15020119tj\r
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20803 STEVENS CREEK BLVD
CONTRACTOR: SILICON X
PERMIT NO: 15020119
CONSTRUCTION INC
OWNER'S NAME: SAICH WAY STATION LLC
2051 JUNCTION AVE
DATE ISSUED: 04/24/2015
OWNER'S PHONE: 4084534700
SAN JOSE, CA 95131
PHONE NO: (408) 418-0099
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
_ r
License Class Lic. 4 32 1
SAICH STATION - INSTALL (N) DEMISING WALL (60
LINEAR FT) IN SHOP 6 & INSTALL TWO 6 TON HVAC
tt _ (A I �
UNITS
Contractor S " I � � y\ � Date 15
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
Sq. Ft Floor Area:
Valuation: $25000
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
APN Number: 32632042.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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
WITHIN 180 DA fRMT 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 D OM LAST CALLED INSPECTION. i
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comp)
---- Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
�^
RE -ROOFS:
Signature Date +�
All roofs shall be inspected prior to any roofi linalled. If a roof is
fi new materials for
installed without spection, I a t ov
inspectio
❑ OWNER -BUILDER DECLARATION
re of Appli Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL R OF VERI S Td B " 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)
I, 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 the Cupertino unicipal Code, Chapter 9.12 and
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
the Health & Safety Code, Sections 2550 5 3, and 25534.
'M S
Owner or authorized agent: Date:
permit is issued.
Vfll
I certify that in the performance of the work for which this permit is issued, I shall
IYV
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
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
i
" lie
1,Dg-5- 93�
CONSTRUCTION PERMIT APPLICATION `C)\
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION V�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O V
CUPERTINO (408) 777-3228 • F 777-3333 • building(cDcupeptino.org
NEW CONSTRUCTION ❑ ADDITION TERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERNUT #
PROJECT ADDRESS ,209J �� ,1
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CONTACT NAME
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME_
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LICENSE NUMBER a �Z9 �—
LICENSE TYPE �2
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ARCHITECT/ENGINEER NAME A
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DESCRIPTION OF WORK / r ,/J _ _/ _ 'j�� , f, /NS rP-//
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E�T1W USE S �/
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PROPOSEDP_f s �I
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TR.TYPE
V .TY
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
L
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREADECK
AREA
TOTAL DECKJPORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
#DWELLINGUNITS:
ISA SM;CONU UNIT [YES
SECOND STORY [YES
BEING ADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIV
TOTAL VALUATION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER
EICHLERHOME? NO
By my signature below, I certify to each of the following: I am the property owner o&AlTorized a t to act on th 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 rate. 1 agree to comply with all applicable local
ordinances and state laws relating Li ing construction. I authorize representatives Of Cupertino to enter the above -i n[ified poperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INF REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_New SFD or Multifamily dwellings:ly _ r 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.
❑ 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
BUgAPP.201 ].,toe revised 06 Q1/11
CITY OF CUPERTINO
i� FEE ESTIMATOR — BUILDING DIVISION
19
ADDRESS: 20803 STEVENS CREEK BLVD
DATE: 02/19/2015
REVIEWED BY: MELISSA
APN: 326 32 042
BP#:
1
VALUATION: 1$25,000
"PERMIT TYPE: Building Permit
_!�2
PLAN CHECK TYP : Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
-in BQ zone? ® Yes 0 No
PENTAMATION
PERMIT TYPE: 1 GENCOM
WORK
STATION - INSTALL N DEMISING WALL 60 LINEAR FT IN SHOP 6 & INSTALL TWO 6
SCOPE
MAICH
N HVAC UNITS
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dietrirt_ atr.)_ Theee f-oe are hnced nn the nreliminary infarmatinn availahle and are anly an estimate_ Contart the nent for addn 11 info_
FEE ITEMS (Fee Resolution 11-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= Lf.
$610.00
Interior Partitions
1PARTICOMM
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
2 #
$286.00
Mechanical
1BCAIRHA I A/C Units (<=10K cfm)
Pen -nit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
0,0
hrs
$0.00
= # Mechanical
$286.00 1MFR=<100 Furnace, Forced -Air
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction Tax: 1BCONSTAXC
$0.00
Administrative Fee: 1ADMIN
$45.00
0
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
Travel Documentation Fee: 1 TRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICo
$7.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$149.001$1,182.00
TOTAL FEE:
$1,331.00
Revised: 02/14/2015