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14030110 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21771 STEVENS CREEK BLVD CONTRACTOR:� C� ef�j(3a1 P (5 PERMIT NO: 14030110 //�/C• OWNER'S NAME: CUPERTINO GA YA TRI LLC DATE ISSUED:03/18/2014 OWNER'S PHONE: PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL Is— p T.I. (1,355 S.F.)TO RECONFIGURE INTERIOR OFFICE License Class IO Lic.# 90S� / SPACE. ADA UPGRADES TO PARKING AREA INCLUDING ContractorlAle, Date lit I STRIPING AND SIGNAGE 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: 1 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 rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$14000 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 APN Number:32620049.00 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.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF P 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 ED INSPECTION. 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 Date: U with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. p RE-ROOFS: Signature Date v 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. ❑ 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 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 Code,Sections 25505 25533,a 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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,l 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 CONSTRUCTION PERMIT APPLICATION O l 12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION D� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 [ CUPERTINO (408) 777-3228• FAXZALTERATION/TI 77-3333• buildinq(bcupertino.orq `"� ❑ NEW CONSTRUCTION ❑ ADDITION ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS77� A O APN# —SOA i OWNER NAe /S / /�/ PHONE �� �f J T�/ E-MAIL STREET ADDRES�D /�Cys N moi(/ CITY STTE ZIP FAX CONTACT NAME,,:,::0L/*� TJrlSI PHONE ® 6 ���/ _VC , E, Z (/7 STREET ADDRESS/ STATFAX /Oft, ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR A CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER XTENANT CONTRACTOR NAME , LI NiJ LICENSE TYPE BUS.LIC#� �J COMPANY NA;�5 `j f/SE-MAI filE:fif� FAX �r�/ I • I"� STREET ADDRESS ' S�'ATE [ �•r'1q �O )� PHONEY ` ,� ARCHITECT/EN U, N;ft LICENSE NUMBER J ` BUS LIC# COMPANY NAM�� E-MAIL FAX STREET ADD S le ,'r�, ..moi•/' C ,ZIP //)r P DESCRIPTION OF WORK • (�V �J� *. r�.tws Gey o vi°G ; EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES 0/ftf 0 •1 USE TYPE OCC. SQ.FT. VALUATION($) EXISTG f� NEW FLOOR DEMO TOTAL //tri AREAX/,0 AREA �.�"' AREA,— NET ARE A/� BATHROOM KITCHEN KITCHEN OTHER iw •• !l�ti�/ REMODEL AREA r..�� REMODEL AREA �1 REMODEL AREA ZA" PORCH AREA DECK AREA ,TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑AT #DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ol�0 ADDITION? O PRE-APPLICATION ❑ ES IF YES,PROVIDE COPY OF IS THE BLDG AN TOT) ALUATION- PLANNING APPL# 0 PLANNING APPROVAL LETTER EICHLER NOME? By my signature below,I certify to each of the following: I am the property owner or authorized agent to onroperty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and veri accurate. I agree to comply with all applicable local ordinances and state laws relating to building con �h resentatives of Cupertino to enter the above-Identif d pr erty for inspection purposes. Signature of Applicant/Agent Date: �� SUPPLEMENTAL INFO TI0-N REQUIRED PLAN CHECK TYPE - � ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TRE-COI LATER BUILDING PLAIN REVIEW existing building(s). Demolition permit is required prior to issuance of building `!hs✓.. perinit 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. E-1 LARGE FIREDEPT Copy of Planning Approval Letter or Meeting with Planning prior to ElMAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21771 STEVENS CREEK BLVD DATE: 03/18/2014 REVIEWED BY: MELISSA APN: 326 20 049 BP#: ���3�7/� VALUATION: 1$14,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 B TA WORK T.I. TO RECONFIGURE INTERIOR OFFICE SPACE. ADA UPGRADES TO PARKING AREA SCOPE INCLUDING STRIPING AND SIGNAGE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,111-B,IV,V-B 1,355 $2,092.21 IBTIPLNCK $1,301.07 IBTIINSP TOTALS: 1,355 $2,092.21 $1,301.07 MECH,HOURLY 0 Yes (F) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District, etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS 9,ec Resohi ion 11-053 EL,71/13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,092.21 Select a Misc Bldg/Structure Suppl. PC Fee: Q) Reg. 0 OT Q.Q hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,301.07 Suppl. Insp. Feer Reg. 0 OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes ) No $0.00 E) Advanced Planniiw), Fee: $0.00 Select a Non-Residential E) Building or Structure 0 i Strong Motion Fee: IBSEISMICO $2.94 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $3,397.22 $0.00 TOTAL FEE: F $3,397.22 Revised: 01/15/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST Of JOB ADDRESS: / 7 7/ —5V4a✓f SW A44 PERMIT# OWNER'S NAME: AVVar~ MRtap PHONE# fO8 is GENERAL CONTRACTOR: 10~ /r��i BUSINESS LICENSE# ADDRESS:/Crs a I.0 04Z4F CITY/ZIPCODE: *Our municipal code requires all businesses working 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: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile F*ger/'Contractor Signature Date Nqj) ,fEDFN13K1DGE 153 Second Street,Suite 101 Los Altos,CA 94022-2825 Phone:650.917.1311 Fax: 650.917.1312 21771 Steven Creek Blvd Cupertino, CA Improvements Bldg Permit 14030110 Contact List Contractor Trade Company Phone Email License# Business License Number Demo Edenbridge 650-917-1311 caatley@edenbridnehomes.com 855519 351181 Black Diamond Electric & Phone Electric 925-777-3440 mike@blackdiamondelectric.com 724171 35210 Finish Carpentry Edenbridge 650-917-1311 cgaggy@edenbridgehomes.com 855519 351181 HVAC Edenbridge 650-917-1311 caatley@edenbridgehomes.com 855519 351181 Acoustic Ceiling North a to Acoustics 415-850-9790 'im(a)north ateact.com 902329 33597 Drywall and Steel Studs Edenbridge 650-917-1311 cgatley0edenbridgehomes.com 855519 351181 Painting Edenbridge 650-917-1311 cgatley0edenbridgehomes.com 855519 351181 mike.giosso@siteoneservices.co Carpet/Hardwood Home Select 925-918-3388 m 897914 3 21-' Finish Clean Edenbridge 650-917-1311 cgatley@edenbridgehomes.com 855519 351181 UNREASONABLE HARDSHIP EXEMPTION FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION - ALBERT SALVADOR. P.E.. C.B O., BUILDING OFFICIAL -IR INO 1"300 TORRF ^.JFNl-1; rl[PEP T tn(q r,% . .014 ,`) CUPEftTifVO (408)777-3228 •FAX (408)777-3333• building[aicupertino.orq For Tenant Improvements where the Cost of Construction does not Exceed 'S'13:9; 34.0©, SITE ADDR-�EJS7Sf FA-v'0 ,( APN ` E P# CITY ZIP Sy/cam TOTAL CONSTRUCTION COST A $ ...e�.J.... ........... DESCRIPTION OF WORK: 6& The following is a list of costs to provide access features in order to comply 100%with the current State Title-24 Disable Access Standards.(AII costs to be documented by actual bids or other information accepted by the Bui ding Official.) Accessible Features Complies with if not,list required upgrades in order for Cost to make feature current standards? features to full com I fully accessible? 1.Path of travel to accessible entrance. zo At S (►�.� i 2,Cost of providing a primary entrance. (Including but not limited to,thresholds,landings,door hardware, max.door pull.etc.) / 3.Cost of providing the primary path of travel to the specific area of alteration,structural repair,or v0 �X 1 S j�6� S . �'� addition. 4,Cost of providing accessible restroom facilities. e 40WAW 40 $ 30 fti' 5.Cost of providing an accessible drinking fountain. (If $ ��� required or if a drinking fountain is provided.) f/ Q 6.Cost of providing accessible public telephones(if provided) 7.Cost of providing other accessible features.including $ but not limited to,parking,storage,alarms etc. TOTAL COST OF ACCESS FEATURES(B): $ Has the same tenant performed work in the same tenants ace within the last three years? Calculate(B 1 A)x 100% Description of access features to be prgvided: ���• �� �,//���.� /� �i►A`/� l _� TOTAL COST OF PERCENTAGE (20%minimum 1 PROPOSED UPGRADE S lexpendfture is r uired) ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify that the above noted information is true and correct. Name(print): L,6N6 C � Signature' — Date: Firm address:'��( 1�1-N�l�.•►/���Zti7 -� e: t�/7�� Phone: FOR DEPARTMENT USE ONLY – ---------------—------— -- The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 11348.2.1. 7 The above named project has been granted an unreasonable hardship exemption fpprplhe requirements of the State of California CCR-Title r (Regulation for the Accommodation of the Disabled)pursuant to 2010 CBC Section 113413.2.L z, , t 1 COMMENTS: uur Building Official Designee(print): A Signature: Date: ' Ha 1111,PI.-11 iorlfiorm ZfllZ.r/oc re rrseri i/l /' 13