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14060145 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19638 STEVENS CREEK BLVD CONTRACTOR:,IK BAKER PERMITNO: 14060145 CONSTRUCTION INC OWNER'S NAME: EVERSIIINE VI,LP 226 MCF,VOY ST DATE ISSUED:08/22/2014 OWNER'S PHONE: 4083431088 SAN JOSE,CA 95126 PHONE NO:(408)882-0199 ❑ LICF,NSF,D CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG � ELECT ' PLUMB t License Class Lic.# /��6J7�(� y"' { MECH RESIDENTIAL COMMERCIAL Contractor iii od D e 8-Zz—141 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:(SUITE 230)TENANTIMPROVEMENT FOR"FUTURES IN (commencing with Section 7000)of Division 3 of the Business& Professions EDUCATION"(E OCCUPANCY)(5,715 S.F). Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to sell'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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$142875 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36906012.19638 Occupancy Type: APPLICANT CER"1'IFICA"PION 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 PERMIT EXPIRES IF WORK IS NOT STARTED Upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which mcrue against said City in consequence of the 180D YS FROM CALLED NSPECTION. granting of this permit. Y. ally,the applicant understands and will comply with all non-point sour ations per the Cupertino Municipal Code,Section 9 18 Issued b �� Date: Signature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any rooting material being installed. 11'a roof is 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER �hereby affirm under penalty of perjury one of the following three z,eclarations: HAZARDOUS MATERIALS DISCLOSURE "11I have and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material. Section 3700 ofthe Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air contaminants as defined b Bay Area Air Quality Management District 1 will pcnmit is issued. maintain compliance t e Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall health:0r,-ut Safety C tions 25505,25533,and 25534. 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 Owner o ' agent:become subject to the Worker's Compensation provisions ofthe labor Code, I mustDater forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct I agree to comply with all city and county ordinances and state laws relating Lender's Name_ to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City f Cupertino against liabilities,judgments, costs,and expenses which may ace e, gamst said City in consequence of the granting of this permit.Additi the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source r u . gs per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9,18 /f Licensed Professional Signature__ Date ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildingCckupertino.org PROJECT ADDRESS ;]/�u/(il/�1 APN# OWNERNAME Jt' HO E E-MAIL STREET ADDRES ,(� ./� .TY,STA - FAX nal CONTACT NAME PHONE E- A WV STREET ADDRESS / �� CITY,STATE,ZIP \ FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME {� l LICENSE NUMBER LICENSE TM BUS.LIC# t 4 In � i� �/W COMPANY NAME (I IL FA44 , STREET ADDRESS WI/,1 CI ST T ZIP y� ,y� •� P O ARCHITECT/ENGINEER NAME /(,L LICENSE NUMBER `/ BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-FamilyPROJECT IN WILDLAND PROJECT IN STRUCTURE: F1Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ No OLAR PANELS ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: �n KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATI N XJ DESCRIPTION OF WORK / RECEIVED BY: By my signature below,1 certify to each lowing: I am property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information 1 ha rovi d is correct. 1 h e read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating bu ons on. authorize representatives of Cupertino to enter the abo r--iidenti ed property for inspection purposes. Signature of Applicant/Agent: Date: < S PPLEME AL IN ORMATION REQUIRED OFFICE USE ONLY I ❑ OVER-THE-COUNTER ❑ EXPRESS' x ❑ STANDARD c� ❑ LARGE y ❑ MAJOR PVApp_2011.doe revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION DDRESS: 19638 STEVENS CREEK #230 DATE: 06/23/2014 7 REVIEWED BY: MELISSA PN: 36906012.19638 BP#: `VALUATION: $142,875 OPERMI[TTYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK "FUTURES IN EDUCATION' T.I. TO RECONFIGURE SPACE ADD ADA RESTROOMS (5,7 5 S.F. 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,III-B,IV,V-B 5,715 $2,406.28 IBTIPLNCK $4,765.52 1BTIINSP TOTALS: 5,715 $2,406.28 $4,765.52 MECH,HOURLY 0 Yes ) No PLUMB,HOURLY 0 Yes Q No ELEC,HOURLY Q Yes )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 (Eee Resolution 11-053 Eff 7/1`13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,406.28 Select a Misc Bldg/Structure Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $4,765.52 Suppl. Insp. Fee.-(D Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes E) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential ) Building or Structure 0 i StronV Motion Fee: IBSEISMICO $30.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $7,207.80 $0.00 TOTAL FEE: $7,207.80 Revised: 04/01/2014 Building Department City Of Cupertino 10300 ToiTe Avenue (Cupertino,CA 95014-3255 CU P ERTIN 4 Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR .,IST JOB ADDRESS: 19638 Stevens Creek Blvd. Suite#230 PERMIT# 14060145 - OWNER'S NAME: Evershine IV, LP PHONE#408,862 0199 GENERAL CONTRACTOR: JK Baker Construction BUSINESS LICENSE# 23677 ADDRESS: 226 McEvoy St. C1.TY/71PCODE: San Jose 95126 "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL. OR "NAL OCCUPANCY INSPECTTON(S) WILL. BE SCHEDULED UNTIL THE GENERAL CONTRACTOR ANT) ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# X _Cabinets & Millwork _IK Baker Construction, Inc. 23677 _ Cement Finishing XY Electrical JK Baker Construction, Inc. 23677 Excavation Fencing X Flooring/Carpeting ~~ _- � Todd Nicholl Floors t VX A(-384 B&91) Linoleum/Wood �X� Glass/Glazing Royal Glass, Inc. ^^ 27069 Heating X Insulation JK Baker Construction, Inc. 23677 Landscaping Lathing Masonry W .._ ....._ _...__.... X Painting/Wallpaper - Faith Painting, Inc. �A !d t��Zg/ y y� Paving .. ^� Plastering - X Plumbing '^ _ Michael Venosta Plumbing -PPoo? 14 Roofing Septic Tank ~Skeet Metal X Sheet Rock 7 �JK Baker Construction, Inc. 23677 ^^ Tile Owner/Contractor Signature Date COURTESY INSPECTION REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION A E., C.B.O., BUILDING OFFICIAL ?%LD NO 10300 TORRE AVENUE•C CA 95014-3255 (408)777-3228-FAX(408)777-3333•bui}�111i cu ertino.or BUI IINQ A®�C TION#: DATE SUBMITT D: RESS: /96�{o STEVE1dS Chk - gT� 230 AP 1 PREPARATION BUILDING PERMIT#: OWNER'S NAME: PHONE#: FAX#: 'f98 . '543 . to 8$ MAILING ADDRESS (if different from site address): I g6 zn Scg:vEn+S ct21c - 'H0 , Wr e1 V-TINo, cA S e t4 CONTRACTOR: PHONE#: 714- 80•kCJL FAX#: 418. CONTACT: PHONE#: WA^rT PMIS FAX#: 46 0. f LIMITS OF WORK REQUESTED FOR COURTESY INSPECTIONS: 1 request to start construction work in which a building permit has not been completely secured. I have obtained a tenant improvement preparation permit if the scope covers the removal of interior non-structural elements within the building. 1 have submitted a building permit application and plans for the tenant improvement project and it is currently in the plan review process. I agree to call for courtesy inspections for the limited work god on this application. I fully understand that I will be responsible to redo the work performed under courtesy inspections,,if t -waT not_fw_1IyzqmpIy with the approved set of plans and all State and local rules and regulations. Owner:........ Print:....we NE opc!a ?..........I...........................Date:..$:.(f.'�.. ............... ContractQf:......,%..................... ...............................................Print:.........................................................................Date:.............................. - OFFICE USE ONLY- The Request is:❑ GRANTED ❑ DENIED Bldg Official lnspector:......................................................................Date:................................ INSPECTION RESULTS INSPECTION TYPE INSP.DATE TIME SPENT 'RESULTS INSP. COMMENTS(REASON IF INSPECTION FAILED) 9301 gAi-hy /s, N, 14 yh�-hy /5, `RESULTS: P—Pass,F—Fall,C—Cancel,I—Incomplete,N—Not Required,R—To be Rescheduled CourtesylnspForm_2011.doc revised 03114112 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX (408)777-3333• building(a)cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE AD S S APN BP# OWNER NAME J�' OWNER ADDRESS DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. I understand if I Pmy or otherwise engage any persons other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderFonn 2010.doc revised 04/14110 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners si nature. Property Owner's Signature: Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owners drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 C 1� ONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ` 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•budding a)cupertlno.org \v�, ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS /) In_ 1� 1--mW-511 (%��../,I uP/ n�o APN# ,3Cq—0`j _ / 7• OWNER NAME If �1 1 _ PHONE� �.�OE-MAIL STREET ADDRESS 1�I,2.OJ (�,�y(,� /JLIi�A� r} CITY, STATE,ZIP CONTACT NAME PHONE STREETADDR&AWU �^ CITY,STATE,ZIPFAX - ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC 9 t COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARC i :( NGI R NAME \ LICENSE NUMBER ^ BUS LIC# COMPANY NAME 'L lV i Q�� O T E-MAIL ,}�/lJC ` a h ^n - FAX S t STRE ADDRESS �L, lx I�� CITY,STATE,ZIP 1 Vl.i PHONE DESCRIPTION OF WORK I ` ' uI CALST - bo-it w SIC- ` jhVA- EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES V /�iT r rf ce USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG `�'\" NEW FLOOR I wDEMO �l V TOTAL /- AREA AREA AREA NET AREA own SF's 1J 67 r2l V, JL,� (bl I// BATHROOM KITCHEN OTHER ` y \�L V / „` 1 -/ REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UMTS IS ASECOND UNIT []YES SECONDSTORY ❑YES ) BEING ADDED? RI NO ADDITION? PRE-APPLICATION OYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE TOTAL VALUATION: PLANNING.APPL# gNO PLANNING APPROVAL LETTER EICHLER HOME? RNO 7^ . � S By my signature below,1 certify to each of the following: I am the property owner o authorized agent to act on the property owner's behalf. I have read this application and the information 1 have provided is correct. 1 have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to bu' ing co tr epresentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP 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 permit 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. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to 11 MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. �n,�/V. � Iw 1 h I -� S ❑ ENVIRONMENTAL HEALTH B1dgApp 2011.doc revised 06/21/11