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13060136-EXPIREDCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10255 S DE ANZA BLVD CONTRACTOR: Q L_ PERMIT NO: 13060136 L.On-s-tYu C_ +I on DATE ISSUED: 01/03/2014 OWNER'S NAME: ROBERT ALLARIO OWNER'S PHONE: PHONE NO: L7 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] TRINETHRA- COMM. T.I INSTALL FAST FOOD CORNER License Class Q Lic. # '10 3 3 5 WITHIN (E) MARKET, TO INCLUDE FLOOR SINK, Contractor.D 4 L- (�pN 5't R/ucriGN Date 0 1 1 0'3 0--t4 NON-BEARING WALL, A PREP SANDWICH TALBE, COUNTER 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. Sq. Ft Floor Area: Valuation: $20000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35917001.10255 Occupancy "Type: Section 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITIHN 180 DAYS T 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 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 Date: 3 granting of this permit. Additionally, the applicant understands and will comply u with all non -point source regulations per the Cupertino Municipal Code Section r ROOFS: to any roofing material being installed. If a roof is All be inspected any 9.18. r r� ,0 j 51'2.01+ Date,_/ I l�Cl Signature roofs shall prior 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 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). 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(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 for this the Health & Safety Code, Sections 550055J, 2555333, and 25534. Section 3700 of the Labor Code, for the performance of the work which Owner or authorized agent: v Date: x 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption,) 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 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10255 S DE ANZA DATE: 06/17/2013 REVIEWED BY: MENDEZ PC FEE ID APN: BP#: , 'VALUATION: $20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building 1MTIPLNCK PENTAMATION 1M TI PERMIT TYPE: A USE: Permit Fee: $535.00 WORK TRINE HRA- COMM. T.I INSTALL FAST FOOD CORNER WITHIN E MARKET TO INCLUDE SCOPE I FLOOR SINK, NON-BEARING WALL, A PREP SANDWICH TALBE, COUNTER TOPS AND p OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID M (Tenant Improvements) II-B,III-B,IV,V-B 88 $2,676.00 1MTIPLNCK $535.00 IMTHNSP Permit Fee: $535.00 Suppl. Insp. Fee.S Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: ,Idmirfistratice Fee: O Work Without Permit? Yes No $0.00 TOTALS: 88 $2,676.00 Travel Documentation Fees: $535.00 Strony- Motion Fee: IBSEISMICO MECH, HOURLY © Yes (!-) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY © Yes Q No - ---- ---- MISC ITEMS Plumb. Plan Cheek ',c. Plan Check Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F)Reg. Q OT IElec. Permit Pee: /�1rcr ;Lies /t. Insp 11her Plumb Insp. El Elea. Insp ED ' L z /a. Insp. Fee: "h ntb. hasp. I ez: Permit Fee: $535.00 Suppl. Insp. Fee.S Reg. Q OT 0,0 NOTE: This estimate does not include fees due to other Departments (i.e. manning, ruouc rrorn�, moire, �.nu.u.y ��rv�. ��•• �• .. ---a�., :.., _, .*_f_.__#;n n .;/oh/o and nro mik an estimate. Contact the Dept for addn'l info. District, etc Z. mese lees ure bused on ene_ rcu..u,�..1 FEE ITEMS (Fee Resolution 11-053 Ef: 7,} '1!12) ... -n.... ..••»••»• FEE -•--- -• - QTY/FEE - ---- ---- MISC ITEMS Plan Check Fee: $2,676.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F)Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $535.00 Suppl. Insp. Fee.S Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: ,Idmirfistratice Fee: O Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure Travel Documentation Fees: Strony- Motion Fee: IBSEISMICO $4.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3,216.20 $0.00 TOTAL FEE: 1 $3,216.20 Revised: 04/29/2013 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.org I3&ol3�, ❑ NEW CONSTRUCTION fS ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PR0IECT ADDRESS �N Ly' APN # �`"/ / 7 / (� OWNERNAME �\ L i� A PHONE 4d$ �'i� ZZO" E-MAIL >tM1�vw�c;�! L • mac} STREET ADDRESS -72-57o GL1� iZt" i�O n, S -� CrrY STATE, ZIP 14y,! DS r 1 FAX -r' CONTACT NAME $ t'"�t.7 t ,y A 1 jai' PHO !? �l J 04; !;6 E-MAIL 1 Q 1l0S GC'f s & CACA i c tie X STREET ADDRESS t4 FEMIA �uQ �' CITY, ST TE, ZIP Irl tT 9 t,, ///i���14 FAX I� A n ` "l ❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME tER Y1N .���•� LICENS 13 6 LICENSE TYPE BUS. LIC # q COMPANY NAME.D Ar L �.:S:T9 t4E-MAIL L ' FAX STREET ADDRESS 2i V> r+i�-i-rprf Liv �T CITY, STATE, ZIP Shrj Taste , [GA PHONE 4a$ $7- ?' 4-7 ARCHTTECTIENGIIVEER NAME ov LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESSC z$ 0 T Am E o -f -i. -r R STATE, ZIP " pJ,�x; f21iL PH NE 6 5 /g 16 0 DESCRIPTION OF WORK A s`r FooD _Q i tN 4FAisro4 Rmcc-R-` S`rbRE Moe.40 1tJ Fie,I�,c7z poo, fiRoM 2�S fAit <2,✓T /v.Fx� �o-oR S �a Kra 4 iN5r•T ALL 1 NL3 EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA Q g NEW FLOOR AREA DEMO AREA TOTAL NET AREA✓1 , SS �', �+>✓` L.� BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ONO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIV _ BY: TOTAL VALUATION: PLANNING APPL Fl NO PLANNING APPROVAL LETT [JER EICHLER HOME? NO ce -, By my signature below, I certify to each of the following: I am the property owner or aut iorizol ag 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 bui construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. . Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED Pini caEcx TYPE ROUTING SLIP ❑ OVER -TRE -COUNTER INc 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. ExPRES.�,' 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 DPT . _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ submittal of Building Permit application. MAJORAtTARY SEVIER DISTRICT - ❑ ENVIRONMENTAL HEALTH BIdgApp_2011.doc revised 06/21111 CUPERTINO 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: [ O Z 55 S, v► Zr, W J d PERMIT # 3 d 6 0 t 3 OWNER'S NAME: /� o PHONE # GENERAL CONTRACTOR: C404 BUSINESS LICENSE # ADDRESS: 3 2 t \I i2rgltL-ION GT CITY/ZIPCODE: 5-Ae-J oSC— g 5-15 1 *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CU ERTINO BUSINESS LICENSE. -Al- 1 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting LZ Linoleum / Wood Glass / Glazing Heating Insulation Landscaping ZZ Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35917001.10255 DATE ISSUED.......: 06/17/2013 RECEIPT #.........: BS000020445 REFERENCE ID # ...: 13060136 SITE ADDRESS 10255 S DE ANZA BLVD SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ROBERT ALLARIO ADDRESS 14169 OKANOGAN DR CITY/STATE/ZIP ...: SARATOGA, CA 95070 OPERATOR: SylviaM COPY # : 1 RECEIVED FROM ALIGN TRADERS CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS ..........: CITY/STATE/ZIP ...: TELEPHONE ........: FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---- NEW BAL ----------------------- 1BCBSC VALUATION -------------------- 20,000.00 ---------- 1.00 0.00 1.00 0.00 1BSEISMICO VALUATION 20,000.00 4.20 0.00 4.20 0.00 1MTIINSP SQUARE FEET 88.00 535.00 0.00 535.00 0.00 1MTIPLNCK SQUARE FEET 88.00 2676.00 ---------- 0.00 2676.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 3216.20 0.00 3216.20 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CHECK 3,216.20 CHK --------------- TOTAL RECEIPT 3,216.20 Susan Winslow To: projects@creativemagnificence. biz Subject: Permit application expiration letter Attachments: 10255 S DE ANZA BLVD.pdf Importance: High Hi Ashwani, Attached is a copy of the permit application expiration letter for permit #13060136 for 10255 S De Anza Blvd. The permit application will expire on Thursday 12/14/13. The permit is ready to issue. Please have the owner or contractor come to our office to pull the permit no later than 12/14/13. If you let the permit application expire you will need to pay additional fees. Let me know if you have any questions. Sincerely, Susan Winslow Administrative Clerk Cupertino Bldg Dept 408-777-3246 UM O�Umm 8,1)t4rerr4ckrkeLs luly 15, 2013 Mr. Sean Hatch City of Cupertino Community Development Department Building Division RE: Plan Check #13060136 - ADA Compliance Trinethra -Cupertino 10255 S. De Anza Blvd U--,ar Mr. Hatch: ! am the tenant at the referenced address. I am writing to inform you that the existing Trinethra Market is compliance with the current ADA standard. Should you have any questions or required additional information, please contact me at the business address, email or telephone number. ,?Pspectfull y, Kishore Muvva 408 • 996 • 2400 110255 S De Anza Blvd • Cupertino • CA 95014 Info a aligntraders. com