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14070042 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 16 RESULTS WAY CONTRACTOR:UNITED MECHANICAL PERMIT NO: 14070042 INC OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET 2161 OAKLAND RD DATE ISSUED:07/11/2014 OWNER'S PHONE: 4088622007 SAN JOSE,CA 95131 PHONE NO:(408)232-9000 I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 1 APPLE-BLDG 16; INSTALL NEW GAS LINE License Class t111&,44444 /� �Lic.# 5 1 Contractort,&''�15b f/ 1&,44n444c- 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. 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000 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:35720041.16 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 ROM 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-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 7' 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 I 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 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) 1,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 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 I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 thol Bay Area Air Quality Management District performance of the work for which this permit is issued. will maintain compliance with t Cup tino nicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec'o s 2 5 5 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a 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,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.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 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 1 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 "1 COMMUNITY g DEVELOPMENT.DEPARTMENT. BUILDING DIVISION �U 10300 TORRE AVENUE^ CUPERTINO, CA 95014-3255 (408) 777-322B^ FAX(408)777-3333^ building d( cuoertino.org CUPERTINO 1 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION//DEFE/RR.ED ORIGINAL PERMIT PROJECT.ADDRESS Q( ! �� I AP 9- jUZ rs 1 5 /72`� / � 60 W ONERN'AME AU e(e/e limo I Pq p1> ��ji -2 000? E-MAIL STREET ADDRESS I CITY, STATE,ZIP I FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX OWNER ❑ 01AN t-BTJMZEER ❑ OWKERAGENT ❑ coN-RAcToR ❑CONTAACTORAG-.:NT ❑ ARC�TCT ❑EtiGINEz'R ❑ DEVELOPER ❑ TENAN'T CONTRACTOR NAME '^n - 1 LCL I LI H9 3,57 , 9&Z5,1!5 /IO Z� LICENSE TYPE I BUS.LIC COMPANY NAME (J y� E-MAILL FAX STREET ADDRESS CITY,STATE,ZIP I PHONE ARCHITECTIENIGINEER NAME I LICENSE NUMBER BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONST&TYPE I R STORIES USE TYPE OCC. sQ.F7. I VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA N'FT AREA BATHROOM YITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH]AREA DECK AREA TOTAL DECK/PORCH.AREA GARAGE AREA: DETACH []ATTACH N DWELLING UNITS: ISA SECOND UNIT [:3 YES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? ANO s — SES-P3iO-N ECORYOF _IS-TH_E_-BLDG.A_N E YES �RECEF �i a ,� {'c TOTAL VALUATION: PLANNINGADPLR E]NO PLANNING APPROVAL LETTER EICHLER HOME. By my signature below,I certiry to ea c the following: I am the pro erty owner or authorized ag t to act on the operty owner's behalf. I have read this application and the information I hav pro ided is c It. I h read e Description of Work and rift'it is acc . I agree to comply with all applicable local ordinances and state lavas relating t build a ion au oriz epresentatives of Cupertino to enter L eabove-identified prope�rtyrfor inspection purposes. SienatureofApplicant/Aeent: Date: �'_t SUPP 4ENT INFORM. TIO. REQUIREDAM— Lar, New SFD or Multifamily d-vvellings: Apply for demolition permit for ©g OBER TICOLIRTER r ��BUIIbL\GPL§i�REiZESV existing building(s). Demolition permit is required prior to issuance of building , +x permit for new building. �If RAI 51. YCaPREssf v� PLAI�nI1GPLANREi7E�f _Commercial Bldgs : Provide a completed Hazardous Materials Disclosure STDARD�� s ;ruBrri�wpTiR.s _�� rr form if any Hazardous Materials are being used as part of this project. y _Copy of Planning Approval Letter or Meeting with Planning prior to fl submittal of BuildingPermit application. TsAi si nnisTRrCTF �-NT ONT�4ENTHE:4T3TA' Bldg.4pp_2011.doc revised 06/21/11 CffTY OF CUP EllBUNO FEE IESTMATO R- ]BUff LDffNG DffVffRON ADDRESS: 16 results way DATE: 07/11/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PIAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1CPGA A WORK SCOPE Plumb.Plan Check 0.0 hrs $0.00 1-Jec, Pian Check t!, ; P,;, r I r, Plumb.Permit Fee: 1PPERMIT laec Perini[1 ve . in�i Other Plumb Insp. 0.0 hrs $48.00 Other 1. 1c:C. Insp. 1•e, I'lu?„1r. h7sp. Fee: h'IeC.Insp. Fee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are on! an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-033 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Plumbing Suppl. PC Fee: E) Reg. ® OT E0 hrs $0.00 $72.00 1BPGAS Piping, Gas>4 Outlets PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 El Administrative Fee: (ADMIN $45.00 Work Without Pen-nit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure 0 d Strong Motion Fee: IBSEISMICO $5.60 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $147.60 $72.00 TOTAL FEE: $219.60 Revised: 0711012014