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12100009 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20682 STEVENS CREEK BLVD CONTRACTOR:SSW CONSTRUCTION PERMIT NO: 12100009 OWNER'S NAME: BYER PROPERTIES 500 GIUSEPPE CT#9 DATE ISSUED: 12/21/2012 OWNER'S PHONE: 4156262937 ROSEVILLE CA 95678 PHONE NO:91(x773-9595 ❑ LICENSED CONTRACTOR'S DECLARATION � BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL r Contractor SS t.t) 41 A !S_/ DateZ '( 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BOUDIN BAKERY-COMMERCIAL TENANT (commencing with Section 7000)of Division 3 of the Business&Professions IMPROVEMENT(4,015 SQFf) 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$350000 permit is issued. APPLICANT CERTIFICATION APN Number:35908020.20682 Occupancy Type: I certify that I have read this application and slate 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 har5yl4sthe City of Cupertino against liabilities,judgments, costs,and expeyPtsouirce ich m accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of thist. Add tionally,the applicant understands and will comply with all non-po regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. �iG7 f /- Issued by: Date: Signature8z--- Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that 1 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 1,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: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sce.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BET-FER 1 hereby affirm under penalty of perjury one of the following three declarations: 1 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 1 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 defi�gf$d 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 complimc�Avith 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&Safedde,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I bccome subject to the Worker's Compensation provisions of the Labor Code,t must Owner o/auttt2y'r(ized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 work's correct. t 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. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20682 Stevens Creek DATE: 10/01/2012 REVIEWED BY: APN: BP#: / �,� VALUATION: 1$350,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1ATI USE: PERMIT TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. A(Tenant Improvements) II-B,III-B,IV,V-B 4,015 $2,485.08 IATIPLNCK $2,042.72 IATIINSP TOTALS: 4,015 $2,485.08 $2,042.72 MECH,HOURLY Yes (D No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No tfech. Plan Check Phwrh. Pham Cheek Elec. Plan Chock fleck. Pernri!Fee: Plrtmb. Per•mii Fee, hlec. Permit Pee: Other,bfech. Insp. Wier Plumb Insp. E1__L__ Ocher Flee,Insp. E17- Alcch.lav). Fe c: Plrunh. 1nsh. Fee: Elec. brsp.Fee: NOTE: This estimate does not include fees due to other Departments(i.e.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 addn7 info. FEE ITEMS(Fee Resolution I1-053 a.' 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,485.08 Select a Misc Bldg/Structure Suppl. PC Fee: (j) Reg. 0 OT 1-0—.0-1hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $2,042.72 Suppl. Insp. Fee Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consli-nction Tax: F ,4dininictrative Fee' O Work Without Permit? Yes No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Doc-umentalion Fees: Building or Structure 0 i Strong Motion Fee. IBSEISMICO $73.50 Select an Administrative Item BldP_Stds Commission Fee: 1BCBSC $14.00 SUBTOTALS: 1 $4,615.301 $0.00 TOTAL FEE: $4,615.30 Revised: 07/01/2012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20682 STEVENS CREEK BLVD CONTRACTOR:SSW CONSTRUCTION PERMIT NO: 12100009 CORP OWNER'S NAME: BYER PROPERTIES 500 GIUSEPPE CT APT 9 DATE ISSUED: 12/21/2012 OWNER'S PHONE: 4156262937 ROSEVILLE,CA 95678 PHONE NO:(916)773-9595 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL License.Cl,ss� �Li.,#�� i� Z Cf,_y BOUDIN BAKERY-COMMERCIAL TENANT Contractor F 'oL�,O�.0 (I'Y✓f�- Date 2 / '�G IMPROVEMENT(4,015 SQIT) 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 ` (commencing with Section 7000)of Division 3 of the Business&Professions qal re,-� S,)6n,: 4-,I WC,I IL f)i Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: C L I have and will maintain a certificate of consent to self-insure for Worker's Qt P 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:$350000 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:35908020.20682 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 18ffDA PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180 DAY 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 Iss Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Dale 2 / 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 Signature of Applicant: Date: I hereby affirm that 1 am exempt from the-Contractor's License Law for one of 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(Sce.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. 1 will 1 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 1 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 Scction 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality anagement District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal ode,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 2 34. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. 1 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,l 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 l have read this application and stale 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 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 t 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 :I CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 20682 Stevens Creek Blvd DATE: 12/14/2012 REVIEWED BY: Sean APN: BP#: *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building PENTAMATION 1GENCOM USE: PERMIT TYPE: A WORK Deferred Submittal #1: Walk in cooler for Boudin's. SCOPE ,Neth, Plan Check Plumb, Plan Check Plec. Plan Check .Neth. permit Fee: Plumb. Permit Fee E-lec.Permit Fee: Other Afech. Insp. 01her Plumb Insp. Lj _L___ (bher Floc, Insp. E17-- ilech. Insp. Fec. Plumb. Insp. Fee: l;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-). 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 Eff 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 n] hours Plan Check, Hourly Suppl. PC Fee: Q Reg, 0 OT0.0 hrs $0.00 $266.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Doc:urnentation Fees: Building or Structure 0 Strong Motion Fee: $0.00 Select an Administrative Item Bldp-Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $266.00 TOTAL,FEE: $266.00 Revised: 10/01/2012 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: 20682 STEVENS CRK BLVD DATE: 0210112013 REVIEWED BY�M-CISSA APN: 359 08 020.20682 IIP#: 00 "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1GENCOM USE: PERMIT TYPE: WORK DEFERRED SUBMITTAL# 1 -WALK-IN COOLERIFREEZER SPECS & DETAILS SCOPE Afech. Plan Check Phimb, Plum Check FT Elee. Plan Check rtitec•Ir. 1'eruiil Fee: Plumb. Permit Fee: Is'lec. Perdu fire: Qrher Alech, Insp.. E17- Ulher Plumb Insp. 0iber Elec. Insp. A•lech, hrsp.Fee: Plumb. hrsp, Fee: Elec, Insp. Feet: NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc . Thesefees are based on lire prelimina. information available and are only an estimate. Contact the De t or addn'i info. FEE ITEMS (Fee Resolution 11-053 E,fff 7/1112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 1 hours Plan Check,Hourly Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $133.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax, Administrative Fee: Q Work Without Permit? Yes 0 No $0.00 0 Advanced Planning Fee: $0,00 Select a Non-Residential (D Travel Documentation Fees: Building or Structure A Strong Motion Fee: $0.00 Select an Administrative Item Bldg_Stds Commission Fee: $0.00 SUBTOTALS: $0.001 $133.00 TOTAL FEE: F $133.00 Revised: 01/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20692 STEVENS CREEK BLVD CON'TRACT'OR:SSW CONSTRUCTION PERMITNO: 12100009 CORP OWNER'S NAME: BYER PROPERTIES 500 GIUSEPPE CC APT 9 DATE ISSUED: 12/21/2012 OWNER'S PIIONE: 4156262937 ROSEVILLE,CA 95678 PIION E NO:(916)773-9595 LICENSED CONTRACTOR'S DECLARATIONr BUILDING HERMIT INFO: BLDG ELECT PLUMB License Class� Lie. �S� e MECH F_ RESIDENTIAL F_ COMMERCIAL � Contractor I A&J.f, Dale Z I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BOUDIN BAKERY-COMMI'RCIAL TENANT (commencing with Section 7000)of Division 3 of the Business&Professions IMPROVEMENT(4,015 SQIT) Code and that my license is in full force and effect. 1/24/13 REVISION 9 1 -M.E.P.CIIANGES TO T.I ISSUED 2/28/13 2/1/2013-D177FERRED# 1 WALK-IN COOLER ISSUED 2/1/3013 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 htsurance,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: Valualiun:$350000 APPLICANT CERT'IFICAT'ION I certify that I have read this application and state that the above information is APN Number:35908020.20682 Occupancy Type: correct. I agree to comply with all city and county ordinances mid 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, PERMIT EXPIRES IF WORT{ IS NOT STARTED costs,and expenses whit ay accrue against said City in consequence of the granting of this perm'. A ditionally,the applicant understands and will comply WITHIN 180 DAYS F PERMIT ISSUANCE OR with all non-point urc- egulations per the Cupertino Municipal Code,Section 180 DAYS ST CALLED INSPECTION. 9.k8. Signature Date by: ate: 2--f 13 11 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law fur one of R1;-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection, I aeree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. neftl Business&Professions Code) l '� >p 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: ate: constrict the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS T'O BE CLASS"A" B[I:I'TF,R 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California health&Safety Code,Sections 25.505,25.533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Heallh& Safety Code,Section 25532(x)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by lite Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain c diance with the Cupertino Municipal Codc,Chapter 9.12 and the Compensation laws of California. If,after making this certificate ofexemption,I lleallh Sa cry Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Own r or,ttthorized agent: Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that 1 have read this application and stale that the above information is correct. 1 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 ol'work's to building construction,and hereby authorize representatives of this city to enter for 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 ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Dale Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION MDDRESS: 20682 STEVENS CREEK BLVD DATE: 0112412013 REVIEWED BY: MELISSA PN: 35908020.20682 BP#: z , *VALUATION: Iso *PERMIT TYPE: erm PLAN CHECK TYPE: Tenant Improvement PRIM Commercial Building PENTAMATION 1GENCOM U PERMIT TYPE: WORK REV# 1 - M. E. P. C SCOPE Moclr. Flan Check Plrunh,Plan Check Flee. Plan Check 4teclr. Perrnir Fey:: Phrmh. Penni?Fee: Islec. Permit Fee! Oilper Aiech. Insp. Other•Plumh InsP. Lj Other Elec. Insp. 'Vcch. Insp, FGe: Phanh. lnsp. Fe • Elec.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 ees are based on the prelimina information available and are only an estimate Contact the De tor addn'l info. FEE ITEMS (Fee Resolufion 11-053 Eff 7/1/121 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? O Yes (E) No $0.00 hours Plan Check,Hourly Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 $266.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: _T_T $0.00 Construction Tax: Adininharalive Pee: Work Without Permit? Yes (j) No $0.00 0 Advanced Planning Fee: $0.00 Select allon-Residential Q Treivel Documentation Fees: Building or Structure i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $266.00 TOTAL FEE: $266.00 Revised: 10/01/2012 r CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20682 stevens creek blvd DATE: 03/01/2013 REVIEWED BY: melissa APN: 359 08 020 BP#: f l 1J' 'VALUATION: Iso *PERMIT TYPE: Building.Permit PLAN CHECK TYPE: Addition PRIMARYSFD or Duplex PENTAMATION USE: PERMIT TYPE: ,t WORK �t. inspection with l.arry on friday, march 1st SCOPE Xtech. Pion(:'heck Phomh. Plun('hark I.-kc.flan('heck ivrech. Peron!Fee: Phimb.Permit Fee: I lec. Permit Fee: Other hfech. Insl). ether Plumb Insp. Lj Usher E1er.Ins[). EI dleeh.Insp. Pea, Plumb. hue. Fee: Eley. Insp. Fee: NOTE: This estimate does not include fees due to other Departments(Le. Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the relimina information available and are only an estimate. Contact the De t or addn'.l in o. FEE ITEMS (Fee Resolution 11-053 ETf 7/1/121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: Reg. Q OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feee. Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: . $0.00 PME Permit Fee: $0.00 Construction Tax: F-1 Administrative Fee: Work Without Permit? O Yes C) No $0.00 E) Advanced Planning Fee:' $0.00 Select a Non-Residential Q Trai.el Doemnentation Fees, Building or Structure 0 A Strong Motion Fee: $0.00 = hrs Inspections BldaStds Commission Fee: $0.00 $399.00 IINSP<=2HR Outside Work Hours SUBTOTALS: $0.00 $399.00 TOTAL FEE: 1 $399.00 Revised: 01/01/2013 CONSTRUCTION PERMIT APPLICSOffiRED 1 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 DATE CUPERTINO (408) 777-3228• FAX (408) 777-3333• building(akupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI 5d REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSEsr y� _ 8Z c � �vb ATN N OWNER NAME � ��� � ty,��l L-3 PHONE , �1 5 �n� E-MAIL STREET ADDRESS �C XXrr �t CITY, STATE,ZIP S AX Ga P aT�`1'C_ N F 1 s CC, c:,& ��� f� 27(0 CONTACT NAME v,1�� /h �v 0 N T 6 �j1 3� �( r 1 �LJA RAZrC_t 47,Gc>� STREET ADDRESS �YSTATE,UZIP7 �� r O FAX Stov-+ 9-r ❑OWNER ❑ OWNER-BUILDER El OWNER OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT El ARCHITECT 11 ENGINEER El DEVELOPER ❑ TENANT CONTRACTOR S'1 c5:p-i3 LICiJtJMBER LICENS TYP BUS.L1C11 COMPANY NAME E- FkX c-rr�vcr r a d� A.-,_ - Ajffr_-ter WN. OV 9F- S .�r�3 STREET ADDRESS ��� CI Y,STATE,ZIP . ILad 4-- PHIS �� 1.5,7s, ARCHITE T/ENGINEERNAME LICENSENUMBER BUS.LIC# K- 6 t well ToI�t.J ���c _!;"-15 r.-.;, COMPANY NAME E-MATL FAX 1L Nt5i 6 Rtee2lea-C. STtt=ETADDr7� . DESCRIPTIONS� CITY,STATE, (( DII6 OF/WORK Cil- 11 I EXISTING USE PROPOSED USE CONSTR TYPE I STORIES USE TYPE OCC. SQ.FT. VALUATION($� EXISTG NEW FLOOR DEMO TOTAL AREA AREA 7 AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH 0DWELLTNGUNITS_ IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED- []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PRO VIDE COPY OF IS THE BLDG AN ❑YES RECEIVED r /V TOTALON: 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 agent to act on the property owner's behalf. 1 have read this application and the information 1 have provided is c I have read the Description of Work and verify it is accurate. I agree to eomply with all applicable local ordinances and state laws relating to buildi structio thoriz. pre tatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicanl/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ,: 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 PLANNING PLAN REVIEW- Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PURLIC 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 ❑ n11nJOR ❑ SANITARY SEWER DISTRICT' submittal of Building Permit application. ❑ ENVIRONMFNTALHEALTH BldgApp_201 Ldoc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 GUPERT[NO (408)777-3228• FAX(408)777-3333• bullding(cDcupertino.org eTION ❑ ADDITION ❑ ALTERATION/n REVISIO /DEFERRE ORIGINAL PERMITS4 PROJECT ADDRESS�j_ 06M ���j OWNERNAM rf P /�`� [E-MAIIL STREET ADDRESS cI' CITY, STATE,ZIP FAX CONTACT NAME sj E rG C) STREET ADDRESSP0. V. ( / r? C Y,STAT P`+ 7C � ��/�� FAX OWNER ElIL OWNER-BUDER 13NQR OWN-ER ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECC/ENCINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK jDC r� EXISTING USE PROPOSED USE CONSTR-TYPE #STORIES USE TYPE OCC. SQ.FT, VALUATION(5) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NEP AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKJPORCH AREA GARAGE AREA: DETACH ❑ATTACH P DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY YES BEINGADDED? []NO ADDITION? [I NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN E)YES RECFi, TOTAL VALUAT ON: PLANNING APPL 4 E]NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO r•`•"'� " By my signature below,I certify to each of the following: I am the property owner or autlloriz d agen ac[ a 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. 1 agree to comply with all applicable local ordinances and state laws relating to buildin construction. I authorize representatives of Cupertino to enter the abo v identirl d property for inspection purposes. Signature of Applicant/Agent- — Date: SUPPLEMEI,VAL INFO TION REQUIRED . � � � f:'Li `^"W." PLANCHEC��TIPE i �� � � °�ROUTIN�SP, .- _New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ovER-THE cou:T>Rr p ; HUTLD[rc PLAn Ri viEw s sryd ;z a permit for new building. ❑ exptzEss � � ❑-PLANNING 1 LAN�izEV�Ew' _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD'— .,y © `PURLTcv<oRKs <, z;, form if any Hazardous Materials are being used as part of this project. Q' ARCE b DFtt DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to rinloR` ❑ sA;rrARv sa��Ea'ulsrRTcr # submittal of Building Permit application. f, `; k3 s . -t ❑,�ENYII20KMENTAL HEALTH' BId,aApp_2011.doc revised 06/21/11 CONSTRUCTION PCRTMENT-BUI ATI ot COMMUNITY DEVELOPMENT DIVISION 10300TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO @_ (408)777-3228• FAX(408)777-3333• buildinqcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Tl REVISION/DEFERRED ORIGINAL PERMIT# 1Z COQ PROJECT ADDRESS, `n APN# Q 0 2 0. OWNER NAME PHONE E-MAIL CJ(� STREET ADDRESS CITY,STATE,ZIP FAX CONTACT N ^� (:\(� %V L I/ �._ E-MAIL STREET ADDRESS { CI ,STATE, ZIP l/ Y FAX ScNo L�UIS� P�U`_ 1LC4 A, x ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICE NUM � LICENSE TYPE BUS.LTC# COMPANY NAME E-MAIL FAX STREET ADDRESSV] �'` CITY,WTE,ZIP PH i ARCHITECTIENGINEER NAME J LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK - EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA; DETACH ❑ATTACH #DWELLING UNITS: IS.SECONDHNIT ❑YES SECONDSTORY [DYES BEING ADDED? []NO ADDITION? E)NO PRE-APPLICATION []YES IFYES,PROVIDE COPY OF ISTHEBLDG AN EJ YES 1 EIVEpe TOTALVALUA ON: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO • {t �V By my signature below,I certify to each the f Ilowing: I am the property owner or authorize bent to e property owner's behalf. I have read this application and the information I hav provide is correct. I have read the Description of Wor and ve rt is accuTa e. 1 afire to comply with all applicable local ordinances and state laws relatin buildin construction. I authorize representatives of Cupertino to enter the abov -identi5 d property for inspection purposes. Signature of Applicant/Agent, Date: SUPPLE E FORMATION REQUIRED PLAY CHECK TYPE oirrtN 's>iP _New S!'D or Multifamil dwellings: Apply for demolition permit for ❑ pv Ex TiIE CouNT>R III"PLAN REVrEw existingbuilding(s). Demolition permit is required prior to issuance of building .. , permit for new building. ❑ �EXPass i !� ❑ PLANNtivc PLAN IiEyIE54 _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD t ❑ ruBLIC woRKS' Tor— if any Hazardous Materials are being used as part of this project. ❑ LARQE� FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to t ❑ MAJOR s ©,SANITARY SE,NERD1STRPCT submittal of Building Permit application. ,'` ©{ ENVIRONMENTAL HEALTH -. BldgApp_2011.doc revised 06121/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 COPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS:2C7lo3Z ST t1E S E— I jo. PERMIT# Z OWNER'S NAME: y - _ S PHONE# GENERAL.CONTRACTOR: 6 &o&;-s—, BUS[NESS LICENSE# ADDRESS: Sbo&Q a'Gr oCITY/ZIPCODE: *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: o Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing n Electrical A,4 F,---yL1E fP Flooring/Carpeting Linoleum /Wood Glass /Glazing Heating A� L�- 7 I� Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing v�0 cJ W,6. 1�/C- Roofing Septic Tank Sheet Metal Sheet Rock Tile �a o2 aLS� /Z 1Z jl�n�erl Contractor Signature Date