13090132CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20357 STEVENS CREEK BLVD
OWNER'S NAME: W D V PROPERTIES
CONTRACTOR: T -OSE
I Con soh' "*' ^_
PERMIT NO: 13090132
DATE ISSUED: 11/12/2013
I OWNER'S PHONE: 4159954782 1 . I PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class_ _ Lic.#�
Contractor f�i1JA - arg,eg C -^i w 6ateate��
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.
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
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
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 i
9.18.
Signature " Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
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
permit is issued.
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.
Signature
Date
JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
CUPERTINO DAY SPA- COMM. T.I 1334 SQ FT CHANGE 12
DOORS TO 36" WIDE FOR ACCESSIBILITY. INSTALL 6
ADA
SIGNAGE,INSTALL 2 GRAB BARS IN BATHROOM. 2
Sq. Ft Floor Area: I Valuation: $2000
APN Number: 31626090.20357 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DPERMIT ISSUANCE OR
180 DA O ST CALLED INSPECTION.
ii b �
b ""°"- Date: li
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:
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. 1 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, 25533, and 25534.
Owner or authorized agentXi` Dater
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 Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINQ (408) 777-3228 • FAX (408) 777-3333 • buildinana cupertino.org DUPLICA
❑ NEW CONSTRUCTION ❑ ADDITION (ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
'„x.12
PROJECT ADDRESS „ I ry P APN # y
OWNER NAME
PHONE :
E -MAR,
STREET ADDRESS 't J��
J/
CITY, STATE, ZIP
FAX
CONTACT NAME /
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 7
LICENSE NUMBER 7
LICENSE TYPE
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK'! �., C/V
QMµ....
77, JJ ",
F
7
y ` Llf�
EXISTING USE
/PROP(ep USE CONSTR.
TYPE
# STORIES
7
USE
TYPE
OCC.
SQ.FI.
VALUATION ($)
AREA
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
�
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODELAREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: EIDETACH
❑ ATTACH
N DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY:
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
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. I have read this
application and the information I have provided is con-ect. I have mad the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: ''%j
SUPPLEMENTAL INFOWATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ O 'ER-THE-COUN YR
❑ 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`
❑ PLANNING PLAN REVIEW
Commercial BIdgs: Provide a completed Hazardous Materials Disclosure
STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑
❑
LARGE
EIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
El
Cl
submittal of Building Permit application.
ntnJOR
SANITARXSEwERDISTRICT
I it
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc ). These feet are hosed on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef 7/1/13)
1.11 i
j FEE ESTIMATOR
yr 1. UrIMN1111%J
- BUILDING DIVISION
MISC ITEMS
ADDRESS: 20357 stevens creek blvd DATE: 09/17/2013
REVIEWED BY:
mendez
Plan Check, Hourly
1STPLNCK
APN: BP#:
�`� c' G)
-VALUATION:
1$2,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
$0.00
PRIMARY
Commercial Building
PENTAMATION
1GENC0
USE:
hrs
$0.00
PERMIT TYPE:
WORK
cu ertino day spa- comm. t.i 1334 s ft"
$0.00
PME Permit Fee:
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc ). These feet are hosed on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
2 hours
$278.00
Plan Check, Hourly
1STPLNCK
Suppl. PC Fee: Q Reg. 0 OT
10.01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee -0 Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
7r�FAaraY^;ll"�.Mdt'r' Ta;a:
Q
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
I i
7)-'Iti (V 0ocinnearoli arr
Strong Motion Fee: IBSEISMICO
$0.50
=hrs
$556.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
Si75'A
$1.50
$834.00
" Tfi►AI
$835.50
Revised: 08/01/2013
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: sl „5' CC 6 11
PERMIT # 1 309 b 1 7i
OWNER'S NAME: ' ;,1 /
PHONE #
GENERAL CONTRACTOR: r
BUSINESS LICENSE #
ADDRESS: 40 - -& e"
CITY/ZIPCODE: e "
*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:
s/
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature Date