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12120050-EXPIREDCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1361 S DE ANZA BLVD CONTRACTOR: RADISH PERMIT NO: 12120050 CONSTRUCTION OWNER'S NAME: BOREL BANK & TRUST COMPANY 419 RINCON AVE DATE ISSUED: 12/042013 OWNER'S PHONE: 4086630860 SUNNYVALE, CA 94086 PHONE NO: (408) 739-4015 Iff LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL 0 BOBBIE'S CAFE- ADA IMPROVEMENTS, REPLACE License Class_ Lie. # �g `tel c� APPLIANCES, REMOVE AND REPLACE DOORWAY Contractor u—j r 5 j^ clo fl/' 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 Sq. Ft Floor Area: Valuation: $27000 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: 36619047.00 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 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 D YS FROM ED 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 6 Z granting of this permit. Additionally, the applicant understands and will comply s with all non -point source regulations per the Cupertino Municipal Code, Section ROOFS: 9.18. I, Signature '�"' 4a�t.N� Date � y All roofs shall be inspected prior to any roofing material being installed. If a roof is any r 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 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). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 5505, 255 , and 25534. Owner or authorized agent: Date: G%� I 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 CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �\ (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org \ CUPERTINO n MFW C nNSTRI IC TInN n AIDIIITInN n AI.TFRATION / TI n REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS/ 2 �� T 1/ ,jlw-yl/ /�W6L/F LPN # OWNER NAME %L i( PH� JQ0 7 i� E MAVYN�L� . �• C STREET ADDRESS�T!{/',((/ / CO ) - CITY, STATE, ZIP (�� v n FAX CONTACT NAME/LL ��✓� I�IgNR`9�^�Cj `,Js{ PHON ./_� / / ^Q L` \ Q W� E-MAIL n l� STREET ADDRESS �R/IV �O �yE CITY, S ` �b1UD FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME ) E-MAIL _/G nC �✓ L / • FAX n STREET ADDRESS E CITY, STATE, ZIP �`vv/N�DNA v PH E / / 6/ C (p�j Q b ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK RCA"G C W� 0 `J E Ge ADA i M 1'pode gan pw_ 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 DECKIPORCH AREA GARAGE AREA: LJ DETACH ❑ ATTACH # DWELLING UNITS: 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 ❑ YES RECEIVED BY:�DTfilj. }!AL�TION: a PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO [i(� (7O 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 pro � ' 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 const coon. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Lo'' Date: ( y SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE 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 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: 3 PERMIT # 12-1 0 0 OWNER'S NAME: PHONE # 1540L(o C7h O GENERAL CONTRACTOR: 4 ; L- 0 BUSINESS LICENSE # ADDRESS: cmfj e, J,, -_j e CITY/ZIPCODE: *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 CUPERTINO BUSINESS LICENSE. I ami using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date 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 UNREASONABLE HARDSHIP EXEMPTION FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org (For Tenant Improvements where the Cost of Construction does not exceed $128,410.90) SITE iD 6 SS� � APN 34 -If-oz !f_oz - BP# CITY (% %b C� ZIP 504- TOTAL CONSTRUCTION COST A $................................................ DESCRIPTION OF WORK: Ov>E E A M Q P_&P The following is a list of costs to provide access features in order to comply 100% with the current State Title -24 Disable Access Standards.(AII cnsts to he dnmimented by actual bids or other information accented by the Buildina Official.) Accessible Features Complies with If not, list required upgrades in order for Cost to make feature Description of access features to be provided: current standards? features to fully comply? fully accessible? 1. Path of travel to accessible entrance. PERCENTAGE (20% minimum expenditure is re uired � f e:E � 0�� $ 12-00 - 2. Cost of providing a primary entrance. (Including but not limited to, thresholds, landings, door hardware, $ 5-50— max. door pull, etc. 3. Cost of providing the primary path of travel to the specific area of alteration, structural repair, or $ _4n�_ addition. 4. Cost of providing accessible restroom facilities. $ 5. Cost of providing an accessible drinking fountain. (If $ required or if a drinking fountain is provided.) 6. Cost of providing accessible public telephones (if $ provided) 7. Cost of providing other accessible features, including $ �r but not limited to, parking, storage, alarms etc. TOTAL COST OF ACCESS FEATURES (B): $ 's, :�' 5'r Has the same tenant performed work in the same tenants ace within the last three ears? w 1� , �' Calculate (B / A) x 100% Description of access features to be provided: TOTAL COST OF PROPOSED UPGRADE / -7 $ Z� C PERCENTAGE (20% minimum expenditure is re uired % ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify t"ttTabTAwiQted mation is true and correct. Name (print)L' ` Signature: CC-- Date: I I �-- Firm address: ✓"' 5 �C NZJ� �(�%�� Title: M/�%g�7 in4�e e� Phone: �`�� 3 C6P60 FOR DEPARTMENT USE ONLY ❑ The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 11348.2.1. ❑ The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR -Title 24 (Regulation for the Accommodation of the Disabled) pursuant to 2010 CBC Section 1134B.2.1. COMMENTS: Building Official Designee (print): Signature: Date: HardshipExemptionForm_201 1. doc revised 02/25/11