14080271 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20111 STEVENS CREEK BLVD CONTRACTOR: DOUBLE ED PERMIT NO: 14080271
CONSTRUCTION INC
OWNER'S NAME: TRANS-CONTINENTAL REAL ESTATE INVS 189 BELEVUE AVE DATE ISSUED:08/28/2014
OWNER'S PHONE: 4087300808 PARTY CITY,CA 94014 PHONE NO:(415)420-8145
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL 0
TO CLEAR CODE ENFORCEMENT CASE: LITTLE TREE
License Class JO Lic.# Q MONTESSORI-T.I PREP 4860
Contractor 1JJ'(f � (3� 4�/SfDate
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.
1 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:$20000
1 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:31623026.00 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 18 O ERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FRO CALLED INIto 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 CALLED INSPTN.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 'S
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupert o Municipal Code,Section
9.18. /
RE-ROOFS:
Signature r 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt fromthe 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. 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 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 25505,2553 ,and 255 4.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dater
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,alter 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION r o
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 co
777-3228•FAX(408)777-3333•building(a7cupertino.crg
GUPERTINO (408)
❑NEW CONSTRUCTION ❑ ADDITION [:] ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS �0 APN 9 / �1-� (71 3 - 6 z(0
OWNER NAME PHONE , 7 o,Ic(7 LKS. E-M IL SCJ
t3 0
STREET ADDRESS �oO A/II,�� AV-f f G CITY, STATE,ZIP ��nk7 , /ll^U� I/T FAX
CONTACT NAME �/ �-- PHONE V(Jl E-MAIL�II
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER _P..-DBVELOPE ❑ TENANT
CONTRACT(-"- I -�`�� LICENSE NUMBER LICENSE TYPE BUS.LIC 9
LJ
COMPANY NAME , E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC U
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK T - /7r
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC, SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: ISA SECOND LIN IT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESEIVED BY` TOTAL VALUATION:
PLANNING APPL ❑ E] REC
k NO PLANNING APPROVAL LETTER EICHLER HOME? NO 'Z0/ O Ls-0
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the 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 build g construction. uthorize representatives of Cupertino to enter the abo�d on ied Property for inspection purposes.
Signature ol'Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED CHECK TYPE UTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER rEIPLANNING
ILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of buildi
permit for new building. El EXPRESS 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 ❑ MAJOR ❑ 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: 20111 scb DATE: 0812812014 REVIEWED BY: Mendez
APN: BP#: �' 7/ `VALUATION: 1$20,000
'PERMIT TYPE: Building PermitPLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1l-IPREP
USE: PERMIT TYPE:
WORK To Clear Code Enforcement Case: Little Tree Montessori-T.I prep 4860
SCOPE
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 prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolu/ion 11-0�3 E�/ 71 131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 L__L_j # Tenant Improvement Prep
Suppl. PC Fee: Reg. 0 OT 0.0 Thrs $0.00 $417.00 1TIPREP
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:(j) Reg. 0 OT I 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes 0 No $417.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure
Stroh Ntotion Fee: 1BSEISMICo $5.60 Select an Administrative Item
Bldg_Stds Commission Fee.: 1BCBSC $1.00
SUBTOTALS: $423.60 $417.00 TOTAL FEE: $840.60
Revised: 08/20/2014