B-2017-0875CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0875
10201 TORRE AVE CUPERTINO, CA 95014-2131 (369 41 005) SERVICE WEST INC
SAN LEANDRO, CA
94577
OWNER'S NAME: I & G DIRECT REAL ESTATE 21 LP
OWNER'S PHONE: 408-982-8433
LICENSED CONTRACTOR'S DECLARATION
License Class B: C -61/D-34 Lic. #570176
Contractor SERVICE WEST INC Date 05/31/2018
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:
t. 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.
z. I 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
permit is issued.
APPLICANT CERTIFICATION
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, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature �- Date 6/19/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
z. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
z. I 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
permit is issued.
s. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
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, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Date 6/19/2017
DATE ISSUED: 06/19/2017
PHONE NO: (510) 746-3700
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
AMAZON - 1 ST FLOOR T.I. OFFICE/INTERVIEW ROOM (500 S.E);
2ND FLOOR T.I. OFFICE/CONFERENCE/TEAM ROOM (1750 S.F.);
3RD FLOOR (1400 S.F.) CONFERENCE/OFFICE
Sq. Ft Floor Area: I Valuation: $350000.00
APN Number: Occupancy Type:
36941 1 A (Tenant Improvements),B (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Avende
Date: 06/19/2017
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.
Signature of Applicant:
Date: 6/19/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 2553 nd 25
Owner or authorized age . �
Date: 6/19/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION Mr -(N l✓
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingOcupertino.org
CU'PERTINO
❑ NEW CONSTRUCTION ❑ ADDmoN ® ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJEcTADDIms 10201 TORRE AVENUE
APNk *1005
OWNERNAUE I & G DIRECT REAL ESTATE 21 LP
P10 (408) 982-8433
E-MAIL .com
STREETADDREss2107 N. FIRST ST. SUITE 655
CITY, sTATE,z1P SAN JOSE, CA 95131
FAX
CONTACT NAME THERESA HAYES
PItONE(206) 441-1449
E-' thayes@nelsononline.com
STREET 150WESTLAKE AVE N, SUITE ONE
CITY,STATE, zIp SEATTLE((, WA 98109
I
FAX
13 OWNER 11OwNER-BUIr.DER 13 OWNER AGENT 13 CONTRACTOR 11 CONTRACTOR AGENT x ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANT
CONTRACTOR NAME SERVICE WEST
LICENSE NUMBER #5701767
LICENSETYPE
IiUS.LICt!
C61/D34 and B
COMPANY NAME SERVICE WEST INC.
&MAIL ruben@servicewest.com
FAX (510) 343-2805
sTREETADDRE82054 BURROUGHS AVE.
CITY, STATE, ZIP SAN LEANDRO, CA 94577
J
PHONE (510) 716-3700
ARCIRTECTIENOINEER NAMF.
LICENSE NUMEER
BUS. LIC #
COMPANYNAME NELSON
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OFwDIm DEMOLITION OF EXISTING DEMOUNTABLE PARTITIONS. INSTALLATION OF NEW
DEMOUNTABLE AND SIESMIC BRACING.'I
�P-A�RRTITIONS
N10
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
BUSINESS
BUSINESS II
I
-A
3
USE
TYPE
OCC.
SQ.FT.
VALUATION(S}
� G27,810 SF
ARBA �oR 0
AREA 0
NET AREA 27,810 SF
BATHROOMKITCHEN
REMODEL AREA NA REMODEL AREA NA
OTIIER
REMODEL AREA NA
PORCH AREA
DL'+CK ARIIA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
NA
NA
NA
NA ❑AI9ACH
#DWELLINGUNITS:
ISASICCONDUNIT [I YES
SECONDSTORY ❑YES
0
BEING ADDRD? 14NO
ADDITION? DQNO
PRH -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL 0 NO PLANNINGAPPROVAL LETTER
IS THR BLDG AN 11 YES
EICHLER HOME? ® NO
RE ED BY:
Jr`
TOTAL VALUATION:
JI
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. have read tl"
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' oonsfruction. I. a"P ' representatives of Cupertino to enter the above -identified properly for inspection purposes.
Signature of Applieant/Agcnt: .� Date: el /7
SUPPLEMENTAL n#56NFION ICED
PLAN C EECK TYPE
ROUTING SLIP
El OVER-TIDr? COttNTER
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing buildbig(s). Demolition permit is requited prior to issuance of building
BTIIL4ING PLANREV1Ew
permit for new building.
❑ EXPRESS
❑ PLANNINGPLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11STANDARII
❑ P LIC WORKS
form if any Hazardous Materials are being used as part of this project
❑ LARGE
_ FIRS DEPT ROW
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Pennit application.
❑ ENVIRONMENTALHEALTa
BldgApp_2011.doc revised 06/21/11
)S.
6