13040008CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20330 STEVENS CREEK BLVD
CONTRACTOR: DEVCON
PERMIT NO: 13040008
CONSTRUCTION INC
OWNER'S NAME: SVF CUPERTINO CITY CENTER CORPORATI
690 GIBRALTAR DR
DATE ISSUED: 04/11/2013
OV^ER'S PHONE: 6505205483
MILPITAS, CA 95035
PHONE NO: (408)942-8200
G LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
License Class Lic. k 39 3
3RD & 4TH FLR T. I. TO CREATE NEW OFFICE SPACES
/
��
WHICH INCLUDE PARTITION WALLS AND ELECTRICAL
Contractor ��_►» / Date di
&
I hereby affirm that 1 am licensed under the provision of apter 9
MECHANICAL FOR OFFICE SPACES
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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: $900000
performance 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
APN Number: 36901020.00
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 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 DAYSST 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
Date: l 13
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
"°
RE-ROOFS:
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:
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).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
1 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 1 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 Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 Labor Code, for for
the Health & Safety Code, Sections 2550, and 25534.
,°
✓
of the the performance of the work 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, 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, 1 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
1 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
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
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C—UPERTINO
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CONSTRUCTION PERMIT APPLICATION oO
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION AP
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O
(408) 777-3228 • FAX (408) 777-3333 • building(1cupertino.orq \41
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PROJECT ADDRESS ^t Vf(h1, �t f
APN fl U D
OWNER NAME
E-MAIL
STREET ADDRESS CITY, STATE, ZIP
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FAX
CONTACT NAME a�-� �'��� PH I�• �w•� �•� EMAIL �,�r4` Q. tO
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 0NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR
LICENSE ER
LICENSE TYPE BUS. LIC fi
COMPANY NAME �♦On /I��s •
C
E MAIL��c . FAX
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STREET ADDRESSD
9M HONE
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AOO-`•`
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ARCHITECT/ENGINEER NAMEO � LICENSE NUMBER /� ^ BUS. LIC #
9d6
COMPANY NAME
E-MAIL FAX
I N�
STREET ADDRESS
CITY, STATE, ZIP HONE
DESCRIPTION OF WORK
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ore /
EXISTING USE
�
PROPOSED USE CONSTR-
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TYPE I
' �
I STORIES
USE
TYPE
OCC.
SQ.IT.
VALUATION ($)
EX1S G
AREA efG010
NEW FLO�OR
AREA 7i00
DEMO
AREA .--jam-
v
TOTAL
NET AREA yc ole
r_y/�
o r' ''rt
��
I
f+
9010, 1000
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
I GARAGE AREA: LJ DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECOND STORY ❑ YES
BEINGADDED? E] NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
A
IVED V LU ION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
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V
By my signature below, I certify to each of the following: I am the property owner or au ed a ent to act the pr owner's behalf. I have read this
application and the information I have provided is coEre ave read the Description of Work and verify it I te. I agree to comply with all applicable local
ordinances and state laws relating to buildin n. I a resentatives of Cupertino to enter the above-ide tifie roperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT�L�10N D
PLAN CHECKT E
ROUTING SLIP
❑ OVER-THE-COUNTER
BUILDING PLAN REVIEW
New SFD or Multifamily d for demo Itlon permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
XPRESSPLANNING
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
❑ MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
Bldg,4pp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
19
ADDRESS: 20330 STEVENS CREEK BLVD DATE: 04101/2013
APN: 369 01 020 BP#: ��"
REVIEWED BY: MELISSA
'VALUATION: 1$900,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
BP FEE ID
PENTAMATION
PERMIT TYPE: I B l;
WORK
3RD & 4TH FLR T. I. TO CREATE NEW OFFICE SPACES WHICH INCLUDE PARTITION WALLS
SCOPE
AND ELECTRICAL & MECHANICAL FOR OFFICE SPACES
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-A,111-A,V-A
4,600
$2,831.20
1BTIPLNCK
$4,562.64
IBTIINSP
Eicc. last). Fee:
$4,562.64
Suppl. Insp. Fee:Q Reg. Q OT
O.
hhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Con,towcti"on Tax:
�clrrairtrstrcrtrve .Fee:
0
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
4,600
$2,831.20
"' �,
$4,56264'
Strong Motion Fee: IBSEISMECO
EC1�C5[7RL //,,Sus c
<,� �„�: i ,.,,_,,,,in.,i�;.s.o✓� i,,,,.., „1, ,,,,.,,.,ti it
_.
PALM$ HUURLI ,10, Yes ;, • o
il,��,, r,r,...7
L+LIHJC' HUl7RL' Yes%; • No
Mcclr. Nan Check
Phemh. %/Cart Check
Check
i
''rc h. Merril Fee':
TIwmh. Permit Fcc.
Lzlcac. Permit F«e.
cC�As
'tl
.
0!1?r)1cr. lnsp.(7))E?F'
Ll
,Tech. Insp.
I'Iv b, Tres/). Fee:
Eicc. last). Fee:
NOTE This estimate does not include fees due to other Departments (Ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,831.20
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$4,562.64
Suppl. Insp. Fee:Q Reg. Q OT
O.
hhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Con,towcti"on Tax:
�clrrairtrstrcrtrve .Fee:
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure �
i
Travel Documentation Fees:
Strong Motion Fee: IBSEISMECO
$189.00
Select an Administrative Item
Bldg. Stds Commission Fee: 1BCBSC
$36.00
�„
' SUBTOTALS:
,
$7,618.84
$0.00 TOTAL FEE:`
$7,618.84
Revised: 0410112013