%� • G
� J •
i
DESCRIPTION OF WORK
I
EXISIING USE
PROPOSED USE COPE
# STES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA !
NEW FLOOR
AREA D
DEMO
AREA,
TOTAL !�/�
NETAREA/0 J
V��//
t/O
DD
BATHROOM
REMODEL AREA V14—
KITCHEN
REMODEL AREA
OTHER .
REMODEL AREA I
PORCH A
DECK ARE
w'�L
+_ //TTIS
TOTAL DEC RCH AREA
GARAGE A: DETACH
❑ ATTACH
# DWE LING UN S.
A SECOND UNTIT []YES
SECOND ORY []YES
BEING ADDED? r9ii0
ADDITION? )ZNO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY':
TOTAL VALUATION:
PLANNING APPL # JaNO PLANNING APPROVAL LETTER
EICHLER HOME? [JrNO
(�
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. Ich-avve tread this
application and the information I have provided is correct. I have read the Description of ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu g constructions' t upertino to enter the above-' entifi o e for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THF,COUNTER
❑ BUILDING 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.
PRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
p
❑
LARGE
FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application
❑ ENVIRONMENTAL HEALTH
BldgApp 201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 14 RESULTS WAY
TYPE OF
CONSTR.
DATE: 02/10/2014
REVIEWED BY: MELISSA
APN: 357 20 041.14
BP#:
1�401���
VALUATION: $200,000
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
IBTIPLNCK
$1,035.59
PENTAMATION
PERMIT TYPE: 1 B TA
WORK
APPLE T.I. 1000S.F. TO EXPAND E
COMPUTER LAB. ADD CORRIDOR FOR RESTROOM USE
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
sJ.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
11-13,111-B,IV,V-B
1,000
$2,071.77
IBTIPLNCK
$1,035.59
IBTMVSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,035.59
Suppl. Insp. Fee:Q Reg. Q
OT
F0.0Thrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
1,000
$2,071.77
1
$1,035.59
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
t)ictrirt otr ) Thoco fooc aro hacod an tho nroliminary in/brmatinn availahlo and aro ank an actimato. Cnniart tho vont fnr addn'I infn_
FEE ITEMS (Fee Resolution 11-03 E(/ TT,13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,071.77
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (D Reg. 0 OT
FO.07
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,035.59
Suppl. Insp. Fee:Q Reg. Q
OT
F0.0Thrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Pla.nninFee:
$0.00
Select a Non -Residential
Building or Structure
i
Strong Motion Fee:
IBSEISMICO
$42.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$8.00
SUBTOTALS:
$3,157.36
$0.00
' TOTAL FEE:
$3,157.36
Revised: 01/15/2014
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
/ Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 4)&4,
PERMIT#
OWNER'S NAME: E-Cj 14) 0 Le ",'40 Lte
%
PHONE # y b3' q 0
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS: Z ' ,�
CITY/ZIPCODE: /00/ 5635
*Our municipal code requires d1l 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
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE
Cabinets & Millwork
Cement Finishing
V
Electrical
Excavation
Fencing
�-j
Flooring / Carpeting
"-L2
Linoleum / Wood
Glass / Glazing
Heating
F
7
Insulation
Landscaping
Lathing
Masonry
Painting /Wallpaper
6"1
Paving
Plastering
A
Plumbing
Roofing
3
Septic Tank
Sheet Metal
�V
Sheet Rock
Tile
Owner / Contractor Signature
-1
�:5 ?
liate
CUPERTINO
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(aDcupertino.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.
x
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.
�C
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.
HasMat 2011.doc revised 03/07/11