B-2017-0354CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0354
19240 STEVENS CREEK BLVD CUPERTINO, CA 95014-2504 (375 06 006)
SLATTER
CONSTRUCTION INC
SANTA CRUZ, CA
95060
OWNER'S NAME: HALL TOM L AND ELEANE TRUSTEE
DATE ISSUED: 06/20/2017
OWNER'S PHONE: 831-600-4018
PHONE NO: (831) 425-5425
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class BLA Lic. #709778
Contractor SLATTER CONSTRUCTION INC Date 07/31/2019
X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH _ RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
LIGHTHOUSE BANK; T.I.-ADD 3 TELLER STATION, CUSTOMER
I hereby affirm under penalty of perjury one of the following two declarations:
SERVICE AREA AND WAITING AREA; CONVERT STORAGE ROOM
1. I have and will maintain a certificate of consent to self -insure for Worker's
TO MOVABLE VAULT UNITS AND SAFE DEPOSIT BOXES; ADA
Compensation, as provided for by Section 3700 of the Labor Code, for the
UPGRADES (717 S.F.)
erformance of the work for which this permit is issued.
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.
Sq. Ft Floor Area:
Valuation: $150000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
375 06 006
B (Tenant Improvements)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
SignatureDate 6/20/2017
Issued by: Abby Ayende
OWNER -BUILDER DECLARATION
Date: 06/20/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 6/20/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
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
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 05, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 6/20/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 6/20/2017
Licensed
Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION T)- Zc)R ~ 03�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 16
(408) 777-3228 • FAX (408) 777-3333 • buildingCo)cupertino.ora
❑ NEW CONSTRUCTION ❑ ADDITION rl ALTERATION / TI 17 RFVISION / DFFFRRFzn C1RICNNA1 PFRMIT E
PROJECT ADDRESS 19240 STEVENS CREEK BLVD, CUPERTINO, CA 95014
APN # 375-060-06
OWNER NAME LIGHTHOUSE BANK - Jon P. Sisk - President
PHONE (831) 600-4018
E-MAIL
STREET ADDRESS 2020 N. Pacific Avenue
CITY, STATE, ZIP Santa Cruz, CA. 95060
FAa{ (831) 480-5976
CONTACT NAME r� �i�C1l/
PHONEE-MAIL
Ir/��,6WSp(?C�rl0r^ C':� l
STREET ADDRESS
CITY, STATE, ZIP VA_15 Gh ' / A q� / /
J
FAX
❑L'ENGIINEER ❑ DEVELOPER ❑ TENANT
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 03 ARCHITECT
CONTRACTOR NAME fno 1 4�
LICENSE NUMBER
LICENS PE
BUS. LIC # n
COMPANY NAME �
S ICL k CO3-StYGC-,G�f 1,
E-MAIL
(`e �
FAX
V' L
G 12 e ! I S a
STREET ADDRESS lye S
CITY, STATE, ZIP Sew [ C
PHONE
r(/
ARCHITECT/ENGINEER NAME BRIAN SPECTOR
LICENSE NUMBER C 30491
BUS. LIC # 2493
COMPANY NAME SPECTOR CORBETT ARCHITECTS
E-MAIL BRIANS@SPECTORCORBETT.COM
FAX
STREET ADDRESS 54-C PENNY LANE
CITY, STATE, ZIP WATSONVILLE, CA 95076
PHONE (831) 319-4045
DESCRIPTION OF WORK THE PROJECT CONSISTS OF TENANT IMPROVEMENTS TO THE EXISTING COMMERCIAL BUILDING. THE IMPROVEMENTS
ARE: RECONFIGURE THE ENTRANCE LOBBY TO INCLUDE 3 NEW TELLER STATIONS CUSTOMER SERVICE AREA AND
WAITING AREA; CONVERT STORAGE ROOM TO ACCOMMODATE MOVABLE VAULT UNITS AND SAFE DEPOSIT BOXES;
ACCESSIBILITY/ADA UPGRADES.
EXISTING USE
BANK
PROPOSED USE CONSTR.
BANK
TYPE I
# STORIES
I
V -N
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA 2,339 SF
NEW FLOOR N/ADEMO
AREA
N/A
AREA
TOTAL 2339
NET AREA
BANK
B
717
150,000
BATHROOM
REMODELAREA N/A
KITCHEN
REMODEL AREA N/A
OTHER
REMODELAREA 718 SF
PORCH AREA
DECK AREA
N/A
TOTAL DECK/PORCH AREA
N/A
GARAGE AREA: DETACH
N/A
N/A ❑ ATTACH
#DWELLING UNITS:
IS A SECOND UNIT ❑YES
SECOND STORY aYES
BEING ADDED? ❑NO
ADDITION? O
PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF
PLANNING APPL # ®NO PLANNING APPROVAL LETTER
ISTHEBLDGAN ❑YES
EICHLER HOME? Q NO
RECEIVED BY:
_1
f,I y
TOTAL VALUATION:
150,000
"4'
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on e property owner's behalf. I have read this
application and the information I have prod , 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 bui ng construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: ' 03.1r)' 1 %
SUPPLEMEN AL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
El OVER-THE-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.
❑ EXPRESS
Q- 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.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
_
submittal of Building Permit application.
El MAJOR
❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doe revised 06/21/11
M
VI
INSPECTIONS, Inc.
DSA FILE#
4 CONSTRUCTION INSPECTION SPECIALISTS DSA A 1 #
9O suOL ST , BLDG. H • SAN JOSE, CA 95126 = f Appl.
.(408) 288-8460 • Fax. (408) 271-0902 • - OSHPD
IEW.LOgL /
ANCHOR INSTALLATION INSPECTION REPORT
City of. CCApe,r Date g/1 0/f 7
Project e' — Pro' ct� # --
Addre's /et qQ _Ss e veers C, e K ) 'Permit# f- � �/7 a
Inspecto\s,Name � /r''. ./P c. r e z-- ID .
Installation Inspection of. f-fitififingteel-{ o . ,Epoxied Allth read Anchorsa iela-Anlao,xs_
OWitnessed the drilling of the holes and verified proper diameter and depth
(or)
Xlenspected predrilled holes and verified proper diameter and depth
r
Observed the cleaning of the holes and the 'ection- insertion of Is y Srat7 . '
epo .r /epoxy capsules/grout, ICC ER# 67/55> Expiration Date 42//;---"/
/�,/✓
I Witnessed the proper insertion of.
--'' (No ) 7;1 diamete a thread anci' --retnfiurcrng-steel-dowels /. p i a h,exs.
,,/,. .2 inches in length, embedded ,/'' � inches, at the following location 7/d q
. ^r J lJ o'• Ccs`` ._ 't WI 4-4 /74- PO /41 co"t'� 91 Per 11:::41"?
(No ) diameter allt ead anchors / reinforcing steel dowels / exp #ion anchors
inches in length, embedy' inches, at the following to bion
(No ) / diameter allthread anchors / reinforcing s1,eel dowels / expansion anchors
inches/4i lengtft, embedded inches, 4the following location
Notes
(1;11 A fIC-1), "--.1:5 L.; <-7 1/e--,1/74 7e;;C;7/or-V
To the best of my knowledge, work inspected was in accordance with the building department approved design drawings,
specifications and applicable workmanship provisions of the C B C except as noted above
Inspectors' signature , -`r. „&."<"