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12080104CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 4 RESULTS WAY CONTRACTOR: XL CONSTRUCTION PERMIT NO: 12080104 OWNER'S NAME: ECI TWO RESULTS LLC 851 BUCKEYE CT DATE ISSUED: 08/09/2012 OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB I Lic. # 64 �6 1D License Classt9 r r MECH RESIDENTIAL COMMERCIAL Contractor i� jj1/'1 Date if I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: APPLE - COMMERCIAL T.I. PREP NON-STRUCTURAL (commencing with Section 7000) of Division 3 of the Business & Professions (INTERIOR WALLS, FLOORING AND CEILINGS) Code and that my license is in full 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $215000 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 permit is issued. APN Number: 35720042.4 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS OM LAST CALLED INSPECTION. granting of this pe 't. Additi ally, a applicant understands and will comply with all non-po' urce re ions er the Cupertino Municipal Code, Section 9.18. - Issued 1iL Date: Signature Date 2- RE -ROOFS: ❑ OWNER -BUILDER DECLARATION 13 All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I have and will maintain Worker's Compensation Insurance, as provided for by Safety Code, Section 25532(x) should I store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued, I shall Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owr a thori ed age ner- become subject to the Worker's Compensation provisions of the Labor Code, I must �Q1�1(r Irk Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of %ork's I certify that I have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION 0 ALTERATION / TI ❑ REVISION / DEFERRED ORIG AL PERMIT # PROIECTADDRESS 4 Results Way - TI Prep APN# 357 20 042 OWNER NAME ECI TWO RESULTS LLC PHONE;-, /.�� QCI l, I .:;10 E-MAIL STREET ADDRESS1 3 0 1 SHOREWAY RD S TE 250 CITY, STATE, ZIP Be lmont CA 94002 FAX CONTACT NAME Marco Innocenti PHONE 408.240.60007 08.240.6000 E-MAIL minnocenti@xlconst.com STREET ADDRESS 851 Buckeye Court CITY, STATE, ZIP Milpitas, CA 95035 FAX 408 . 240 .6001 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT N CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Marco Innocenti LICENSE NUMBER 647480 LICENSE TYPE B BUS LIC # 21836 COMPANY NAME XL Construction E-MAIL minnocenti@xlconst.com FAX 408.240.6001 STREET ADDRESS 851 Buckeye Court CITY, STATE,ZIPMilpitas, CA 95035 PHONE408.240.6000 ARCHITECT/ENGINEER NAME David Sabalvaro LICENSE NUMBER C-015925 BUS. LIC# COMPANY NAME Studios Arch E-M'�--rossman@studiosarch.com FAX 415 . 398 .3829 STREET ADDRESS 4 0 5 Howard St Suite 588 CITY, ST, ZIP TESan Francisco, CA 94105 PHONE 415 . 398 . 7575 DESCRIPTION OF WORK TI Prep: Demolition of interior walls, flooring, and ceilings. EXISTING USE Business Group B PROPOSED USE CONSTR. Business Group B I TYPE II B #STORIES 2 USE TYPE OCC. SQ.FT. VALUATION($) EXISTG AREA 34,08 9 NEW FLOOR AREA N/A I DEMO AREA 34,089 TOTAL NET —A34,089 BATHROOM N/A KITCHEN O LAREA N/A OTHER N/A REMODEL AREA AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGEAREA: DETACH N/A N/A N/A NA 0ATTACH # DWELLING UNITSNA / BEING ADDED". IT ❑ YES SECOND STORY YES ADDITION" NO ONO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL # (RNO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME" W NO RECEIVED BY: /+ TOTAL VALUATION: $215,0001 By my signature below, I certify to each of the fol wing: I am the pr erty o r or authorized agent to act on the property owner's behalf. I have read this application and the information I have prov. d correct. I have re he Des 'tion of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil n struction. I author' represqwves of Cupertino to enter the above-identl€ied operty for inspection purposes. Signature of Applicant/Agent: Date. SUPPLEMENTALATIONRE D PLANCHECKTYPE ROUTING SLIP ❑ BUILDING New SFD or Multifamily dw ings: Apply for demo ition permit for _ existing building(s). Demolition permit is required prior to issuance of building OVER-THE-COUNTER PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ 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 ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 �-■-■�� CITY OF CUPERTINO FF.r+. F.cTIMATnR - BUILDING DIVISION Lk ADDRESS: 4 results way 1 -2nd floor DATE: 08/09/2012 REVIEWED BY: bobs. -N, APN: BP#: *VALUATION: $215,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY USE: Commercial Building 0.0 PENTAMATION 1TIPREP PERMIT TYPE: WORK t.i. reP non structural SCOPE $0.00 NOTE. This estimate does not include fees due to other Departments (4e. Planning, Public wortcs, Fire, aanuary,3ewer tnsrrict acnoot .,_ .. TL,. - f - L-11 __ •1... 01:.., ..% nfinn nvniln%l0 nnJ arO n"hD aH octimato- rnntart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-0531✓ff. 7/1!11) FEE QTY/FEE Elec. Plan Check 1'11 m F. ------------ CJther Lletl'i. lnsp. 'lwr Ptumh Insp. 01her Elec. Insp .1lech. Insp. Tee: 1'hmrh. hisp. Tee: 0.0 NOTE. This estimate does not include fees due to other Departments (4e. Planning, Public wortcs, Fire, aanuary,3ewer tnsrrict acnoot .,_ .. TL,. - f - L-11 __ •1... 01:.., ..% nfinn nvniln%l0 nnJ arO n"hD aH octimato- rnntart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-0531✓ff. 7/1!11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $388.00 Tenant Improvement Prep ITIPREP Suppl. PC Fee: (2) Reg. 0 OT f 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 ilrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 L t,'OnsInIction KIX., F Idrnia1.�fraff.w Fee: O Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 � `ravel Documentation Tees: Strong Motion Fee: IBSEISMICO $45.15 Select an Administrative Item Rld�, Sids Coiiiimssion Fee: 1BCBSC $9.00 SUBTOTALS: $54.15 $388.00 TOTAL FEE: $442.15 Revised: 07/01/2012 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS:4 Results Way PERMIT # 12080104 OWNER'S NAME:ECI TWO RESULTS LLC PHONE #408-240-6000 GENERAL CONTRACTOR: XL Construction BUSINESS LICENSE # 21836 ADDRESS:851 Buckeye Court CITY/ZIPCODE:Milpitas, CA 95035 *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 Please check applicable subcontractors and complete the following information: Date t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # x Cabinets & Millwork Mission Bell Casework 25336 X Cement Finishing 21108 25264 ./ x Electrical Redwood Electric Group Excavation _ Welker Bros. Fencing x Flooring / Carpeting Linoleum / Wood x Glass / Glazing Silicon Valley Glass 26943 x Heating Unite Mechanical 27361 X Insulation Accurate Firestop 34279✓ x Landscaping Jensen Corporation Pyramid Painting 9697, Lathing Masonry x Painting / Wallpaper 25999,/ Paving Plastering x Plumbing United Mechanical 27361 x Roofing Statewide Roofing 23509 Septic Tank x Sheet Metal United Mechanical 27361 x Sheet Rock Bayside Interiors 25898 X Tile Rinaldi Tile 27336 5/28/13 Owner / Contractor— nature r �i�