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15040090 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20525 MARIAN]AVE CONTRACTOR:DEVCON PERMIT NO: 15040090 CONSTRUCTION INC OWNER'S NAME: 20525 MARIAN]DRIVE LP 690 GIBRALTAR DR DATE ISSUED:04/13/2015 OWNER'S PHONE: 4087833025 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL / 2ND FLOOR LAB 2433.COMM.T.I 1546 SQ FT License Class_ Lic.# 3 C1 Co 6C 3 Contractor _Date 1 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. 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:32656001.20525 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.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS O RMIT 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 180 DAYS FRO A ALLED INS PE TI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1� granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: ✓ with all non- in ource regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signat Date7// l All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION 1 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. 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 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 Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety CodmStfil5505,25533,and 25534Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized ag permit is issued. Date: 3 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 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. Date CONSTRUCTION PERMIT APPLICATION ra COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �.( 5 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �'l� CUPf RTINO (408)777-3228• FAX(408)777-3333•buildinq(a)cupertino.org \(,, ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSJ � APN# 3 IJ�D� � 2(P Seo OWNER NAME /� P NE� E-MAIL STREETADDRESS C Y, STATE,ZIP i FAX 4*1 CONTACT N �/ P ONS, MAIL STREET DRESS ,,CITY,STATE;ZIP �t FAX 1-h Ifn ❑ OWIJER ❑ OWNER-BUDDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSE NUMBER LI NSE TYPE BUS.LIC# �Cvy� C COMPANY NAMe7, 4AIL FAX��c e rk�t- asst. - S REST ADD SSS �1 Y TAI �� (,SO HONEfj ARCHITECT/ENGINEER NAMEz—r ^ LICENSE�I 20 11 BUS.LIC# Lgo Pi 7 COMPANY NAME E-MAIL FAX Vt I/1 /� /�rM FAX tt CIA '7c 1 son r 1 `�1•��J f f 1 STREET ADDRESS CITY,STATE,ZIP P ONE !34, S S CA 06 1 I,!> �. DESCRIPTION OF WORK.--- 4 4 l - � EXISTING USE PROPOSED USE CONSTR TYPE #STORIE // TYPE USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO I TOTAL Z AREA AREA Co I NET AREA BATJAROOM 'KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH ❑ATTACH 4!DWELLING UNITS: IS A SECOND UNIT [3 YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION �'SS IF YES,PROVIDE COPY OF IS THE BLDG AN El YES EWE TOTAL VALUATION: PLANNINGAPPL# o PLANNING APPROVAL LETTMER EICHLER HOE? O By my signature below,I certify to each of the following: I am the property owner 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 relator Iding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED Y` 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 ermit or new ung ' t # rk P fbildio EXPRE$$ M, w PLANNIAGPLANREVIEW vg Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q STANDARD t � LICWO r form if any Hazardous Materials are being used as part of this project. (] LARGE �' '� art _Copy of Planning Approval Letter or Meeting with Planning prior to ' � S -11 �� submittal of BuildingPermit application. fi$Al\ITARYSERERDISTRIGT PPln ;ENVIRONMENTALHEALTA BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20525 mariani ave DATE: 04/13/2015 REVIEWED BY: Mendez APN: BP#: 150 `VALUATION: 1$200,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: I PERMIT TYPE: WORK APPLE 2ND FLOOR LAB 2433. COMM. T.I 1546 SQ FT SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. sS. B (Tenant Improvements) II-B,III-B,IV*13 1,546 $2,175.46 IBTIPLNCK $1,489.31 IBTIINSP TOTALS: 1,546 $2,175.46 $1,489.31 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY 0 Yes ( No ELEC,HOURLY 0 Yes 0 No NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . 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 Z/M FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,175.46 Select a Misc Bldg/Structure Suppl. PC Fee: (F) Reg. 0 OT 0.0hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,489.31 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes Q No $0.00 0 Advanced PlanninL Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Strong Motion Fee: IBSEISMICO $56.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $8.001 1 SUBTOTALS; $3,728.771 $0.001 TOTAL FEE: $3,728.77 Revised: 04/01/2015 From: 04/14/201 08:55 #684 P-001/001 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax:408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: `�j Icy�� PERMIT# I (fes OWNER'S NAME: PHONE#4epg'' 1I GENERAL CONTRA TOR: BUSINESS LICENSE# ADDRESS CITY/ZIPCODE: *Our municipal code requires all businesses wor ing in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: &/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets & Millwork �� l `j 3 47, Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating co Insulation Landscaping Lathing Masonry Painting/Wallpaper G{ / Sa /„ Paving Plastering Plumbing Roofing Septic Tank ,,-Sheet Metal j1�� L) -. 2-1 Z Sheet Rock Tile Owner/Contractor Signature Date