14100048 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20370 TOWN CENTER LN CONTRACTOR:DOYLE CONSTRUCTION PERMIT NO: 14100048
INC
OWNER'S NAME: FUND VIII CUPERTINO LLC 48521 WARM SPRINGS BLVD STE 307C DATE ISSUED: 10/08/2014
OWNER'S PHONE: 4089730783 FREMONT,CA 94539 PHONE NO:(510)687-1771
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
STE#255-T.I.TO DIVIDE UNIT INTO TWO SPACES
License Class__.__ Lie.# ! �( � / (439 S.F.)
Contractor _:Cl_ C&Ofi(,)& i Date Sj
I hereby affirm that I am licensed under the provisions Ch pter 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:$5000
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:36940059.20370 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 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 LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the �j �i
granting of this permit. Additionally,the applicant understands and will comply Issued by: / �/� �TG�� Date: APlj 'l
with all non-point urce regulations per the upertino Municipal Code,Section
9.18. ,
J RE-ROOFS:
Signature ate /� l All roofs shall be inspected prior to any roofing material being installed. if a roof is
installed without first obtaining an inspection,l agree to remove all new materials for
inspection.
❑ OWNER-BU .RILD DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the 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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). l 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.I2 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 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,S ons 1- 5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
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,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.
Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Ale
CUPERTINO (408)777-3228• FAX (408)777-3333• buildinq(a cupertino.orq
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PPEERMIIT#
P O:AD RESS ZG}-� WW1C1;1'I� APNO Q U U O J--9. 20 3�-a
25;6 ` 7
OWNER NAME /V PH oN k 7�_ o, p E-MAIL
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STREET ADDRESS CITY^, STATE,ZIP FAX
CO TACT NAME PHONE E--4M-AIL
STREET ADDRESS CIT ;STATE, ZIP FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT eO CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CObRRACTCR NAME LICENSE NUMBER LICE'SE TYPE BUS.LIC k
t{4 2 3
CO A PANY NAME E-MAIL FAX
0111 L-E + U CRO N -1-ptVVM f1 9 Pr
STREE A RESS CI STATE,ZIP PHONE
`i ott Nlt 5 Q�1►�C�5 �-V 0 3�1 L- u-t- cc q 5_ S 1 0 r ' - 1 7`1
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
b
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COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
N -c ri0 ;r 5A.J 30-
DESCRIPTION
0DESCRIPTION OF WOK
yv,kc 2 S.E,
t7EWGv wv &-Iq CC5 To dny UP ow Ice, tnA.
EXISTING USE PROPOSED USE CON TR.TYPE 7773777
t(J oy( CC USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG rrll ( NEW FLOOR 1 DET40 TOTAL
AREA 1 v' ��/' AREA AREA NET AREA
BATHROOM KI HEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH
❑ATTACH
k DWELLING UMTS IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑ TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO ��CJ
By my signature below,I certify to each of the following: I am the p perty 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 re he Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel ng to b ing construction. I author representatives of Cupertino to enter the above-identifi d property for inspection purposes.
Signature ofApplicant/Agent: Date:
SUPPLEMENTAL INFORMATION RE I DPinN cHEcxT E .; ROUTING SI;P
New SFD or Multifamily dwellings: Apply for demolition permit for OVER TR&CouN1ER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
.`
permit for new building. 'EXPIiEss ❑ PLAAAING�PLANREVIEPI
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD ❑ PiIBLlcwoxxs +
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', ❑ SANITARYSEWERDISTRICT
submittal of Building Permit application. ,_;;
+ ❑,ENVIRONMENTAL HEALTH _
BldgApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20370 TOWN CENTER LN DATE: 10/08/2014 REVIEWED BY: MELISSA
APN: 36940059.20370 BP#: *VALUATION: 1$5,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building __7PENTAMATION 1 B TI
USE: PERMIT TYPE:
WORK �STE # 255 -T.I. TO DIVIDE UNIT INTO TWO SPACES 439 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,111-B,IV,V-B $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY 0 Yes (D No PLUMB,HOURLY 0 Yes Q No ELEC,HOURLY ® Yes Q No
E1__L_ E1__L_ --t_
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 (Fee Resolulion 11-053 ff 7,/,13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes (D No $0.00 1 hours Plan Check, Hourly
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes Q No $0.00
Suppl. Insp. Fee:Q Reg. Q OT Fo,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure 0
i
Strong Motion Fee: IBSEISMICO $1.40 3.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.001 $429.00 1STINSP Inspection,Hourly
SUBTOTALS: $2.40 $572.00 TOTAL FEET-. -$574.401
Revised: 07/10/2014
Building Department
City Of Cupertino
10300 Tone Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: ,ol �v / v,2� LLQ. PHONE# �0 — Cly .-p7
GENERAL CONTRACTOR: bb [C BUSINESS LICENSE #
ADDRESS: CITY/ZIPCODE: s£vvtcc.tik �� ��5�5
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACT S HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. E)
I am not using any subcontractors: 01 �
Sign ture 6ate
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date