B-2017-0762 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0762
10650 S DE ANZA BLVD CUPERTINO,CA 95014-4450(369 37 027) PLATINUM BUILDERS
INC
SAN JOSE,CA 95112
OWNER'S NAME: BYER PROPERTIES LP DATE ISSUED:09/14/2017
OWNER'S PHONE:214-553-3245 PHONE NO:(408)456-0300
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class)3 Lic.#889818
Contractor PLATINUM BUILDERS INC Date 01/31/2019 X BLDG _ELECT _PLUMB
MECH_RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)rof Division 3 of the Business&Professions Code and that my
license is in full force and,effect. JOB DESCRIPTION:
SHERWIN WILLIAMS-T.I.;RETAIL(3389 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
G=;y• . 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
permit is issued. Sq.Ft Floor Area: Valuation:$150000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 37 027 M(Tenant Improvements)
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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
'source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
•
gnature Date 9/14/2017 Issued by:Abby Ayende
Date:09/14/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/14/2017
I hereby affirm under penalty of perjury one of the following three declarations: • ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person M any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions,of the the Health&Safety Code,,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. ,eer or authorized agent:
APPLICANT CERTIFICATION •
ate:9/14/2017 1
I certify that I have read this application and state that the above information is ►. _ c s k _ ►DI e1
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 9/14/2017 Professional
3--7,o11-- P 2
\46.7 CONSTRUCTION PERMIT APPLICATION
/' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
/,,,s-f.:94., 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building a(�,cupertino.orcl
❑NEW CONSTRUCTION ❑ ADDITION El ALTERATION/TI El REVISION I DEFERRED ORIGINAL PERMIT ii
PROJECT ADDRESS S. PC: ANZw1 F-t.v n 1 l'vf'F27'! .0 I1'� APN a �') �Z'�
�D�n�d /� N
OWNER NAME 4e(''Nye
( `c I PHONE n 1r r4��` � s- E-MAIL
STREET ADDRESS (-pr,� �/d��I ffV•D ln,� f 1 C Y`STq (,MeI-PI•`,, �`7 �%'I.(/'1� FAX
�X JJ Ii lam•V {� (lV� �{/4tr 4.1 Stip' 4'l V
CONTACT NAME{-) PHONE E-MAIL
oNNI- oLLvn Ati 09/ 3.5 -9a,26 Rol,v),-e3AKCe/ileCV-ran4e,ev,di
STREET ADDRE CITY,STATE,ZIP. FAX
'lobo C4w-r'C.- sr. ZU.� S J 'DI-qo + r d� 92im. /9- -- 9�'
❑OWNER ❑ OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 2I'-ARCHITECT In ENGINEER 0 DEVELOPER 0 TENANT
CONTRAC O NAM/E�Q ra. Al'; f LICENSE NUMEEF/$Q p I p,1 LICENSE TYPE el I BUS.LIC at/02g 2
COMPANY NAME 1 Glr��� Y1 tci- V rLcLelei ciA itkvn b l e •cerin FAXLI Qii/`90 G_Q
STREET ADORE-SC/Cr?N.
+�}J6( . CITY,STATB,ZIP je) _ _ AA PHONPt/OQ -�/SG.630 J
ARCHITECT/ENOI NEER NAME Q 1' LICENSE NUMBER . BUS.LIC N t7
Si4-174EiriAX 1 /c a 2 S '7
COMPANY NAME E-MAIL FAX
STREET ADDRESSCITY,STATE ZIP PHONE
�/oec CC °,Q-r/r - saiJ cl -6,o cep 90/0 5 Gni...9 l's .1'7
DESCRIPTION qF WORK
N L--kJ 1C E-Tit•/L. Y/. lueLJ wpi-u-S 1 'DC-1440L07-red cF--(6) l..I/ aS ) CC-W-4/(7i
ALIT 0irr�tIC r/NIS//ES', /'L - 5-,Ai / 6-7-66-re/c4 - k'c H t' : RverAvelt- p
tV U s-rieuc-ruz 4L
EXISTING USE PROPOSED USE CONSTR.TYPE N STORIES
11-z-iz- M V l2 f USE TYPE DCC. SQ,FT. VALUATION(5)
AXIS' 33 F? i NEWE •3OR 3 / DEMOREA539 C,TOTAL 33$3 p Q y�I� .�797 g1 cv � .
AREA - j AREA AREA NET AREA Filo S'TUI2� V JJ /'I -�v/ -/'IJV 1�
BATHROOM KITCHEN OTHER
REMODEL AREA /�. REMODEL AREA f REMODEL AREA /
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: B DETACH
f ATTACH
N DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES
,.------ BEING ADDED? ❑NO ADDITION? ONO
PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS THE BLDG AN YES I
PLANNING APPLE NO PLANNING APPROVAL LETTER EICHLER HOME? El❑NO i {l� Iv$ \�f`j 's.a.` 4 ,-4 L ,f; . TO LIV ATaIO�N\;
By my signature below,I certify to each of the following: I am the property owner or authorized agent to,et on ti e 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 relating to building construction. Iaylhoze representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: r:-*�. ICC t--A-4---- Date: s)9/1 7.
SUPPLEMENTAL INFORMATION REQUIRED �a't''''"•,' =•'. °'
t� .... �$. .PG: L; ICrTdY � KI. �`.x�t�ti,FY �t10�3,'�AfGSLIP,',�; �!•
New SFD or Multifamilydwellings: Applyfor demolition permit for y�, ii � W t x
I i`
'
Y
_ .fl �t ) ff , C L NEVtEk
existing building(s). Demolition permit is required prior to issuance of building ,. g�tk ,,ig. 4.kVifkiRt t
4
,
permit for new building. . Otr3ir14441'G44ligiIEIV
I 4 .;,44,40;w: TPs arlf{ Iia tti i 4
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure r N Tr a w '(1,-;104,4440444:; :g
® ' A9 rxIr ':
form if any Hazardous Materials are being used as part of this project. `'` , i " o ; ' `av a 4i r !) C R ��p,?F., ' , I
Copy of Planning Approval Letter or Meeting with Planning prior to m ,r 4waIt N IS„: fix ° Y.r r:
_ 1;1.3.s.'", Q.'„ v,, , , � AVITARYSEWERDISTRICT
submittal of Building Permit application. +}nt, ' tIt• w . nMr
.5,N.!;r: r ..
. ?. ' ..i'.Y .❑.`:ENVIRONMENTAL HEALTH ,
BldgApp_2011.doe revised 06/21/11