13120165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR:GIDEL AND KOCAL PERMIT NO:13120165
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 574 DIVISION ST DATE ISSUED:01/21/2014
OWNER'S PHONE: 4088730121 CAMPBELL,CA 95008 PHONE NO:(408)370-0287
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
FLOORS 1 &2,UPGRADE ALL RESTROOM FACILITIES(2
License Class Lic.4 Ll ON EACH FLR,4 TOTAL)FOR ADA COMPLIANCE
Contractor &-"A e �oYIS-�•_ Date-17A,'?441 H
I hereby affirm that I am licensed under the provisions of C apter 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 fallowing 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:$150000
1 have and will maintain Worker's Compensation Insurance,as provided for by
iSection 3700 of the Labor Code,for the performance of the work for which this APN Number:36901028.00 Occupancye:
permit is issued. Type:
APPLICANT CERTIFICATION
1 certify that i have read this application and state that the above information is PERNUT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITIIIN 180 DAYS O 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 F AST 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
granting of this permit. Additionally,the applicant understands and will comply Iss V. Date: I Z r
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date Z ., 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.
❑ 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(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Cade,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
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 flay 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.I2 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Hcalth&Safety Code,Sections
,2550S 255339 and 25534. !
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 1 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 IS 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
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPEEtTIP10 (408)777-3228•FAX(408)777-3333•building -cupertino.orq
❑NEW CONSTRUCTION ❑ ADDITION ❑ AALLjTERATION 1 TI ❑ REVISION I DEFERRED ORIGINAL PERMIT 4
PROIEGT Afrss /f� I�r�h } APN 0 % I (J ZS
OWNERNAME _ PH 7a) E-MAIL
srRE� y� 7 � �} 7_ �/3o c¢)r,sr 7�E, �b
7FA;:�cvv �
CONTAC'NAME `•/J/!�c'.K � L_PHOGoFf� E-MAIL
STREET CTIY. TE,ZIP /
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAM LICENSE N BER 77SS-M
BUS.LIC#
Pi&Wr
COMPANY NAME // E-MAIL FAX
STREET ADD � ,� (/[•' CITY, TE,ZI / rj `'�; PHONE
. I r
ARCHITECT/ENGINEERN do 61 I.ICENSENUMBE,R a BUS.LIC 11
COMPANY NAME e� /�'� E-MAIL '4,
/ 7` 34 -4-
STREET AOES 54. -61 i CITY,STATE,ZIP C O elle PHONE
_% ?3
DESCRIPTION OF WORK JL 66 &,\.
EXISTINGUS� PROPOSED USE CONSTR,TYPE es r 5 USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR+✓-, DEMO TOTAL O>
AREA AREA AREA NET ARFA �3 f s� o c'o
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECKTI
TOTAL DECKIPORCH AREA GARAGE AREA: DETACH
❑ATTACI
N DWELLING UNITS: A SECOND UNIT ❑YES SECONDSTORY ❑YES
E1NGAIIIED? [J NO ADDITION? [:]NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLpC pN ❑YES R TOTAL VALUATION:
PLANNING ADPL G ❑NO PLANNING APPROVAL LETTER EICHLER HONE? ❑NO 50 CA:,(:)
By my signature below,I certify to each of the following; I am the property owner or authorized aon the property owner's behalf f have read this
application and the information 1 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 to buildin struction. 1 authorizeprrsontativeno3"�pertino to enter the above identified property for inspection purposes.
Signature of Applicant/Agent; Date:
SUPPLEME INFORMATION REQUIRED PLANCHECKTYPE ROUTING SLIP
_New SFD or Multi ily 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 for new building, ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑.PUDLIC WORKS
form if any Hazardous Materials are being used as part Of this project. ❑ LARGE ❑ PIRE DEPT
_Copy of Planning Approval Letter Or Meeting With Planning prior to El .LuoR 11SAN[TARY SEWER DISTWCT
submittal of Building Permit application.
❑ ENVIRONMENTALIIEALTH
B1dgApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20400 STEVENS CREEK BLVD DATE: 12/1912013 REVIEWED BY: MELISSA
APN: 369 01 028 BP#: / ' 1.Zo --r 'VALUATION: 1$150,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1B TI
USE: PERMIT TYPE:
WORK FLOORS 1 &2 UPGRADE ALL RESTROOM FACILITIES 2 ON EACH FLR 4 TOTAL FOR ADA
SCOPE COMPLIANCE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. SS
B (Tenant Improvements) 11-B,1I1-B,IV,V-B 738 $2,061.55 IBTIPLNCK $902.85 1BTIINSP
TOTALS: 738 1 $2,061.55 1 1 $902.85
MECH,HOURLY O Yes O No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No
bfech.Plan CheckT-T Phinib_Plan Chack FT Elee.Plan Check
ltr:cls. Permit f'e�; Plumh.Permit Pee: Eller.Penn it Fare:
Other,llech. Insp. Other Plumb Insp. Ll Other Elec.Insp. Ll
Mech. Insp.Fee; Phunb.hnp. Fee: Elec. Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Warks,Fire,Sanitary.Sewer District,School
District,etc). Thesefees are based on the relimina information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS(Fee Resolution 11-053 Ef):' 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,061.55 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $902.85
Suppl. Insp.Fee.S Reg. Q OT 0,0 1 hrs $0.00
.PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fera: Q
Work Without Permit? O Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Trm,el Dnc.°rrtttenlutiorr Fees:
Building or Structure O
i
Strong Motion Fee: 1BSEISMICO $31.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $6.00
SUBTOTALS: $3,001.90 $0.00 'TOTAL FEE: 1 $3,001.90
Revised: 10101/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone:408-777-3228
C U P E RTI N O Fax:408-777-3333
CONTRACTOR /SUBCONTRACTOR LIST
JOB ADDRESS: 2-0 GU Zp np S'C''ffl PERMIT# 12 O [ H 3 12 D 163
OWNER'S NAME: "eJA%w3 )2Z-. PHONE# d - 37-O -D7- 0
GENERAL CONTRACTOR: 6j.,Ae l icacsl [ow 4-rmtja^ BUSINESS LICENSE#
ADDRESS: -7,j CITY/ZIPCODE: Lwmbe I GA- 95zb
*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 am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
✓ 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
�
_ /'21
Owner/Contractor Signature Date