14070013CITY OF CU P]EIE TINO BUILDING PERMIT
BUILDING ADDRESS: 19720 STEVENS CREEK BLVD
CONTRACTOR: THE SHWAN DESIGN PERMIT NO: 14070013
AND BUILDERS INC
OWNER'S NAME: EVERSHINE VI LP
415 S MURPHY AVE DATE ISSUED: 08/22/2014
OWNER'S PHONE: 4083431088
SUNNYVALE, CA 94086 PHONE NO: (408) 593-8723
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
PEOPLE IMPACT- TENANT IMPROVEMENT (1896 5Q FT)
License Class_/'�_ Li,. #�
Contractor 41k.,)
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.
hereby affirm under penalty of perjury one of the following two declarations:
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: $180000
ave 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: 36906009.19720 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
PERMIT EXP IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
��� fly® DAYS ® ]E][�lai[�� ISSUANCE ®�
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 AYS jFROM T CAjLIL]ED INS jEC�'�0�.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
�J
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date: !i
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Q] �
� 2
ROOFS:
Signature Dat
All roofs shall be inspected prior to anyny roofing material being installed. If a root' 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.1044, 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. 1 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 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
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dat e �2 g
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, 1
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
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
CCIiJS RUC CI J PER ,IIT �;PP �H. 10�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
' �- . 1 (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.oM
CU.P.F�I`I ICU OE97 49 13
❑ NEW CONSTRUCTION ❑ ADDITION AALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
APN #
OWNER NAME PHONE EMAIL
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❑ OWNER ❑ OWNER -BUILDER ❑ ❑ CONTRACTOR AGENT` ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
OWNER AGENT
CONTRACTOR NAME 546\40
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LICENSE NUMBER
LICENSE TYPE
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DESCRIPTION OF WORK
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EXISTING USE
PROPOSED USE CONSTI;.�E
#S 0 IES USE
TYPE
OCC.
SQ.FT.
VALUATION
VTOTAL
(S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
Q-�
AREA NET AREA e�V e
�
v
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKITORCH AREA
GARAGE AREA: DETACH
E3 ATTACH
# DWELLING UNITS:
IS A SECOND UNIT 171YEs
SECOND STORY El YES -
BEING ADDED?0
ADDITION? 0
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY 6F
PLANNING APPL # O PLANNING APPROVAL LETTER
IS THE BLDG AV S RECEIVE Y: -
EICHLER HOME?
OTAL VALUATION:
k4 f.
By my signaturelbelow, I certify to each of the following: I am the property wner or authorized agent to act on the 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 relating tobuilding construction. I authorize representatives of Cupertino to enter the above identified property for inspection purposes.
Signature ofApplicant/Agen . Date: (( �� /_/ _06
SUPPLEMENTAL INFORMATION REQUIRED':
CHECKTYPE=itoullNssirP,;.
❑,;ovZR- TxcoliNTERBUILDING
PIAN REvieW .
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
t
permit for new building.
❑'.EXRRESS. '
PLANNING P.LAN REVIEW
f
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTANDARbJ.
- P�4nLTC WORKS
_
form if any Hazardous Materials are being used as part of this project.
❑-LARGE
$IR -E DEPTa
_ Copy of Planning Approval Letter or Meeting with Placating prior to
y
L�lMAJOR :'
❑ SA1 ITARY'SiWER DISTINCT
submittal of Building Permit application.
-'
❑ ENVIRONMENTAT.HEALTH -
BldgApp_201 1. doc revised 06/21/11
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MY OF CUP E]IRUNG
FEE ]ESTTIViIATOR - BUff LDffNG Ill ffWSffCN
ADDRESS: 19720 Stevens Creek Blvd DATE: 07/03/2014 1REVEEWEIID BY: Sean
APN: ]BP#: Zilp �190/ 3 *VALUATION: $180,000
*PERMIT TYPE: Building Permit P1LAN CIIIIECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATIION 1E TI
USE: I PERMIT TYPE:
WORK Tenant improvement (People Impact) 1896 sq fl).
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
IFLR AREA
s.t:
PC (FEES
PC FEE ID
IBP (FEES
]BP IEEE IDD
E (Tenant Improvements)
II-B,III-B,IV,V-B
1,896
$3,776.95
IETIPLNCK
$3,361.16
IET1INSP
floc. hull). Fac.
Suppl. Insp. Fee -0 Reg. ®OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constritclion :Tax:
it dntinistralive Fee:
0
Work Without Permit? Yes E) No
$0.00
Advanced Planning Fee:
TOTALS:
1,896
1 $3,776.95
1
$3,361.16
0
M ECH, HOURLY ()Yes 0 No
PLUMB, HOURLY ® Yes G No
IEILIEC, HOURLY 0 Yes C) No
Mech. Plan Check
Plumb. Plon Check :::] E
Elec. Plan ('beck
1dat:l;, Permir Fee:
Pltnnh. Permit Fee:
Eiec. Permit Fee:
Other ;Meeh. Insp.
Orhew Ph/mh Tarp.
Other Flec. hrs/r.
Mech. Insp. Pee:
Plumb, Insp. Fee:
floc. hull). Fac.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Eire, Sanitary Sewer District, School
Di.etrirt- Pir_ f_ Thoep fops are havod an tho nroliminaru infarmniinn availahlo and are nnlv an ostimote. C antael the /Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 &71'1113) 7%1;'13)
1F1ElE
QTY/FEE
MIISC ITEMS
Plan Check Fee:
$3,776.95
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. () OT
0.0 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,361.16
Suppl. Insp. Fee -0 Reg. ®OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constritclion :Tax:
it dntinistralive Fee:
0
Work Without Permit? Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Travel Documentation Foes:,
Strong Motion Fee: 1BSEISMICO
0
Select an Administrative Item
7—
Bldg Stds Commission Fee: 1BCBSC
$8.00
SUBTOTALS:
$7,183.91
7 $0.001
TOTA1LlFEE:
$7,183.91