B-2016-2039 - REV1 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2039
19600 VALLCO PKWY STE 120 CUPERTINO,CA 95014(316 20 108) PLATINUM GENERAL
CONSTRUCTION INC
SAN GABRIEL,CA
91776
OWNER'S NAME:CUPERTINO PROPERTY DEVEL I LLC DATE ISSUED:04/05/2017
OWNER'S PHONE:626-551-5181 PHONE NO:(626)2558222
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B,C-1 7 Lie.#272$QSx X BLDG_ELECT—PLUMB
Contractor PLATINUM GENERAL CONSTRUCTION INC Date 05/31/2018 —
Ihereb affirm that l am licensed tinder the visions o£Cha Chapter —MECH—RESIDENTIAL X COMMERCIAL
y pro p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
SUITE 120;1ST FLOOR;T,I,-RESTAURANT REMODEL(2,697 S.F.)-
I hereby affirm under penalty of perjury one of the following two declarations: BOILING POINT
r. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-FOOD EQUIPMENT AND FUEL STORAGE-ISSUED
Compensation,as provided for by Section 3700 of the Labor Cade,for the 06/14/2018
performance ofthe work For which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
1 Sachin 3700 of the Labor Code,for the performance of the work for which this
1. permit is issued. Sq.Ft Floor Area: Valuation:$80000.00
APPLICANT CERTIFICATION
I certify that I have read this applicallon and state that the above
Information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31620 108 A(Tenant Improvements)
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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06/1412018 Issued by:AbbyAAyende
Data:04/05/20]7
QWN
F - E 1, RATION
I hereby affirm that I am exempt from the Contractor's License Law for one ofthe RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If.roof is
r. I,us owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sate(Sec.7044,Business&Professions Code)
z. 1,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:06/14/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the li azardous materials requirements under Chapter 6.95 of the
Section 3700 ofthe Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not em to person in an manner so as to become subject to the material.Additionally,should I use equipment or devices which craft hazardous
p y any pe y mann J air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California,If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety Cade,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply With Such provisions or this permit shall
be deemed revoked. Owner or authorized agent: �-
APPLICANT CERTIFICATION Date:06/14/2018
I certify that I have read this application and state that the above Information Is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is
issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against Ilabllitles,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECI.ARAq'ION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 06/1412018 Licensed
Professional
CONSTRVCI 'PERMIT APPLICATION
COMMUNITY DEVELO.PME}.I ilEPARTMENT•BUILDING DIVISION
10300 TORRE.AVENUE•CUPERTINO,CA 95014-3255p
(408)777-3228• building@cuertin" PEMIT#B-'P-�S)l6, - ,0;'—
CUPERTINO
REV# I — DEF#_
❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION❑T.I. ❑MEP ❑R&ROOF ❑SWIMMING POOL/SPA
PROIHCT ADDRESS ,V LL[73 �W(4y APN#
OWNER OIIPHONE
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STREETADDRESS CITY,STATE Z
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CONTRACTOR NAME ❑OWNER-BUILDER ICOPAPANYNAME LIC SENUMBER LICENSE TYPE
IES
STREETADDRESS �� �� CITY STATE, Ip ,
E-MAIL (PHONE (/� BUS. C F
❑ARCHITECT DOWNER OWNER AGENT L1 CONTRACTOR AGENT❑ENGINEER❑DEVELOPER 10 TENANT
CONTACT NAME E-MAIL
77 i((✓Itgqchc2o 1/12
S7b 60 DDRFSS ZIP
NLCr;`(13�v�{ C-L t SBD fE,llmsLk C %1769 PH o 3 121 yo
DESCRNTON
V V ���{� 1 � •�QI (�Y!
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY []INDUSTRIAL ❑COMMERCIAL
L•XISTING US7SP
NEW FLOOR SF PORCH SF DECK SP DEMO SF STORIES, TOTAL NET SF USE TYPE OCC SQ.FT. VALUATIONREMODELREMODEL KITCHEN REMODEL CTHR GARAGE 11ATTACHED
BATHROOMSF SF SF E]DETACHED
EXISING ❑YESEICHLGR YES SECOND STORY ADDITION (]YES
FIRE SPRINKLERS❑NO E]NO ❑NO
DWELLING SECOND DWELLING ❑YES❑ATTACHED❑DETACHED OTHER
UNITS, UNITADDITON: ElNO SF
POOLSEl FIBERGLASS Q VINYL-LINED❑GUNITE [j PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED L3 YES ❑NO TOTAL-SF
RE NED BY TOTALATION:
CnurvrercW,,Multi-Fuvfly BuflAbms wI I P,bife Sminrrnirrc Poof—ofires Devn't a fn(E �' a fnf Hmlh npp nunf
RE-ROOF EXISTINGROOFTYPE: [:]BUILT-UP ROOF E]ASP14ALT SHINGLES[]WOOD SHARES❑WDO,
SHINGL ❑T G OTHER(SPECIFY)
REMOVE/REPLACE❑NO ff NO PLYWOOD❑rh" ❑ /E" PLYWOOD TYPE: PITCH: ROOF CLASS
EYES 11N LAYERS_ THICKNESS❑S/B" OTHER ❑OSB ❑CDX OTHER —•12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF OASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES El OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #.f SQUARES
By my signature below I certify to each of the following: I am the property owner or authorized agent to act 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. I acknowledge and authorize all information contained on this application form
to be made available for public record. -_ ---
Signature of Applicant/Agent „ Date:
SUPPLEMENTAL INPORMATIO!I,REQYSIRED`i- �'
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial.Buildings:Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
'HOA-Provide a letter of approval from the Home Owner's Association
kA\ p BldgApp_2017.doc revised 08/01/17