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14050039crry OF CIJPERTIN0 BUILDING PERMIT UILDINGADDESS, 19925 STEVENS CREK EBLVD BR CON'ri-CtCTOW NOVO CONsml.JCTION 1'E110 n'"r NO14050039 OWNER'S NAME: S'I'F-,VFNS CREEK INVRS LLC 1460 O'BRIEN DR DATE ISSUIED; 051OW2014 ONNINER'S PHONE: 4094990233 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 JOB DESCRivrION: RESIDENTIAL COMMERCIAL L1CFNSE1D CONTRAGFOH'S DECLARATION APPLE T.I. PREP FOR INTERIOR DEMO OF NON License Ckiss— 2, Lic. STRUCTURAL ITEMS (42,355 SY) I hereby, affirm that I am licensed under the provisions of Chapter 9 (roloolcuting with Section 70,00) of ffivision 3 of the Business & Professions, Code and that in.), license is in full force and effect. I hereby after rin under penalty ofpcl-jol-y one of the Hiowing two declarations: I haveand will maintain as certificate of consent to, self -insure for Worker's Compensation, as provided for by Section 3700 of tire Laboi- Code. I -or (lie perfoiniancc of the Nvork for which this permit is issued Sq. Ft Floor Area. Valuation: 564000 I have arid 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 %PN Number: 316210f89T.00 OccuprincyType: permit is issued. APPLICANT CERTIFICATION i certify that I have read this application and state that the above' intorroation is PERMITETIRES IF WORK IS NOT STARTED correct. I agice to comply xvith all city arid county ordinances and suate laws rchating WITHIN DAYS OF PERMrr ISSUANCE OR to budding cora mmetion,arld hereby authorize repiescruatives of this Qity to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA RO LAST CALLI�D INSPECTION. Y indciuniand keep hamiless [tie CIt: y of Cupertino against liabilities, judgniclus, costs, and expenses which may accrue againstsaid City ill C0flSCqL1CoCC Ofthe IssuLd by: Da granting of this pernot. Additionally, file applicant understands and will comply with all non -point source regulations per file Cupertino Munielpal Code, Section RE-ROOFS.- All roofs shall be inspected prior to any roofing material heing installed. If a roof is 9.18. 1 Signatore 'A /V".— Date.— installed mriliout first obtaining an inspection, I agree to remove aif new materials for inspection. El (JIVNER-BUILDER DECLARATION Signature Date: I hereby affirm that I am exempt frolli the Contraclor's License Lays for one of the following two reasons: ALL ROOF COVERINGSTO 141 CLASS "A" OR 11FITEIR 1, as ow mer of the property, or my employees with wages as their sole compensation, will do the Nvork, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner oftlic property, am exclusively contracting with licensed contractors to 11AZARDOUS MATERIALS DISCLOSURE construct the project (See.7044,13usiness & professions Code). I have read tire hazardous imaterials requirements under Chapter 6.95 of the (."fthforrlia ilellith & Safety Code,, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty, of perjury one of the fbfloMog three maintain compliance Nvith the Cupertino Municipal Code, Chapter 9.12 arid the declarations: licalth & Safety Code, Section 25532(a) should I store or handle hazardous I have arid will maintain a Certificate of Consent to Seff-ilISUTe for Worker's material. Additionally', should I use equipment or devices which emit hazardous Compensation, its provided For by Section 3700 of the Labor Code, for the air contaminants as detined by the Bay Area Air Quality Management District I performance orthe work for which this permit is iSSLied. 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 I letilth & Safety Code, Sections 25505, 25533, and 25534, 'rife ork for which this r file perroraref fw Section 3700 ofthe Labor Code, fom 1 � l, rized agent: Date: b I Owner oantho permit is iSSLIC(l. I certify that in the ficiformance of flit work for which this ficinut is issued, I sliall not C1TlPk)yany-S0ll in any Manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY wter Compensation las of Carl forn ia. if, after making ioc, this cerlificof exemption, I become subject to the Worker's Compensation provisions or [lie Labor Code, I nimt I hereby affirm that there is a construction lending agency for tire performance of forthwith comply x0th Such provisions or fill,, permit shall be deemed revoked. work's for which this permit is issued (See. 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 corrcct. I agree to comply with all city and county ordinances and state laws relating to building C011SIRICtiOl7, and hereby authorize representatives of this city to enter i upon the above mentioned property for inspection purposes, (We) agree to save ARCHITECT'S DECLARATION indemnify arid keep harmless the City of Cupertino against liabilitics,judginents, costs, and expenses Much may accrue against said City in consequence ofthe I understand my plans shall be used as public records. granting of this permit Additionally, the applicant understands and will conipy with all non -point source regulations per the Cupertino Municipal Code, Section Licensed professional - 9 is, Signatore Date_ COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 L_ '408) 777-3228 - FAX (408) 777-3333- building(cDcupertino.org CUPERTINO I L -J NEW CONSTRUCTION L—JADDITION LTERATION/Tl L --J REVISIONIDEFERRED ORIGINAL PERIYOT 4 PROJECT ADDRESSa. -Z, o ON�NER NAVE rc'Av\c, PAONE Y'� I STREET ADDRESSCITY, STATE, ZIP I A- FAX E -NIA CONTACT NAME PHONE " IL , 3 STREET ADDRESSICITY, STATE, ZIP FAX .. .. .. .... El ow,,sR 0 MkNER-BUILDER 71 0%VWE R AGENT CON-MACTOR El coNTRACTOR AGENT ARE; 11 ENGINEER 171 DrNELo?FR El TENANT CO'INITRACTOR NAME LICENSE NUMBER -- LICENSETYPE B BUS. LIC 9 COMPANY NAME t k'S �-y L) (,J 14 E-MAIL V �r t, S V% (�q 6vyivl,�c, bul �v-� FAX STREET ADDRESS CITY, STATE, ZP Loll. PACNE ,kRCETECTIENOTNEER NAME LICENSE N7JIABER BUS LIC 9 COMPANY NAME& E-MAIL FAX STREET ADDRESS CM, S:TATE, ZIP PHONE Gc,� I,'�v,,Jtkkz) CP ("A. ut DESCRIPTION OF WORK . � t91V. -ii,.Ta I r rA, i4cmuhll`tv-1 ..... LIVVA In efr�,u 'it -l"CVt lr)-Icu� mM co" IwWvI6 U'l V,�ilylflfl�', �rl EXISTING USE PROPOSED USE CONSTR- PF STORJ.ES USE TYPE Occ. SQTT VALUATION (S) EXISTG NEwh FLIOCR DEhIO L AREA AREA AREA NET AREA o, BATI-2,00M KITCrIEN ICTHE.R REMODEL AREA RENIODE L ARE A REINIODELAREA PORCH AREA DECK AREA TOTAL DECKTIORCH AREA GARAGE AREA: DETACH F1 ATTAC14 UNIT S� ,IT D r YES ISA ND UNIT SECONDSTO ]Iv [] YES BEING ADDE�D? NO I: E3, ADDITION? F]NO PRP-AYFLWATION FYESIF YES, PROVIDE COPY OF IS T14E BLDG AN [] va�,� TOTAL VAL UATION: PLA2,7INGAPPLI` ®NO PLANNP�G, APPROVAL LETTER EICHLER HONIE? aP By my sipature below, I certify to each offfie foflowing: I am the pn1perty owner or authorized I el the property o,,ner's behalf I have read this g � et �:salcurate. application and ffie infonnation I have provided is correct. I have read the Description ofWork and �; , y it il I agree to comply with all app�licable local ordinances and state Ian's rclating to bu�ldip r nstractiom I authorize representatives ofCupartino to enter the above- identi fie d property for inspection purposes. SiPaaLUe ofApplicantJARent: Date: :,"Jel io SLIPPLEN41-NTAL FINIFORMATION REQUIRED ""I"ROUTIN SLIP New SFD or 'Multifarrifly dwellings: Apply fom Etat deolition ptrinit for 'D R T rawexlst�ng buflding(s). Deniofldon pernift is required prior to issuance ofbu�lding "TS' OPLA permit for new building. Conirnercial Bldgs: Provide a completed Flazardous Materials D1sclosure S, "i A, IN' IJARDI forin ifany Hazardous Materials are being used as part ofthis project. Al Copy ofPlannin'g Approval Letter or.Meeting with Plannln.g prior to "A'Z2 ;ub—rnittal ofBuildin Perrnit application, ,.. . . ... -,,- BIdgApp_2011.doc rev sed 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ,2- PRINIARY Commercial Building USE: I.M.....err T.I. PREP FOR INTERIOR DEMO OF R.UCTURAL JTEMS (42,355F�?I NOTE: This estiniale does not inchielefiees due to other Departments (Le. Planning, Public Works, Fire, Sanitan, Sewer District, School District. etc.). These fee.v tire horsed on the nrelinthiart, information availahle and are onlip an estiniate. Contact the Dent for addii 7 info. FEE ITEMS (Fee Rewhaion 11-053111 7113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 $40 Tenant Improvement Prep SLIPPI. PC Fee: (D Reg,, 0 OT M lirs $01.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:( D Reg. PME Unit Fee: 0 OT lirs $0.00 $01.00 PN/1E Permit [-'ce: $0.00 0 0 Work W thout Permit? 0 Yes No $0.00 Advanced Planmn!,Ce, ,�,, $0.00(F) Select a Non-Resideritial BUilding or Structure 0 Sirom, Njoclorl e1-�j : - IBSFISAWCO $13.44 $405.00 Select an Administrative Item TOTAL FEE: $421,441 131�,!g ',,�tjs [,'ce: .. . .... . .... . . IBCBSC SUBTOTALS: $3.00 $M44