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13040003 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20030 STEVENS CREEK BLVD CONTRACTOR:JOHNSTONE MOYER, PERMIT NO: 13040003 INC. OWNER'S NAME: PREG BILTMORE 1720 S AMPHLETT BLVD STE250 DATE ISSUED:06/04/2013 OWNER'S PHONE: 6509313457 SAN MATEO,CA 94402 PHONE NO:(650)570-6161 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] icense Class Lie.# U( FOUNDATION ONLY-BUILDING A Contracto{ 1t1Iri1 S ��/'I�A�'Date `�3 **SEE NOTES** 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 Cull 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 Seetion 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$0 1 have and will maintain Worker's Compensal ion Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36903004,00 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 WIT 80 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 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-poi source dations per the Cupertino Municipal Co e,Section 9.18. ,m RE-ROOFS: tgntur 't :i,. r,:••1 r ; ='Ltaie All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials For inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that 1 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 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(Sce.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(x)should I store or handle hazardous 1 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 thpfupertino Municipal Code,Chapter 9.12 a d 1 have and will maintain Worker's Compensation Insurance,as provided for by the health&Safety Code,Sec i lys 255ir 5533,itd 25534. Section 3700 of the Labor Code,for the performance of the work for which this sn or-,utltorizedsagrp =-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,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construetion 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(See.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 r is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \6 10300 TORRE AVENUE•CUPERTINO,CA 85014-3255 FC PERTINO (408)777-3228• FAX(408)777-3333•building(c cupertino.org 1 NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION I DEFERRED+ ORIGINAL PERMIT# PROJECT ADDRESS ,��p `=�` r✓ 4G.`J�f► 3� �� a3-ooc� �ba--a3-oo �-a' -yot OWNER NAME �t�i- -. _ � � y PE-MAIL �y'J�c7� Wre: STREET ADDRESS ' L� CITY. STATE,Z1P�{ti _ �� FAX CONTACT NAME '3 G��`li�r C1 � �E MOIL O STRepts'as.%3 or�r54.� L C� C TQ"- C ` tet CA- 94,t4C>- c131-3hrj� OWNER LI OWNER-BUDDER ❑ OWNEERAGENT ONPRACrOR CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑TENANT C i!A OR +} �[� n v� � L9�1�EN�}}IR(��[ 1� LICENSE TYPE BUS.LIC!S CI STATE,7y1P1 el'GO Crl4EER� � . jrf 51` ERf t Bu {¢� C )AP, � { +��r�—'� DESCRIPTION OF WORK CN T G U RO OSEO U` CONSTR.TYPE #STORIES -J 5 p Z) USE TYPE OCC. SQ.FT: VALUATION(S) EXISTG NEW FLOOR DEMO �f TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA {`+R� XVdODELAREA PORCH� DEC A TOTAL DE�RlP1`+Of RICH AR&A GARAG :� ATTACH ftw1 �A`5J f!"lS_ cf""1 ❑ATTACH 8 DwELL�U f5: IS A SECOND UNITPIS SES SECOND SI.ORY ❑SFS BEING ADDED. O ADDITION. O PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF ISTHEBLDGAN []YES CEI8Y TOTAL VALUATION: PLANNINGAPPL!! [:]NO PLANNING Al ROVALLETTER EICHLERHOME! IfNO By my signature below,l certify tofach f e following: I am the property owner or authorized agent o act on the property owner's behalf. 1 have read this application and the information I hate p vi d is correct. I have read the Description of Work and verify it is accurate. I agree to comply with ail applicable local ordinances and state laws relating bui ig c iof-i authorize representatives of Cupertino to enter the above�dentifel property for inspection purposes. Signature ofApplicant/Agent: C Date: SUPPLEMENTA O ION REQUIRED - PLANCHECIcTYPE-1' RourlPr,`L""1` , _New SFD or Multifamily welling,: Apply for demolition permit for ❑ .oVER-THE-COIJNTFR' El BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑-'EXPRESS " PLANNING PLAII REVIEW' _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E.SrnMA M ;" - ❑ PUBLICWORKS form if any Hazardous Materials are being used as part of this project. ' , , • 'LARGEI" �� ❑.FIRE�DEPT` _ _Copy of Planning Approval Letter or Meeting with Planning prior to = submittal of Building Permit application. ❑ iwtroR• u ❑ SANITARY SEIVER DMRICT ENVMONMENTALHEALTH BJdgApp_101 Ldoc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR--BUILDING DIVISION WI�PRRrvUT DRESS: 20030 Stevens creek blvd DATE: 03104/2013 REVIEWED BY: Mendez N: BP#: IG7 �(��)3 'VALUATION: $0 PE: Building Permit PLAN CHECKTYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1GENCOM WORK �BILTMQRE PROJECT- FOUNDATION ONLY FOR RETAIL BUILDING A-C SCOPE Xfcc•h,Plan Check Phrnrb.Plan Check Elec.Plan Check Me111. Perrnif Fee Phrn:b. Pernik Fee: Flec.Perrnir fee: Orlrer Mech.7nsp. 011ier Plumb lnsp. Other Etec,Insp. ilech.Insp.Fee: Phrnrb.hap. Fee, Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(t.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prefintinary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 16 hours Plan Check,Hourly Suppi.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $2,128.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes Q No $0.00 Suppl. Insp.Fee:Q Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (Oonso?iction Too: Administrative Fee,: Q Work Without Permit? O Yes 0 No $0.00 Advanced Plgng nL Fee: $0.00 16 hours Inspections Trm,el Documentation Fees: $2,128.00 ISTINSP Inspection,Hourly � Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS:° $0.00 $4,256,00 Y TOTALFEE: $4,256.00 Revised:' 01/0112013