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14090204CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20450 STEVENS CREEK BLVD I CONTRACTOR: SC BUILDERS INC PERMIT NO: 14090204 OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 1 910 THOMPSON PL i DATE ISSUED: 11/21/2014 1 OWNER'S PHONE: 4089961010 1 SUNNYVALE, CA 94085 { PHONE NO: (408)328-0688 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 3� Lic. # `j b7R�o ContractorSC �jJ tiJE� S J C Date C"� t ,51 1 10 Ls 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. 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. 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 ,Q'ol� ❑ 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). 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 1 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. JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL APPLE T.I. - ADD SIX (N) SECURITY VESTIBULES ON 6TH FLR, INCLUDING ELECTRICAL @ CONFERENCE RM (N) MDF ROOM (2000 S.F.) Sq. Ft Floor Area: I Valuation: $105000 APN Number: 36901027.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION, Issued by: Date: r / t 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. 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Sections 25505,�533,and 25534. Owner or authorized agent: ! Dater I 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed 1� CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0cupertino.org Zo`1 ❑ NEW CONSTRUCTION ❑ ADDITION V ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT .ADDRESS 7APN # 0 rj C.Q_%E ' O OWNER NAMEP�jQ�NE 'KJis.� �I E-MAIL $NVP1_1EZ Ib\b .CaHtcle QpPL1_ .Co STREET ADDRESS CITY, STATE, ZIP FAX t: t 1% vm L.toa CONTACT NAME �`` PHONE hP(LNt_ CUP.�i E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX F t M'tc P v P t,ZT1N� C•�=o ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER XENANT CONTRACTOR NAME LICENSE Ny14 BER LICENSE YPE BUS. LIC # COMPANY NAME E-MAIL FAX v Go �1 STREET ADDRESS CI Y, STATE, ZIP PHONE ��a Tt �a� P�i►Csc. So Rt*; cf. q(* . ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC # Q NA kil Dt-g (L C 15 A COMPANY NAME E-MAIL FAX 1b N ".AoVL9t_ giV las Ca� STREET ADDRESS �' ..►i�2t:7 ��"• CIT STATE, ZIP a � A'�-1SLo Citi `C� � PHONE � S . '1.��5� DESCRIPTION OF WORK '`3�.c �� t �C, h � o <i. G�Yc, � ✓1e e f Qeort �� `�R„v tctdi Cf� C>L �Z�cR EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES ` • '�ays1,►s��S �• aV ✓��1 8 USE TYPE OCC. SQTT. VALUATION ($) EXISTG NEW FLOOR � DEMO TOTAL AREA AREA r AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/POR7AREAGAFAGE AREA: DETACH ATTACH # DWED INGUNITS: IS A SECOND UNIT ❑D STORY YES BEINGADDED? ❑ON? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES EIVE 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 authorize nt to er's be I have read this 4,�eprope application and the information I have provided is co e ave d the Description of Work and verify agree to comply with all applicable local ordinances and state laws relating t uildin constru I authoriz epresentatives ofCupertino to entbo�vee-identified property for inspection purposes. Signature ofApplicant/Agi Date: Z;N ao%t� SUPPLEMENTAL lNFO &4-FQUIRE PLAN CHECK TYPE ROUTING SLIP OVER-TIIE-COUNTER ❑ 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 ❑ PUBLICWORKS form if any Hazardous Materials are being used as part of this project. 1] LARGE ❑ FIRE 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.doe revised 06/21/11 CITY OF CUPERTINO RM -7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20450 STEVENS CREEK BLVD DATE: 09/30/2014 REVIEWED BY: MELISSA APN: 369 01 027 BP#: 'VALUATION: 1$105,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 2,000 PENTAMATION 113 TI PERMIT TYPE: WORK APPLE T.I. - ADD SIX N SECURITY DOORS ON 6TH FLR INCLUDING ELECTRICAL SCOPE CONFERENCE RM & (N) MDF RM OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA S.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) I-A,I-B 2,000 $3,349.45 IBTIPLNCK $2,715.30 1BTIINSP $0.00 PME Plan Check: $0.00 Permit Fee: $2,715.30 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 2,000 $3,349.45 $2,715.30 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes ) No F-1 I E]_L_ Ll --I- 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 based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution II -053 Elf 71 I3) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,349.45 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,715.30 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? © Yes (j) No $0.00 Advanced Planning 1 ee: $0.00 Select a Non -Residential Building or Structure 0 i Strong Motion Fee: IBSEISMICO $29.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $6,099.15 $0.00 TOTAL FEE: $6,099.15 Revised: 08/20/2014