14110043 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10745 S DE ANZA BLVD CONTRACTOR:G SWANSON PERMIT NO: 141 10043
CONSTRUCTION
OWNER'S NAME: MARIDON BRIAN F TRUSTEE&ET AL 1658 WATSON CT DATE ISSUED: 11/06/2014
OWNER'S PHONE: 8314254549 MILPITAS,CA 95035 PHONE NO:(408)946-3311
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
_ HSBC-T.I. TO REMOVE(E)BARRIER TO ACCESSIBILITY
License Class Lic.# TO BANK
Contractor(5,5j Ijki4c,6A)C,N1j,(fJC,„Date Zr f
I hereby affirm that I am licensed under the provisions f 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
Mper onnance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$25000
ave 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:35923017.00 Occupancy Type:
v 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 comity ordinances and state laws relating WITHIN 180 DAYS OF PERMIT 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 FROM L ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of theIL
granting of this pern i. Alitionally,the applicant understands and will comply Issue -hy:— - Date:
with all non-point s c regulations per the Cupertino Municipal Code,Section
9.18. t1I `--
/ � ZD/ RE-ROOFS:
Signature Date ( 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.
❑ .�,INER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Dale:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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. 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
1 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 Ar , Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the uper in Municipal Code,ChaWe9, 2 ad
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sen 55 5, 533,an 34.
Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date `
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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. 1 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 V
O
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• building(7,cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 10745 S. DeAn z a Blvd APN# 3S9 _ Z- U 1
OWNER NAME BRIAN MAR I DON -[ILQ
� 5115PHONE 8 31 , 4 2 5 ,4 5 4 77MAI
L
STREET ADDRESS 10745 S. DeAnza Blvd CITY, STA1'F'yZsIP CU ergo,CA, 95014 FAX
CONTACT NAME NELSON - JORGE MEDINA PHONE 917-239-7013 E-MAIL JME DINA@ NELSONONL INI COM
STREETADDRESS 261 5TH AVE CITY,STATE, ZIP NEW YORK, NY FAX
❑OWNER 11OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT If ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME JOHN CARUSO LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANYNAME G. SWANSON CONSTRUCTION INC. E-MAIL INFO@GSWANSON.COM FAX 408.946.5350
sTREETADDRESS 1658 WATSON COURT CITY,STATE,ZIP MILPITAS, CA, 95035 PHONE 408.946.3311
ARCHITECT/ENGINEER NAME LARA CONTE LICENSE NUMBER C-26035 BUS.LIC#
COMPANYNAME NELSON Architects E-MAIL LCONTE@NELSONONLINE.COM FAX
STREET ADDRESS 261 5th Ave CITY,STATE,zIP New York, NY, 10016 PHONE 212.481.1119
DESCRIPTION OF WORK VOLUNTARY BARRIER REMOVAL / ACCESSIBILITY UPGRADE TO EXISTING BANK. MODIFY
DOOR CLEARANCES AND ADD ACCESSIBILITY SIGNAGE. NO CHANGE TO BUILDING ENVELOPE, USE
OCCUPANCY OR EGRESS. **APPROX 130 SF. AREA OF WORK IN (E) 2838 SF BLDG.
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
BANK BANK V—B 1 USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTGNEW FLOOR
SF ARA OF 130 SF iETAsEEA SAME (E) BANK VB B 130sf**
BATHROOM KITCHEN OTHER
REMODEL AREA N/A REMODEL AREA NIR REMODEL AREA 130 S F
PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAdE AREA: H DETACH
0 0 0 ATTACH
#DWELLING UNITS: ESA SECOND UNIT __0YES SECOND STORY ❑YES
y.
O BEING ADDED? [' tJO ADDITIONYIO ="-
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF Is THE BLDG AN ❑YES VALUATION:
PLANNING APPL# Mo PLANNING APPROVAL LETTER EICHLER HOMEY [XNO
To
Z oo -
By my signature below,I certify to each of the following: I am the property owner or autho' agent to ac a property owner's behalf. I have read this
application and the information I have to d is correct. I have read the Description of Work and verify i is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ng onstruction. uthorize representatives of Cupertino to enter the above-'denti led prope for inspection purposes.
Signature of Applicant/Agent: Date: D/
SUPPLEMENTAL FORMATION REQUIRED PLAN CHECK 76 ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for R-THE-COUNTER ❑ BUILDING PLAN REVIEW
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 1:1STANDARD ❑ PUBLIC WORKS
fo_rm 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
El MAJOR 11 SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 201 Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10745 S DE ANZA BLVD DATE: 11/06/2014 REVIEWED BY: MELISSA
APN: 359 23 017 BP#: VALUATION: 1$25,000
-PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1B TI
USE: PERMIT TYPE:
WORK HSBC- T.I. TO REMOVE E BARRIER TO ACCESSIBILITY TO BANK
SCOPE
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,IVN-B 130 $2,097.00 IBTIPLNCK $588.00 IBTIINSP
TOTALS: 130 $2,097.00 $588.00
MECH,HOURLY 0 Yes (D No PLUMB,HOURLY ® Yes E) No ELEC,HOURLY ® Yes Q No
LJ _L_
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 7 info.
FEE ITEMS (Fee Resolution 11-05. FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,097.00 Select a Misc Bldg/Structure
Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $588.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes (2) No $0.00 E)
Advanced Plannim—Y Fee: $0.00 Select a Non-Residential G
Building or Structure
Strong Motion Fee: IBSEISMICO $7.00 Select an Administrative Item
Bld�z Stds_Commission Fee: IBCBSC $1.00
SUBTOTALS: $2,693.00 $0.00 TOTAL FEE: $2,693.00
Revised: 10/01/2014