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14010013I l g�z CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 14143 S DE ANZA BLVD I CONTRACTOR: =PERMIT NO: 14010013 OWNER'S NAME: BDC HAYWARD LC 13088 AUTUMNWOOD CT I DATE ISSUED: 01/02/2014 OWNER'S PHONE: 4084839453 Efll� LICENSED CONTRACTOR'S DECLLfARATION License Class.._ Lic. # 1?1 ! 7 Contractor (T/ Date 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. 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. I have and will maintain Worker's Compensation Insurance, as provided for by Xction 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point sourc egulatio per the Cupertino Municipal Code, Section 9.18. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date SAN JOSE, CA 95148 1 PHONE NO: (408) 966-2275 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ DENTAL OFFICE T.I., ADD (N) DENTAL OFFICE SPACE TO (E) BIKE SHOP (1492 S.F.) **STILL NEED SANITARY APPROVAL BEFORE FINAL** Sq. Ft Floor Area: I Valuation: $150000 APN Number: 35917019.10493 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ��/v A d- Date: C;7 l/? -/�/ RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sectio 33, and 25534. Owner or authorized a t: Datc:2 /i-1 ily CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional TD G 7 -ry (-) F l%X W -9T1-0 v C 1++-tj 6c, or- CdQTAA--C-n+ 2-- �Gl qn 9.e- Jt— � ►���-� Y o 1�1 Q � �, Pro V i S i v ►-, D� P ym ) o� -,vv 13 ,Q-{e;c a� ivsa" Provision Development Inc. 510 Lawrence Express Way, #105, Sunnyvale, CA 94086, PH. (408)245-0991 FX. (408)245-0319 February 18,2014 Building Official City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 (408)777-3228 Permit No.: 14010013 Project: Dr. Amy Mao Dental Office Tenant Improvement lotR� 44443 S. Deanza Blvd. Cupertino, CA To whom it may concern: This letter is to inform that we are no longer the contractor for the above project. And, We are withdrawing our company name from this permit. We are not responsible for any liability, damage, or any lawsuit arised from this project. Any lawsuit, complaint, and all liability issues should be referred back to the building owner, and or the project tenant. If you have any questions, please feel free to call us at your convenience. Sincerely, John Ha, AIA President CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: "'193 S DE ANZA BLVD CONTRACTOR: PROVISION PERMIT NO: 14010013 DEVELOPMENT, INC. OWNER'S NAME: BDC HAYWARD LC 510 LAWRENCE EXPWY STE 105 DATE ISSUED: 01/02/2014 OWNER'S PHONE: 4084839453 SUNNYVALE, CA 94085 PHONE NO: (408) 245-0991 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E]COMMERCIAL DENTAL OFFICE T.I., ADD (N) DENTAL OFFICE SPACE TO License Class Lic. # (E) BIKE SHOP (1492 S.F.) Contractor& V 1 S , b"►1 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. I hereby affirm under penalty of perjury one of the following two declarations: SANITARY 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 Sq. Ft Floor Area: Valuation: $150000 performance of the work for which this permit is issued. 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: 35917019.10493 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 WIXD180 D RMIT 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 LED 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 sued Date: /71 / granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. u ! ��19 .. 4 Signature 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. ❑ OWN E R-BUH.DER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 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(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 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, Sec ' ns 255051?5533, a 25534. 1 Section 3700 of the Labor Code, for the performance of the work for which this 7 Owner or authorized agent: Z_ 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 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 go CITY OF CUPERTINO Iz&q FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ItM S. DE ANZA BLVD DATE: 01/02/2014 REVIEWED BY: MELISSA JimADDRESS: APN: 359 17 019.10493 BP#: ZV 3 'VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building IBTIPLNCK PENTAMATION PERMIT TYPE: 1 B T� WORK DENTAL OFFICE T.I. ADD N DENTAL OFFICE SPACE TOE BIKE SHOP 1492 S.F. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 1,492 $2,097.32 IBTIPLNCK $1,367.44 IBTIINSP I;?e( lov) F, PME Plan Check: $0.00 Permit Fee: $1,367.44 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 1,492 $2,097.32 Construction .Tier: $1,367.44 MECH, HOURLY © Yes O No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No tllech. Plan Check Phunb. Plan Check F_lec. Plan Check A,lei:hPermit Foe: Plumb. Permit Fee F.Iec. Permil Fe,.- ee:Other Otherhlech. Insp Other Plumb Insp.ELI Other Elec, Insp. Ilech. Insp. F,, I'lumb. Insp. Fee: I;?e( lov) F, NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef/.' 7.7.'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,097.32 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q) Reg. Q OT FO.0 Fhrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,367.44 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction .Tier: ,ldrninistrative Fee: E) Work Without Permit? Yes C) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i 7 ravel Documentation Fees: Strong Motion Fee: IBSFISMICO $31.50 Select an Administrative Item Bldp_ Stds Commission Fee: 1BCBSC $6.00 SUBTOTALS: $3,502.26 $0.00 TOTAL FEE: 1 $3,502.26 Revised: 10/01/2013 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O` 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(cilcugertino.org \ F-1 T rt;Tu rnNCTRTTrTT(-iN n AT)T)TTTnN X AI.TFRATTON / TI n REVISION / DEFERRED ORIGINAL PERMIT 4 PROJECT D S �O APN # �� �i / rJ� _ D C S V l I O ERNAME^ Z(3PC-AYIWA• 1D I._� PHONE 2� 4`23 �3 E-MAIL STREE DREISS •� 2 3 N4 I , f„Y. P—b e, � kCs1 ZY, STATE ZIP r / 7 L La rr FAX CONTACT NAME I HA E-MAIL7c,l-irl v STREET PDRESSCITY, STATE, ZIP A FAX «c 7450 5 LCvtJYZh s I0S H. L ✓ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CTOR E LICEN R LICENSE TYPE BUS. LIC # C1t) Vl PANY NAME E-MAIL ? FAX Z4 O �I �D yuC-yy�- IVtL i'lF/ j > STRET ADDRESS CITYSTATE, ZIP S,s Cz PHON G4> 0 v ARS TECT/ENGINEER NAME LIC ENS NUMBER BUS. LIC # C -21'7 COMPANY NAME- 1.E -MAIL c� i A. F .� I, STREET ADDRESS - CITY, STATE, ZIP HO �bi24D ID L�vwr2>,ce �-x Y(ss cID� t nr v L' b�� DESCRIPTION OF WORK I�n W -IT — "Jag (G G J Ci �N lAk i &C UY1 YC I LA ISTING S`E I- PROPOSED USE �( CONSTR. EXISTING kk a) TYPE v # STORIES ' USE TYPE OCC. - SQ.FT. VALUATION (S) F/i 7k YQ,4Ck )ICAC EXISTG NEW FLOOR DEMO - TOTAL AREA 141Z AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY DYES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES R"'',.�. `. L.� '3 :. TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO - - 5—Q /i(� U By my signature below, I certify to each of the following: I am the property owner or authorized agent tQ act on the property owner's behalf. I have readthis 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 o building co structioa I uthorize representatives of Cupertino to enter theabove-identifiedproperty for inspection purposes. "C �J Date: �ii Signature of Applicant/Agent: , 9 01A SUPPLEMENTAL INFO TIO REQUIRED PLAN CIIECK TITE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 CUPERTINO lnaA,7 CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: , D IVot ' PERMIT # W 01 bal .3 OWNER'S NAME: gpli PHONE # a08'Z4 V GENERAL CONTRACTOR: ;y, �r �'viL BUSINESS LICENSE # ADDRESS: S (0 Lp w np,cA W a,4 CITY/ZIPCODE: 5«H ALI VA4 C`A 40 *Our municipal code requires all businesses working in the city to have a City of Cuperti" business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V 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 �Contjactor Signature 2 0+ - ate IN Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-7606 OFFICIAL NOTIFICATION OF NEW/ADDRESS CHANGE TO: All Agencies FROM: City of Cupertino DATE: February 26, 2014 RE: New/ Change of Address APN #359-17-019 Please note the following address change: 10493 S De Anza Blvd has been divided into two units. The new unit will be 10487 S De Anza Blvd. This address was already a valid address and is being re -instated. See attached map. The new address will take effect immediately. Please update your records accordingly. If you have any questions, please call me at (408) 777-3246. Sincerely, Susan Winslow Administrative Clerk Cupertino Building Dept 408-777-3246 or suew@cupertino.org City of Cupertino Basemap Labels Abc Street Names Primary Address Labels - Freeway Basemap 9 Street Centerline County Major Roads County Freeways Right -of -Way Parcels Community Development City Boundary ® Aerials - Sept 2013 Ale stova* 1o�155 /oy,5+7 0 /Oz/77 I Of 7 n y93 to VF5- / 0 /719 % ( 3597`17- oL3 SCALE 1 :2,042 200 0 200 400 600 ` FEET http://gissvr/cupertinointranet/home/mapFile.aspx N Tuesday, February 25, 2014 2:38 PM CUPERTINO PURPOSE HAZARDOUS MATERIALS CHECKLIST COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.org To minimize possible delays that would result for the Fire Department plan review, please complete the following checklist to determine if an additional level of Hazardous Materials plan review will be required. MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING? PLEASE MARK YOUR ANSWER WITH AN `X' IN THE YES OR NO BOX ON THE SIDE BELOW. YES NO 1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases, hazardous materials, etc. 2. Battery back-up rooms or racks. V 3. Propane tanks. 4. Gasoline stations with underground tanks. V 5. Installation or replacement above ground or underground storage of liquid petroleum products, liquefied petroleum gases, compressed natural gas, explosives or other regulated hazardous materials. t% 6. Gas rooms for dentist, doctors or veterinarians. V 7. Generators with back-up diesel or other fuels. V 8. Large refrigeration systems. V 9. Fuel cell systems. V 10. Commercial pool systems. V 11. Chemical Storage areas. V 12. Flammable liquid storage. 13. Compressed Gases. ( "pyev; Air- 4&-r 'Pe.,,-tJ CIL4-1,) \/ 14. Dry cleaners. 15. Print Shops. 16. Auto Repair and Auto Body Shops. 17. Research and Development. U For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa Clara County Fire Department, at (408) 378-4010. HasMat 2011.doc revised 03/07111