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14040104 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20955 STEVENS CREEK BLVD CONTRACTOR:BSM,INC BUILDING PERMIT NO: 14040104 SERVICES/SYSTEM OWNER'S NAME: WEISS PAUL E AND BARBARA H TRUSTEE 2575 STANWELL DR 2ND FL DATE ISSUED:05/21/2014 OWNER'S PHONE: 6503341500 CONCORD,CA 94520 PHONE NO:(925)688-1234 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] ( �w0� WHOLE FOODS T.I.-FOOD PREP AND SEATING AREA, License Class Lic.# REMOVE/REPLACE/ADD EQUIPMENT&ASSOCIATED Contractor 3 M Date 6 0 MILLWORK (503 S.F.) 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:545000 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:32631022.00 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 S'T'ARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 AY F 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 FROV LAST CALLED INSP CTION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 I 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 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) 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(x)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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 2 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 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20955 STEVENS CREEK BLVD 7 DATE: 04/16/2014 REVIEWED BY: MELISSA APN: 326 31 022 BP#: 1 `VALUATION: 1$45,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION IM TI USE: PERMIT TYPE: WORKWHOLE FOODS T.I. - FOOD PREP AND SEATING AREA REMOVEIREPLACE/ADD EQUIPMENT & SCOPE ASSOCIATED MILLWORK (503 S.F.) OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. M (Tenant Improvements) II-B,III-B,IV,V-B 503 $2,815.06 1MTIPLNCK $752.55 IMTIINSP TOTALS: 503 $2,815.06 $752.55 MECH,HOURLY 0 Yes E) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No Ll _L_ 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 preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fec Resolution 11-053 Elf 7"P131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,815.06 Select a Misc Bldg/Structure Suppl. PC Fee: E) Reg. 0 OT FO.OThrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $752.55 Suppl. Insp. Fee:Q Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes E) No $0.00 E) Advanced Planning, Fee: $0.00 Select a Non-Residential G GS Building or Structure Strony,Motion Fee: 1BSEISMICO t#<5 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 3590,/q SUBTOTALS: $3,579.061 $0.00 TOTAL FEE: Z, Revised: 04/0112014 W�Lkt�X/Il�H 106n 11I1.L.IItu CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION W'PERMIT DRESS: 20955 Stevens Creek Blvd DATE: 04/16/2014 REVIEWED BY: N: 326-31-022 BP#: D C� *VALUATION: $45,000 PE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 M T� WORK REMOVE(E) COOKING EQUIP, REF CASE, & MILLWORK. RELOCATE (E) HOT CASE. ADD (N) SCOPE COOKING EQUIP (UNDER (E) HOOD), MISC EQUIP, & MILLWORK. OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. M (Tenant Improvements) II-B,111-B,IV,V-B 503 $2,815.06 IMTIPLNCK $752.55 IMTIINSP TOTALS: 503 $2,815.06 $752.55 MECH,HOURLY Q Yes E) No PLUMB,HOURLY Q Yes E) No ELEC,HOURLY Q Yes Q No Lj NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff.711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,815.06 Select a Misc Bldg/Structure Suppl. PC Fee: (D Reg. ® OT 1 0,0 1 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $752.55 Suppl. Insp.Fee-.E) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? © Yes ) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure Strong Motion Fee: 1BSEISMICO 20.58 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 2.00 SUBTOTALS: $3,590.19 $0.00 TOT EE: $3,590.1 Revised: 01/01/2014) CONSTRUCTION PERMIT APPLICATION l COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION \ , O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO 1 (408)777-3228-FAX(408)777-3333-building AO cupertino.org A El NEW CONSTRUCTION [:1 ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 20855 S e34S `VXV4- APN# 3 2 'S% 3% - b 2- Z OWNERNAME ' t- `` PHONE �so V V � tiSE�ss E-MAIL \c.n�o @ 5�►e moo. c.o/� STREET ADDRESS 20 �� L CITY, STATE,ZIPu_eqg " �t�, G/4D6a6x 3,of - Ob S Z CONTACT NAME "K+ O' ���� �` alT / eE-IAAIL C Q _ STREET ADDRESS CITY,STATE,ZIP 1D uW F X s� min- r 7 c ca c tt- 't i i tits 7a-6 S'0 ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHITECT ❑ENGINEER 11 DEVELOPER ❑ TENANT IN CONTRACTOR NAME n `C v , `�� LICENSE NUMBE O LICENSE TYPE l V/ BUS.LIC# COMPANY NAME M_ J F•M-' E-MAIL FAX L_ 'N-�vC.,`ll Ie-P C`' M Gear 5t.c.ofY1 A 257 688 STREET ADDRESSCITY,STATE,ZIP P NE S 5 �+►Eu, a- c�-� &A4 y S Zo q - 123 ARCHITECT/ENGINEER`� NA lM� 0.` LICENSE NUMBERQ_ g BUS.LIC# COMPANY NAME E-MAIL FA r.wr�t. A� wpb @-�ick1, aol r . von► y�$ STREET ADDRE S CITY,STATE,ZIP P NE 15-0 e c ft(-tut y15) 7$8-4686 DESCRIPTION OF WORK LE �Q`1.ICM�7� ,' 1��-�.�• �LOC.J�'E �E N'�T hm Lt- k�U�f' EaT UN 4-1P1 S -tom ZWV-k--MR, ""k hr0 U&-S t Ak LIkIIAop-K- . EXISTING USE PROPOSED USE CONSTR.TYP77 77STTIT)IIIES p-oC� USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DENO TOTAL AREA'S (O 244 AREA A;( AREA NET AREA-75/to 3y A4 t-7 6* * v BATHROOM KITCHEN OTHER REMODELAREA (CJ( REMODELAREA ;6 REMODELAREA 1503 PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH -„( 0 ,` I At ❑ATTACH #DWELLNG UNITS: SV IS A SECOND UNIT ❑YES SECI'O"N'D STORY ❑YES 0 BEING ADDED? Wo ADDITION? tro PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES CEIVE TOTAL VALUATION: PLANNING APPL# �ko PLANNING APPROVAL LETTER EICHLER HOME? �'NO S y S o A o By my signature below,I certify to each of the following: I am the property owner or authorized agent t on erty owner's behalf. I have read this application and the information I have provided is correct. I ave read the Description of Work and ven it is a ate. I agree to comply with all applicable local ordinances and state laws relating to build g cons c. authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL I FORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP )*New SFD or Multifamily dwellings: Apply for demolition permit for El ovER.THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. ElEXPRESS ❑ PLANNING PLAN REVIEW 11/A,Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC woRKs form if any Hazardous Materials are being used as part Of this project. i] LARGE ❑ EIRE DEPT N4ACopy of Planning Approval Letter or Meeting with Planning prior to Submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06121/11 gig, �� � �= � ., p , .e tR 4•, r , ,¢, ld� �"_. r.e r .ai!. a2€t� x ��. z� . . ,. � . ;�. �s, �o-.� =t}, ,. ,a•pi*.,: H! H WN!, 11 b{ Ov 11 N 41 v 0 3 1"04 D: "fit 0 MUMM . SIN Cut, ..P BD( ON 11,As AE Q R! SM sw N i%. It, NOW 5 ICI .. .. Oal