13030141I CITY OF CUPERTINO BUILDING PERMIT I
I BUILDING ADDRESS: 10101 N WOLFE RD I CONTRACTOR: TECHCON I PERMIT NO: 13030141 1
OWNER'S NAME: SEARS ROEBUCK AND CO 116200 VINEYARD BLVD STE 100 1 DATE ISSUED: 04/29/2013 1
OWNER'S PHONE: 8472867538 1 MORGAN HILL, CA 95037 1 PHONE NO: (408)778-1350
❑ ��L((ICENSED CONTRACTOR'S DECLARATION
License Class /TR G �7 Lic.
Contractor coot" Date
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:
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. Additio the applicant understands and will comply
with all non -point source re0ationsher the Cupertino Municipal Code, Section
9.18.
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
RELOCATE EXTERIOR SLIDING DOORS AT KIDS LOBBY
TO
THE INTERIOR AT CAFE & REPLACE SLIDING DOORS
WITH
NEW STOREFRONT SYSTEM.
Sq. Ft Floor Area: � Valuation: $20000
APN Number: 31620080.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WIT AYS OF PERMIT ISSUANCE OR
180 DA OM LAST CALLED INSPECTION.
Issued by: IDate:
-_�&//3
RE -ROOFS:
Signature ``'e'— 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
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons'
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
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.
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.
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 l have read this application and state that the above information is
correct. l 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
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. 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 Q
will maintain compliance with the Cupertino cipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 2550 553Y, and 25534.
Owner or authorized agent:
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 ®�
91 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 / 1_0
CUPERTINO
(408) 777-3228 • FAX (408) 777-3333 e building cDcupertino.org �
❑ NEW CONSTRUCTION ❑ ADDITION 4 ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 9
PROJECT ADDRESS D
APP # 3 j 6- 0 g0
OWNERNAMEK"
L
PH�Z Pp�E
/53A91 Oo klgrto a.
STREETADDRFSS333-PP691-y k-9
Y, STATE,ZIP�� '� 6"/21 1 FAX
CONTACT NAM= OW dAVtOe- QW�
PHONE �I a Q d�
WM104*91VAC-d"5eW (c�%
STREETADDRFSS/ "�A gr) �S���}�
Y S E, ZIP S� C�
FAX
El OWNER 11OWNER-B/UI LDFFR'❑ OWNERAGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHnECT ❑ ENGINEER ❑ DEVELOPER PfTENANr
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARC ECT/ENGINEERNAME�� pp - 0,T -
-
LICENSE BER/�1 A�v �
� �j
BUS. LIC#
COMP NY AME E-MAIL A
s
FAX
STREET A DRESSV—
og itgkz I �� CITY, STATE, ZIP � �
Fwmi-sllg
,
DESCRIPTION OF WORK S
/NfAWA At A -0D A5?744ro-ZF f4-1P1A14!5 PSS e-r/1VA/4c
sw/"
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
�j
-Z�' 3, %j /Loi
7
N� i4f4, IC
�J
USE TYPE
OCC.
SQ.FT.
VALUATION ($)
AREA
#nl/vr�a/v'
NEW
AREAO
TOTAL
TAREAJ
-
1,00 a
BATHROOM
REMODEL AREA I
KITCHEN
RI]NODEL AREA /
OTHER
REMODEL AREA
PORCH A
DECK A TOTALDECK/PORCHAREA
GARAGEARFA: DETACH
—`
❑ ATTACH
# OWE ING ITS:
ISA SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEINGADDED? 9110
ADDITION? 9ko
PRE-APPLICATIO []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
T AL VALUATION:
PL INNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? �0
2-0 1 ovv, flys
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act otie perty owner's behalf. I have read this
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 o build' lg{ construction. I uthonze reprye�entatives of Cupertino o enter the abov -identified property for inspection purposes.
�� inid7��'
Signature ofApplicandAgenC �/1M� r'" Date:
SUPPLEMENTAL INFORMATION REQUI
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
4
r� 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 Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGEFIRE
DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06121111
&0*1
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10101 N WOLFE RD DATE: 03/22/2013 REVIEWED BY: MELISSA
APN: 316 20 080 BP#: �D� ® 'VALUATION: 1$20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1ATI
USE: PERMIT TYPE:
WORK T. I. TO REMOVE EXTERIOR EXIT DOORS & RELOCATE BETWEEN CAFE & LOBBY AREA. ALL
SCOPE EGRESS REQUIREMENTS & PATH OF TRAVEL
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
A (Tenant Improvements)
II-8,111-B,IV,V-B
420
$2,267.00
IATIPLNCK
$551.00
]ATIINSP
Elec Insp. Fee:
PME Plan Check:
$0.00
Permit Fee:
$551.00
Suppl. Insp. Fee -.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
420
$2,267.00
Construction 1 ax.
$551.00
MECH, HOURLY Yes 0 No
PLUMB, HOURLY 0 Yes (!) No
ELEC, HOURLY 0 Yes Q No
Xlec:lt: Ilion Check
Phunh, Plan Check
F_lec:..Plan Check
kfech. PerwitFee:
Plumb. Permit Fire:
Elec•, Permir Fee:
Other dfech. Insp.
(/her Plumb Insp.L1 I
Other Elec. Insp. Ll
Me& Insp. Fee:
PJrnnb. Lisp. Flee:
Elec Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are hated on the nreliminary information availahle and are only an estimate. Contact the Dent for addn7 into.
TEE ITEMS (Fee Resolution 11-053 Eff 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,267.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$551.00
Suppl. Insp. Fee -.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction 1 ax.
Administrative .Fee:
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or: Structure
0
0
Travel Documentation Fees:
Strong_ Motion Fee: IBSEISMICO
$4.20
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2,823.20
$0.00
TOTAL FEE:
1 $2,823.20
Revised: 01101/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10101 N WOLFE RD CONTRACTOR:TECHCON PERMIT NO: 13030141
OWNER'S NAME: SEARS ROEBUCK AND CO 16200 VINEYARD BLVD STE 100 DATE ISSUED:04/29/2013
OWNER'S PHONE: 8472867538 MORGAN HILL,CA 95037 PHONE NO:(408)778-1350
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL D COMMERCIAL
License Class AII�,,,�c�7 Lic.# 7 Z T� TO
RELOCATE EXTERIOR SLIDING DOORS AT IUDs LOBBY
Contractor /e-4 C.Dou Date 'z Z®<•3 THE INTERIOR AT CAFE& REPLACE SLIDING DOORS
I hereby affirm that I am licensed under the provisions of Chapter 9 WITH
(commencing with Section 7000)of Division 3 of the Business&Professions NEW STOREFRONT SYSTEM.
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000
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 APN Number:31620080.00 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 WIT AYS 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 Igo DA OM LAST CALLED INSPECTIION.
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. Additio the applicant understands and will comply Issued by: Date:
with all non-point source r ations er the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature ` 't�'� 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
hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 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. I will
I 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 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 theCupertino 'cipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 533,a nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �,��`I—ZAI
permit is issued.
Owner or authorized agent: Date:
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 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.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, 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE^CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333 bullding(cDcupertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS n APN#116-" - 090
'6 r n� - 0 90
OWNERNAME/Til wV/ l L,^/-// �^a q j�-�f PH IDO" -S q d V V
,� R �17!/V N t7 V"I��I'" y '/S 37&19JL .3M4
STREET ADDRESS 333 P0
/A
14 P-11" Y,STJ�
ATE,ZIP 6#121 FAX
CONTACT NAME ES d G a"1 PHONE ®I a py E 104tvAc-el"5,cab P047
STREET ADDRESS/ mQApp Y S A E,ZIP P�^ FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
JARC 'CT/ENGINEERNAME�� LICENSE BER/A/, el Dv s- BUS.LIC#
COMP NY AME E-MAIL t� FAX
s
STREET DRE � � CITY,STATE,ZIP
DESCRIPTION OFNWORK e
" - 77AAl 4f __ y4wokmnev
WAlliM At J"44C,0�� Lqr AIPIA16 PIVXS _allfIA14
swNI;- .
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
AARREAG61l �7 �FLOOR t REE TOTAL !/t5 Z-4, 0®0
BATHROOM KITCHEN /.// OTHER
REMODEL AREA IREMODEL AREA REMODEL AREA
PORCH A DECK EA TOTALDECK/POORCHAREA GARAGE AREA: DETACH
[]ATTACH
#DWE RJG rrs: ISA SECOND UNrr ❑YES SECOND STORY ❑YES
BEINGADDED7 V0 ADDITION? *0
PRE-APPLICATIO ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES T AL VALUATION:
PLANNING APPL# ❑ ;
NO PLANNING APPROVAL LETTER EICHLER HOME? 0 OVV flys
�/CJ
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on a property owner's behalf. I have read this
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 reIa[ingo build''pi'construction. I uthorize repre enta[ives of Cupertino o enter[he abov -identified property for inspection purposes.
/Irvv.- r�r�n16-
Signature of Applicant/Agv Date:
SUPPLEMENTAL INFORMATION REQUIV5 PLANCHECKTYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure P,STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARCEFIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10101 N WOLFE RD DATE: 03/22/2013 REVIEWED BY: MELISSA
APN: 316 20 080 BP#: �D�® -VALUATION: 1$20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1A TI
USE: PERMIT TYPE:
WORK T. I. TO REMOVE EXTERIOR EXIT DOORS & RELOCATE BETWEEN CAFE & LOBBY AREA. ALL
SCOPE EGRESS REQUIREMENTS & PATH OF TRAVEL
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.L
A(Tenant Improvements) II-B,111-B,IV,V-B 420 $2,267.00 IATIPLNCK $551.00 ]ATUNSP
TOTALS: 420 $2,267.00 $551.00
MECH,HOURLY ! Yes E No PLUMB,HOURLY ® Yes No ELEC,HOURLY Q Yes Q No
�fecar:Plan Check Phorrb, Plan Check Elec.Plan Check
tLfech. Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
Other rlfech.Insp. Other Plumb Insp. L1 01her Elec.Insp. El I
,Lech.Insp.Fee: 111tnrth. hrsp. Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,267.00 Select a Misc Bldg/Structure
Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $551.00
Suppl. Insp.Feee. Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction I ax.
Administrative.Fee:
Work Without Permit? ! Yes No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Travel Documentation Fees: Building or:Structure
Stronjz Motion Fee: IBSEISMICO $4.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $2,823.201 $0.001 TOTAL FEE: 1 $2,823.20
Revised: 01101/2013