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12080105CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 5 RESULTS WAY CONTRACTOR: XL CONSTRUCTION PERMIT NO: 12080105 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'SDECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB I— License Class_I S Lic. # 0T1 ©r Contractor ��,p]�siYtir,;�� Date MECH RESIDENTIAL COMMERCIAL 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 DEMOLITION OF INTERIOR WALLS, FLOORINGS, 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $215000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35720041.5 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 upon the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYSM LAST CALLED INSPECTION. with all non -points rc egulation er a Cupertino Municipal Code, Section 9.18. � Signature Date Z Iss lyy: Date: k ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, 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 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 HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sec us 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must Owne autho ' ed t: 2 forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Hork's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I Understand my plans shall be used as public records. Signature Date Licensed Professional CUPERTINO (:�� P�.tV AN-T�'_ CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ingacupertino.org iZ0EU\,v-:�- ❑ NEW CONSTRUCTION ❑ ADDITION X❑ ALTERATION/ Ti ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 5 Results Way - TI Prep APN # 3 5 7 2 0 -&4-2' OWNERNAME ECI TWO RESULTS LLC PHONE -7 E-MAIL STREETADDRESS1301 SHOREWAY RD STE 250 CITY, STATE,ZIPBelmont CA 94002 FAX CONTACTNAME Marco Innocenti PHONE 408.240.6000 E-MAIL, minnocenti@xlconst.com STREETADDRESS 851 Buckeye Court CITY,STATE, ZIP Milpitas, CA 950A`FAx8 .240 . 6001 ❑ OWNER ❑ OWNER-BUELDER ❑ OWNER AGENT M CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Marco Innocenti LICENSE NUMBER 6 4 7 4 8 0 LICENSE TYPE B BUS. LIC # 21836 COMPANYNAME XL Construction E-MAIL minnocenti@xlconst.com FAX 408.240.6001 STREETADDRESS 851 Buckeye Court CITY, STATE,ZIP Milpitas, CA 95035 PHONE408.240.6000 ARCHITECT/ENGINEERNAMEDavid Sahalvarc LICENSE NUMBER C-015925 BUS. LIC# COMPANYNAME Studios Arch E-MAI'crossman@studiosarch.co FAX 415.398.3829 STREET ADDRESS 4 0 5 Howard St Suite 588 CITY, STTE, ZIP San 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 I CONSTR. Business Group B I TYPE I I B # STORIES 2 USE TYPE OCC. SQ.FT. VALUATIONS) EXISTG AREA 47, 3 4 6 NEW FLOOR AREA DEMO AREA 47, 346 TOTAL NET AREA 4 7, 346 ® its �` S 2_ BATHROOM N/A KITCHEN N/A OTHER REMODELAREA N/A REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARN�A A� N/A N/A N/A ❑DETACH ATTACH #DWELLING UNITSN IS A SECOND/A BEING ADDED".NIT ®NO ADDI ION?ORY Qg OS PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # MNO PLANNING APPROVAL LETTER EICHLER HOME? W NO $215,000 e prop owner or authorized agent to act on the property owner's behalf. I have read this By my signature below, I certify to each of t following:fhe application and the information I have v' d is correct.read t Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to d constructionrize pfesentatives of Cupertino to enter the above-'n/ti' led/property for inspection purposes. Signature of Applicant/Agent: Date: 'tel117- SUPPLEMENT IN RMATI N Q D PLAN CHECK TYPE OUINc SLIP ES CT _ New SFD or Multifamily d ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER-THE-COUNTER BUILDING 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. ❑ F.NVHtONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 ,��,�� CITY OF CUPERTINO 1�'fi� a FEE ESTIMATOR — BUILDING DIVISION WilADDRESS: 5 results way 1 -2nd floor DATE: 08/09/2012 REVIEWED BY: bobs. Fee: APN: BP#: `VALUATION: 1$215,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building Elec. Insp. Fee: PENTAMATION 1TIPREP USE: $0.00 PERMIT TYPE: WORK t.i. rep non structural SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, Sanitary Fewer District, Schoot Dictr>iet_ otr_ 1_ Thoco fooc aro hacod an the nreliminary information available and are only an estimate Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Eif. 7111112 FEE ,ek MISC ITEMS Fee: 'lamb. Permit Fee: 0 # Tenant Improvement Prep $388.00 1TIPREP i Other Met n. ii''S,=7-- oiiiciI iumb Insp. other Elec. Alech. Insp. Fee: Plurnb. lisp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, Sanitary Fewer District, Schoot Dictr>iet_ otr_ 1_ Thoco fooc aro hacod an the nreliminary information available and are only an estimate Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Eif. 7111112 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Tenant Improvement Prep $388.00 1TIPREP i Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT Fo.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conswuction Tax: _. trative Fc e. O 0 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G) Building or Structure O i 1. r-a>>el Documentation Fees: Strom Motion Fee: 1BSEISMICO $45.15 Select an Administrative Item Bldt* Stds Commission Fee: IBCBSC $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:5 Results Way PERMIT # 12080105 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 5/28/13 Owner / Contractorture Date G� SUBCONTRACTOR BUSINESS NAME BUSINESS LICEN E # X Cabinets & Millwork Mission Bell Casework 25336 X Cement Finishing L rkl e x Electrical Redwood Electric Group 21108 Excavation Welker Bros. Fencing x Flooring / Carpeting 25264 Linoleum / Wood x Glass / Glazing Silicon Valley Glass 26943, x Heating Unite Mechanical 27361 x Insulation Accurate Firestop 34279,/ X Landscaping Jensen Corporation 9697, Lathing Masonry X Painting / Wallpaper Pyramid Painting 25999 27361 23509 vZ 27361 25898 27336 Paving United Mechanical Statewide Roofing United Mechanical Bayside Interiors Plastering x Plumbing x Roofing Septic Tank X Sheet Metal X Sheet Rock x Tile Rinaldi Tile 5/28/13 Owner / Contractorture Date G�