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13110050 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10355 N DE ANZA BLVD CONTRACTOR:DEVCON PERMIT NO: 13110050 CONSTRUCTION INC OWNER'S NAME: VIDOVICH-CUPERTINO LIMITED PARTNERS 690 GIBRALTAR DR DATE ISSUED:11/21/2013 OWNER'S PHONE: 4086666614 MILPITAS,CA 95035 PHONE NO:(408)942-8200 F LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] License Class Gh f✓ Lic.# R� REV#1-ADD OUTLET RECEPTACLES TO BOTH AREAS-ISSUED 7�,, l -3 12/16/13 Contractor t)Z/Ccn (ags$ I✓1 C Date �21 1t' t 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. 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:$50000 1 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:32633113.00 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 F 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 a e. with all non-point sour regulations per no Municipal Code,Section 9.18. RE-ROOFS: Signature Date �2 (� ( All roofs shall be inspected prior to any roofinmaterial being installed.If a roof is installed without first obtaining ani on,I ree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATIONS ignatur ant: � I hereby affirm that I am exempt from the Contractor's License Law for one of r the following two reasons: ALL R0OPeGVER!>Q9TO 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(x)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 Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Mu ' Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio p 3, 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: r2/ permit is issued. I certify that in the performance of the work for which this permit is issued,1 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.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 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 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISIO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTtNa (408)777-3228• FAX(408)777-3333• buildinp(aDcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS Io 515 r>.e 11k.IXzti k�i!vrt APN n '30 —S-3 — /s� OWNERNAME PHONE E-1ZAIL STREET ADDRESS i r,N`1 I _` (� CITY, STATE,ZIP C n FAX CONTACT NAME l + YC hG PHONE /E-MAIL STREET ADDRESS CITY,STATE, ZIP ! FAX %_-ORR4ER ❑ OWNER-BUILDER ❑ ORT'ERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME n �r V J V�Z LICENSE NLRvIBER ,3r"p 1^� LICENSE TYPE C� BUS.LIC R 1 i/,t� COMPANYI'AME }� ��J(� L} ++ E-MAIL r1 l `l, FAX [1 V `J�Clsef✓\ �CNStrv��-1`�n 'vac_ G��A��221(' LvCeh—teNS}.,�y, STREET ADDRESS / qG v� I CITY,STATE,ZIP ;� PHONE CA!)_ v �2 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK I aI 5 , y. �c wc✓k �,� ;� l 1� 4 C.,, EXISTING USE PROPOSED USE CONSTR.TYPE r STORIES QNB C k. USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG N^ NEW FLOOR DEMO VV TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA 0 REMODEL AREA Q REMODEL AREA O PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: LJ DETACH 0 O (.,::> o ❑ATTACH . w DWELLING UNITS: IS A SECOND UNIT ❑YEs SECOND STORY ❑YES O BEING ADDED? ONO ADDITION? ZNO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES ..RECEINLTOTAL VALUATION: PLANNING APPLH�NO PLANNING APPROVAL LETTER EICHLER HOME? ON By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on theVoperty owner's behalf. I have read this application and the infonnation I have provided is correct. I hav,Fead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu - nstructio authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Itto of ApplicanVAgent: ` Date: (� Ito SUPPLEMENTAL INTFORMATION QUIRED PJAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑�o�ER-T%iE-couiviER ❑ BUH DINGPLAN REiIEw - existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑'EaPREss, ❑ riA.N>rcrinly REVIEYI Convnercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑':STANDARD ❑ PUBLIC WORKS fonn if any Hazardous Materials are being used as part of this project. ❑�LARGE,; ❑ FIRE DERV! Copy of Planning Approval Letter or Meeting with Planning prior to ❑ n3AJOR ; ❑.,SAN ITARY SEMS ER DISTRICT submittal of Building Permit application. ❑ ENYIRONAIENTAL HEALTH B/dgAppT201].doe revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10355 N DE ANZA BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 13110050 INC OWNER'S NAME: VIDOVICH-CUPERTINO LIMITED PARTNERS 690 GIBRALTAR DR DATE ISSUED: 11/21/2013 OWNER'S PHONE: 4086666614 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG Ir- ELECT r PLUMB r License Class_ Lic.#1 /_ � 1 r" 'j� �^_n 3 MECH RESIDENTIAL COMMERCIAL Contractor [/ (� J'�", Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions JOB DESCRIPTION: Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: APPLE-2ND FLR T.I.TO RECONFIGURE LAB AREAS& i. 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 UPGRADE BREAKROOM performance of the work for which this permit is issued. 2. 1 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. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is Sq.Ft Floor Area: Valuation:$50000 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 APN Number:32633113.00 Occupancy Type: 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 with all non-point sot ce regulations per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature Date 211P WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA F OM LAST CALLED INSPECTION. ❑ OWNER-BUILDER DECLARATION ll I hereby affirm that I am exempt from the Contractor's License Law for one of Issued by: Date: the following two reasons: 1. 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 RE-ROOFS: sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is installed 2. 1,as owner of the property,am exclusively contracting with licensed contractors Without first obtaining an inspection,1 agree to remove all new materials for inspection. to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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. HAZARDOUS MATERIALS DISCLOSURE 2 1 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 I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with permit is issued. the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 3. 1 certify that in the performance of the work for which this permit is issued,1 shall 25532(x)should I store or handle hazardous material. Additionally,should I use not employ any person in any manner so as to become subject to the Worker's equipment or devices which emit hazardous air contaminants as defined by the Bay Area Compensation laws of California. If,after making this certificate of exemption,I Air Quality Management District I will maintain compliance with the Cupertino become subject to the Worker's Compensation provisions of the Labor Code,I Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and must forthwith comply with such provisions or this permit shall be deemed 25534. revoked. Owner or authorized agent: Date:�I APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's for to building construction,and hereby authorize representatives of this city to enter Which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date Licensed Professional / CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O� V / 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 1 CUPERTINO (408)777-3228• FAX(408)777-3333• build ingCcDcupertino.org \� ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ©� Al' /�) //1 . APN# / �j�7 r / OWNER NAME 1 �• �7/'1,1�/ PHONE E-MAIL �P h c• d/ (� �/y moi= r Gc7rn STREET ADDRESS L 1 CITY, STATE,ZIf FAX yet) ev CONTACT NAME PHONEDE-MAIL �c, S/ I cfY 1/ STREET ADDRESS / CI ,STATE,ZIP FAX pG ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ( CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Q COMPANY NAME(, E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP Ifo �' PHONE ARCHITECT/ENGINEER AME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL C c✓ y/�L �Gi FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK -AAD&ea; At �`l'ri�i�. '.? �S -f+ %%� 'f�. �L C� f3 • G���Z.�" !1 C>�Z°GZ //1 �/ �•.Ev li,- d rl/ ��I G r C u� � Gt t dt�� Cis EXISTIN USE PROPOSED USE CO ST TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL f, V1? /`}� �J AREA% AREA AREA NET AREA 6-Z 0 �L �ei - , /moi �� e s V/7 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECIGPORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES ED B TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized-age;;Pie on the property owner's behalf. I have read this application and the information I 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 building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicanU'Agent: - Date: l/ _3 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECKTYPE ROUTING SLIP New SFD or Multifamily 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... ❑ PLkNNI NG PL_kN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTAN'DARD; ❑ PUBLIC woRxs, 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 ❑ AL1JOR ❑ snlNrrARYSP«RnISTRICT su_bmittal of Building Permit application. ❑ ENVIRONAIENTAL HEALTI4 BldgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10355 N DE ANZA BLVD DATE: 11/08/2013 REVIEWED BY: MELISSA APN: 326 33 113 BP#: / 'VALUATION: 1$50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 16 TI USE: PERMIT TYPE: WORK APPLE -2ND FLR T.I. TO RECONFIGURE LAB AREAS & UPGRADE BREAKROOM SCOPE 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 520 $2,051.33 1BTIPLNCK $770.11 1BTIINSP TOTALS: 520 $2,051.33 $770.11 MECH,HOURLY 0 Yes () No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes Q No NOTE.This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E(L7/1/132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,051.33 Select a Misc Bldg/Structure Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $770.11 Suppl. Insp. Fee-0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Y (7,M1 ti 1(i <sii� i F,.r t. �.'iYi ,7%2fi s 0 Work Without Permit? © Yes No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 V0 Building or Structure i Strong Motion Fee: 1BSEISMICO $10.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.001 1 SUBTOTALS: $2,833.941 $0.00 TOTAL FEE: 1 $2,833.94 Revised: 10/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U PE RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1035 PERMIT# / Q OWNER'S NAME: /-e-- PHONE # 4/0,5 GENERAL CONTRACTOR: a �,p-y-z BUSINESS LICENSE# ADDRESS: �Jp ( CITY/ZIPCODE: ii/ S03S *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. 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork sr) 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 n4),,-, Tile Owne Contractor Signature Date