13090190 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20750 STEVENS CREEK BLVD CONTRACTOR:BROADWAY GLASS PERMIT NO: 13090190
AND MIRROR INC
OWNER'S NAME: BYER PROPERTIES 2523 BROADWAY DATE ISSUED: 11/08/2013
OWNER'S PHONE: 7602681817 LONG BEACH,CA 90803 PHONE NO:(562)434-8405
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C I Lic.# i"S .5 7 ISLANDS-COMM.T.I SPACE FOR NEW OUTDOOR
II g DINING
Contractor 44�'bt U� �a cess Date PATIO 99 SQ FT
I hereby affirm t rat 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000
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:35908029.00 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 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 F!RO;=]T 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 Is /
granting of this permit. Additionally,the applicant understands and will comply
with all non int source regulati per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date A11 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
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)
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.I2 and the
declarations: Health&Safety Code,Section 25532(a)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 compliancc with t e Cupertino Nknicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti ns 25505,25 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 11 /214-3
permit is issued. Owner or authorized agent: W0.. 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.)
f 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•I10int SOUiCC iCgUlatioliS per the Cupertino Municipal Code,Section Licensed Professional
9.18.
- Date
CONSTRUCTION PERMIT APPLICATION
Is COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION �\
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 V�
(408)777-3228• FAX(408) 777-3333- building(a1icupertino.org
CUPERTINO \�
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ElREVISION/D (ERRED ORIGINAL PERMIT#
PRO / ,UCSS2VIt V W IS C2 -: W�� T + LJ'1 APN x27�f a ` ✓'- /r
OWNERNAME PHONE "'� E-MAIL U
Le , ts 3c�c t1 ( ►`c 1-1 �_TclCtSprieDIS inodscesAducc"-c.c
STREET ADDRESS CITY. STATE ZIP FAX
6"150 �1ee� Sit . Su►�f 120 Crlsbnd 92-00b (
CONTACT NAME PHON LE-MAIL
44 at1jN;nl4 l5 -1 .
bob rye j vel
STREET ADDRESS1342- 1,. I I'�Y e 5lk B,G CITY,STATE, LIP "177 FAX f�14!��• 2-1 I V l
❑ S-bnlo (A
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC
_(e`-fA &0I1 C1 >Jt 1160- 6
COMPANY NAME. E-MAIL FAX
IPEICq wq waosMeS 9IS-791'4- -Ib
STREET ADDRESS CITY,STATE,ZIP PHONE
1 0"1 -ate �1 �►.>d' WoAnc* 6A 945 f92JO el34-toI
ARCHITECT/ NGINEER NAME1]lw` LICENSE NUMBER _.� BUS.LIC
��
I B• fc'rce< `7l A IL
COMPANY NAMEE-MAIL FAX
Lee et hgcq t*cis AIA .I c c rn114`I 2(01 - 1144
STREET ADDRESS CITY.STATE,ZIP PHONE
kt
2 %4.n r-Avw in surlF at Vi:�C' �"ai�,c4, "J X1 -il00 2
DESCRIPTION OF WORK
t�n�no� Irn vemcr�1' c-f 4-e o c�, Ati b cMin
G -fume- 46, Ie I enhance 4e °o wig a w►nJScXeer .
EXISTING USE ], PROPOSED USE CONSTR.TYPE n STORIES
UCZtf1 1jc(�(�
1-_9441 USE TYPE OCC. SrQ.FT. VALUATION(S)
EXISTAREAL 51 < NAR FLOOR DEMEA AREA TOTAL NEETAREAS�I.bs y` v A
BATHROOM KITCHEN OTHER
REMODELAREA 1�I1� REMODELAREA REMODEL AREA f-) A
PORCH AREA DECK AREA TOTAL DECKTORRCH AREA GARAGE AREA: DETACH
N1PA M tAIA NSA []ATTACH
n DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY YES
NIA�l BEING ADDED? NO ADDITION? NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALU TION:
PLANNING APPL F ❑NO PLANNING APPROVAL LETTER EICHLER HOME? PrNO L l
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. 1 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. I authorize representatives of Cupertino to enter the above-ident
ified property for inspection purposes.
Signature of Applicant/Agent: �/l4LX�t W� Date: qq- I+7 f"W 13
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER BUILDINCPLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building ��
permit for new building. El ZIANDARD
SS [? PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure IIS ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑
LARGE IrCF IE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR LJ 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: 20750 stuns crk blvd DATE: 09/24/2013 REVIEWED BY: bob s.
APN: BP#: 3C ALUATION: 1$5,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK U. comm restaurants ace for new outdoor dining patio.
SCOPE
Plumb.Plan Check 0.0 hrs $0.00 .
Plumb.Permit Fee: IPPERMIT :
fr. Other Plumb Insp. E7rs 1 $47.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.2. Theseees are based on the prelimina information available and are only an estimates Contact the Dept/or addn'1 info,
FEE ITEMS (Fee Resolution 11-053Eff 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 99 1 s.f. Patio Cover/Sun Room
Suppl. PC Fee: Q Reg. Q OT 0.0 Fhrs $0.00 $695.00 1PATIOMETA Metal
PME Plan Check: $0.00 F-71 # Plumbing
Permit Fee: $0.00 $70.00 IPGASRES Piping,Gas<=4 Outlets
Suppl. Insp. Fee.-(F) Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Administrative Fee: IADMIN $44.00 Q
Work Without Permit? 0 Yes (F) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: 1TRA VDOC $47.00 Building or Structure
i
Strong,Motion Fee: IBSEISMICO $1.05 Select an Administrative Item
Bldp, Stds Commission Fee: IBCBSC $1.001 1
SUBTOTALS: $140.051 $765.001 TOTAL FEE: 1 $905.05
Revised: 08/01/2013
yx
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTI NO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: .2O 7,5-0 5 JJj c.yp PERMIT# 130Dl
OWNER'S NAME: S PHONE# 6e--
GENERAL CONTRACTOR: $,e p FrptU,q BUSINESS LICENSE# ?4 79
ADDRESS:.2S:23 6, 0,40 rvi4 y &p/V(7 CITY/ZIPCODE: qj�$D
*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 UBGONTRAC ORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. 4 '
I am not using any subcontractor ` C !J
Signature . Date
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
November 7, 2013
CITY OF CUPERTINO
DEPARTMENT OF BUILDING AND SAFETY
AUTHORIZATION TO SIGN PERMITS FOR CONTRACTOR
I hereby authorize Nina Raey, Agent, to act on my behalf in obtaining any and all permits from the Building
Department. I also authorize her to sign any and all required forms for me.
I am properly licensed as required by the State of California, license#638378, expires 02/28/2014.
1 carry current Workers Compensation insurance with Benchmark Insurance Company, policy number
CST5003905, expires 06/01/2014.
1 assume full responsibility under the law for permits obtained by the above authorized person.
This authorization shall continue until the Department of Building and Safety of the City of Cupertino receives
in writing that this contractor cancels such authorization.
Sincerely,
Jason Sylvester
Broadway Glass & Mirror, Inc.
BROADWAY GLASS&MIRROR, INC. 1 2523 E BROADWAY I LONG BEACH,CA 90803
CALIFORNIA ALL—PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
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'Odd Of CaAt011lla
CONTRACTORS STATE LICENSE BOARD
ACTIVE LICENSE
638378 CORP
BROADWAY GLASS AND MIRROR
INC
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02/28/2014 www(:sIb ca qov