13020133 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22445 CUPERTINO RD CONTRACTOR:SAMUEL PERMTf NO: 13020133
CONSTRUCTION
OWNER'S NAME: FRONT PORCH COMMN&SERVS 2141 CAROBWOOD LN DATE ISSUED:08/21/2013
OWNER'S PHONE: 4084545600 SAN JOSE,CA 95132 PHONE NO:(408)221-7900
M LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
ficense Class Lic.# -2- REMODEL(E)KITCHEN&REMOVE(E)&INSTALL(N)
a?3 WALK—IN COOLER&FREEZER.UPGRADE ONE
Contractor �t<°/7 �3`rQ v1/l V�E'� Date EMPLOYEE
I hereby affirm that I am licensed under the provisions of Chapter 9 BATHROOMILOCKER TO MEET CURRENT ADA
(commencing with Section 7000)of Division 3 of the Business&Professions STANDARDS
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 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:5120000
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:326I5130.22445 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 WIT 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 DA OM LAST CALLED INS ECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the �r /
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 4
a RE-ROOFS:
Signature-Y r� * rnrT•�---•_•_Date / 3 All roofs shall be inspected prior to any roofing material being installed.If a roof is
==�-�+•`�- '�-�'=--=�-�;,,�� .�.x Vii`:-'1; ��3�i installed without First obtaining an inspection,l agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Lawfor 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(Sce.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construet 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 complianee with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)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 comEligpce�with the.Cupertino Municipal Code,Chapter 912 and
I have and will maintain Worker's Compensation Insurance,as provided for b the 11. 1111& ilcty,4'or�q;'Sectlons,25505,'ZS533'ltndr25534.
Section 3700 of the Labor Code,for the performance of the work for which this � r �Da^ l
Owner or authorized agent: t�T 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,] 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
1 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, ARCHITECTS 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.
Signature Date
4)
CONSTRUCTION PERMIT APPLICATION �\
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (406)777-3228•FAX(4,,0//6)777-3333•building@cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION L'ALTERATION/TI ❑ REVISION/DEFERRED\ORIGINAL PERMIT#
PROJECT ADDRESS APN k rJ g �f f 0 , z -Z 'J q
OwNERNAME �i+'f7 f7v r� Irlf
I 1 PHONY6,p- / -r�Qa E-MAIL
STREET ADDRESS Z �S (�` CITY,STATE,ZIP O � `, fJ � [�rq FAX
CONTACT NAME GLI Gf/�r s (/pu+]El�� PHONE c a 51E-�S ,S',r E-MAIL C{1Q 1/,n a,0/,,10 n -IJ Cr - e 7
STREET ADDRESS / CITY,STATE,/ZIP ! FAX
// 2Z+�S4.� C CITY, C rf,-LA C4 9JVI
13OWNER ❑ owNERBUII.DER ❑ oWNERAGEkT ❑ CONTRACTOR ❑CONTRACTORAGENr ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ! LICENSE NUMBER D LICENSE TYPE BUS.LIC#
e-" `1112 L'e.I/ SCG 1(-772 7
COMPANY NAME �G/�IUef /I�r_}. E-MAIL
�17 o'r��mUPJ/nGCJ1/�.�t7 FAX
STREETADDRESS C�Y�w�oO.1 -7 /i{ h CIlY,5TATE.ZIP sa 'T S PHONE(„�yd,_ZsI-7000
ARCHITECTIENGINEERNAM(E �L L ISCENSENUMBER ` BUS.LIC
'q�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK r Q
'7Lb
W Tf1 l/�/(r(n� e L J✓� S _ a .Ctirc1 O1
EXISTING USE PROPOSEDUSS CO STR TYPE #STORIES
V^ USE TYPE OCC. SQ.FT. VALUATION(S)
EXLSTG-- ✓ NEW FLOOR DEMO 'TOTAL
AREA/: J 6 `REA 2_5-5— AREA NET AREA
BATHROOM Y• KITCHEN OTHER
REMODELAREA REMODELAREA RFMODELAREA q� /J f3
PORCH�A(FA RDECK A TOTAL�D ❑
/ECKITORCHAREA GARAGEAREA: DETACH Ij I (,
A /�f} AIA ATTACH
/�/
9 DWEL ING LWrrS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEINGADDED? NO ADDITION? []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE BY: TOTAL VALUATION:
PLANNTNG ADPL 0 LINO PIANNTN0 APPROVAL LETTER EICIILER HOME? []N ' /,L-
By my signature below,I certify to each ofthe following: I am the property owner or authorized a on the erty er's behalf. I have read this
application and the information 1 have pro ' ed is correct. I have read the Description of Wor erify it is a . agree to comply with all applicable local
ordinances and state laws relating to buil m[i pstFuction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applieant/Agent: Dale:
SUPPLEMENTAL INFORMATION REQ D PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit fbr new building. ❑ ExPREss PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure F 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 IM9SANITARY SEWER DISTRICT
submittal of Building Permit application-
ENVIRONMENTAL HEALTTi
BldgApp 2011,doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22445 CUPERTINO RD DATE: 02/25/2013 REVIEWED BY: MELISSA
APN:' 326 15 130.22445 EW: *VALUATION: 1$120,000
*PERMIT-TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B TA
WORK REMODEL E KITCHEN & INSTALL N WALK-IN COOLER & FREEZER. UPGRADE ONE
SCOPE EMPLOYEE.BATHROOMILOCKER TO MEET CURRENT ADA STANDARDS (1586SF). ENCLOSE p
OCCUPANCY TYPE: . TYPE OF FLR AREA PC FEES PC FEE ID BPFEES- BP FEE ID
CONSTR.,s.f
B (Tenant Improvements) 11-B,1II-B,N,V-B 1,841 $2,062.80 IBTIPLNCK $1,608.72 IB77INSP
TOTALS: 1,841 $2,062.80 $1,608.72 ;
MECH,HOURLY Q,Yes .Q=No PLUMB,FIOURI:YQ`;- ,-;No : ELEC,HOURLY Q Yes QNo
Ifecli.Plan Check Plupnb.Plcm Check Elec.Plan Check
rlfech.Pernvil Fee: Plumb,Permit Fee: Elec.Pennir Fee:
Other Afech.MST). E1__1__ 011 r Plumb hup. E17-- Other Elea.Insp.
Alech.I=P.Fee: Plumb, Insp. Fee: E1ec•.Imp.Fee:
NOTE:This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School
District.etc. . 77eese ees are based on the prefindna information available and are only an estimate Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolulion 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,062.80 Select a Misc Bldg/Structure
Suppl.PC Fee: ` Q Reg. Q OT O,O hrs $0.00 or Element of a Building
PME Plan Check: $0.00
•Perihit Fee: $1,608.72
Suppl.Insp.-Fee:Q Reg. Q OT O,O hrs $0.00
'PME Unit Fee: $0.00
PME Permit Fee: . $0.00
Conshwetinri To x: _T
Adi''ih`istrative Fee: Q
Work Without Permit? Q Yes Q No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Travel Docinnentation Fees: Building or Structure Q
i
Strons4 Motion Fee: 1BSEISMICO $25.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $5.00
SUBTOTALS: $3,701.72 $0.00 TO'TAL'FEE ., $3,701.72
` Revised: 0110112013
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