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13120153 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19200 STEVENS CREEK BLVD CONTRACTOR:GIDEL AND KOCAL PERMIT NO: 13120153 OWNER'S NAME: CYPRESS BUILDING ASSOC ET AL 574 DIVISION ST DATE ISSUED:02/04/2014 OWNER'S PHONE: 6504248383 CAMPBELL,CA 95008 PHONE NO:(408)370-0287 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class_ Lie.p 5L� UNIT 210- COMM.T.I 5475 TO INCLUDE INTERIOR j� DEMO,NEW INTERIOR WALL,CAGEWORK,FINISHES TO Contracto6f (--VCA-rZ,96 Date t'4 INCLUDE M,E,P FIRE SPRINKLERS TO BE DEFERRED 1 hereby affirm that 1 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: 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:$82125 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:37506005.00 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 DAYS FROM 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: 7 with al ource regulations per the Cupertino Municipal ode, ion 9.l % RE-ROOFS: S enature Date 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 1 hereby affirm that 1 am exempt from the Contractor's License Law for 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). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 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 1 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 devic hich emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined b B re it Qu� ty M nagement District 1 performance of the work for which this permit is issued. will maintain complianc ith the ert' o rpa]Cod ,Cha 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety C de,Section 25 ,2553 ,a d 25534 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a Date-.114 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 I certify that I have read this application and slate that the above information is correct.1 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, ARCHITECT'S 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 CONSTRUCTION PERMIT APPLICATION is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• buildingnDcupertino.org \ ❑NEW CONSTRUCTION ❑ ADDITION ^/ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 19'' f O S-f"�.�let►S / 1 Qe I i i.1 APN A ) 0\1 i i V eu J Q /�1 JMvS PHONE `f,,R ({��'74 SCJ C14AA 'PUIED 0 % FAX CONTACT NAME �I�� PHONE E-MAIL STREET ADDRESS 57, b � Q CITY,STATE, ZIP .J `'1� )_Vi"5l Dl� CCt.rr I pbtll r, Ca q qO FAXL� ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME' 616- LICENSE i LICENSE TYPE BUS.LIC# t COMP DIY AME E-MAIL ��U Lss�� -/ �l, c T �G r�vse al j- T¢E� "L1 inion _S(reeT CLQ AT 6 mzc) ARCHI T ECT/ENG(NEER NAME LICENSE NUMBER c �•-7 BUS.LIC# I M C. COMPANY NAMEE- AIL '3A 19; vt t "t G IT*AKW4 ,1" S�et:'� -if 150 [T ,STA E,ZIP P O ,. - 2252 DESCRIPTION OF bVORK ` `i i a;�c�+% ' C� t� I -R-► i -ri a�ISt rCr� EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES o�te � �ri/ ,/i 16 �J USE TYPE OCC- SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO / TOTAL L—• f AREA 54�� AREA Q AREA 6�` NETAREA �� /'�y/�i r �� BATHROOM KITCHEN OTHER � l REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA PECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH �- ❑ATTACH #DWELLING UNITS: IS A SECOND UNrr ❑YES SECONDSTORY ❑YES BEING ADDED? Q_111O ADDITION? (S PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED v LUATI N: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �- By my signature below,I certify t o ollow ing: e property owner o olized ag is behalf. I have ead this application and the informati have provided co CL L d the Desc ' on of ork and verify it is accurate. I agree to comply with all applicable local ordinances and State laws r sting to building con ctio 1 alit. e represen fives of upertino to enter the above-i enttiiiFi property for inspection purposes. Signature ofApplicandAg t: ` Date: 9 SUPPLEME RMA ON QUIRE PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUMIFER LDING PL.vv 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 ❑ nS '*,oRKs form if any Hazardous Materials are being used as part of this project. ❑ LARGE PuiE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ E,\'YIRON4IEYT-.AL HEALTH BldgApp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUP ERT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 2.00 S-''WU1S 1e, f 2(.Q PEkMIT# OWNER'S NAME: 26�b UU t!l SSOL- � . at PHONE # U - ASO GENERAL CONTRACTOR: 'IID UC.h.,- C&4, Co BUSINESS LICENSE # 2 ADDRESS: 9rvwlt CITY/ZIPCODE: Campbclt gzbog *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 follo%ing information: V/ SUBCONTRACTOR BUSINESS NANI,E, BUSINESS LICENSE # V-- Cabinets & Millwork five �•6e wc� k- JO Cement Finishing lrlectrical Wei ��+t;L X0365 ✓ peMo N12h Demolvf;vn 33Zob Fencing FlooriCy ng/Carpeting ►� �S�r;c�� Ce,l;r (rc�zzl E}c.o�1-;a5 �31y � Glass / Glazing Gl;he �, �S D9 1/ Heating nen► HVAC 1 S 2- Insulation Insulation Landscaping Lathing Masonry V Painting/Wallpaper Paving Plastering ✓ Plumbing 34VVb - Roofin Firms 5prrn k le ,5 U ,)ard rare. pajrch'or 463 Sheet Metal Sheet RockWg11 Tile a � � wuoto for S- ature 4 Date TA/TA '�9bd -1V30A EE :00 vZOZ/8Z/Z0 Building Department City Of Cupertino / 10300"Torre Avenue J/ Cupertino,CA 95014-3255 V Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 2,00 S�'2VQa1S Q Q,[� PERMIT# 20{ OWNER'S NAME: orb 54 tit g SnL- Pk . PHONE# " �J •D Z�S ^�— GENERAL CONTRA TOR: CD �. BUSINESS LICENSE# 2 ADDRESS: CITY/ZIPCODE: Ca.MD6,,u q"b0g *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 13E 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: V SUBCONTRACTOR BUSINESS NAj%4E BUSINESS LICENSE # ✓ Cabinets & Millwork ��ve (�.sewc�l {� 30 Cement Finishing Electrical �}o,N eG�,t.;L a p 3(0 g ✓ 12c"o NIM vevnol;frvr► j3ZO6 Fencing looring/Carpetuig �"Jk f,t n Ft r ��vtrr� /nc , '2'-7 ,64-5 I cc,�s C4\ C�iEin (ti-ctzz` AcoV�,1�;c s x314 2 Glass/ Glazing Oivl Ula�S 2`)Dy M Heating 1?eAnec> RIJAC 16 7-39 Insulation Landscaping _ Lathing Masonry ✓ Painting I Wallpaper )$c Paving Plastering ✓ Plumbing_ _ h vc,l,na 'P in – 3'"i0(o3 Roofing ✓ Fri ypr(vik,lcr5 urc u"CA 1=6re- f7iYd ccffvn �s3 Sheet Metal v Sheet Rock � �•�t wad p�-0 Tile 4"—�wn on for S' ature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19200 SCB DATE: 12/19/2013 REVIEWED BY: Mendez APN: BP#: IX-10 ;S� 'VALUATION: 1$82,125 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1B Ti USE: PERMIT TYPE: WORK unit 210- comm. T.I 5475 to include interior demo new interior wall ca ework finishes to include SCOPE m,e,p fire sprinklers to be deferred OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,III-B,IV,V-B 5,475 $2,395.75 IBTIPLNCK $4,526.75 1BTIINSP TOTALS: 5,475 $2,395.75 $4,526.75 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No Lfc�ch. Plart CJi,°ck wfiih. Plug c7mc'; +n(.hcci( il,kch.Permit Fee Plumb. P6 -Mil Fee: Iec.Per»tit Pc>e OtherA�ech.Imp. ET_L_ Other Plumb Insp- :�c.Insp. ET Aleeh.Insp.Fee: Plumb. Insp, Fee. Elec,Insp.Foe NOTE: This estimate does not include fees due to other Departments(i.e Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimin information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolution I1-053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,395.75 Select a Misc Bldg/Structure Suppl. PC Fee: E) Reg. Q OT 0.0 I hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $4,526.75 Suppl. Insp. Fee-.0 Reg. Q OT 10701 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? 0 Yes (F) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fees: Building or Structure i Strong Motion Fee: IBSEISMICO $17.25 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $6,943.75 $0.00 TOTAL FEE: 1 $6,943.75 Revised: 10/01/2013