13060204 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20330 STEVENS CREEK BLVD CONTRACTOR:DEVCON PERMIT NO:1300204
CONSTRUCTION INC
OWNER'S NAME: SVF CUPERTINO CITY CENTER CORPORATI 690 GIBRALTAR DR DATE ISSUED:06/25/2013
OWNER'S PHONE: 5108613299 MILPITAS,CA 95035 PHONE NO:(408)942-8200
13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALD
License Class Lie.#_3 APPLE-COMM.T.1 250 SQ FT CONVERT(E)CONFERENCE
ROOM INTO AN OPEN OFFICE AREA
6,
Contractob � Date-�
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:$10000
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:36901020.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT XPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT 80 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter 11
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA OM LAST 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 Issued by: Date:
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. RE-ROOFS:
Signatu6L, s7 "'�"-Date 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.
n OWNER-BUILDER DECLARATION Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 sale(Sec.7044,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
1,as owner of the property,am exclusively contracting with licensed contractors to
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. 1 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(a)should I store or handle hazardous
I 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 Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S 5505,2553 k and 2
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag t: Date:
permit is issued.
I 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 CONSTRUCTION LENDING AGENCY
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 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 Nam
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 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 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-
CITY OF CUPERTINO
FELE ESTIMATOR-BUILDING DIVISION
ADDRES30S: - 'F DATE: C/?r I J REVIEWED BY:F1
L?l
APN: BP#: EVALUATION: $10,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION 1 B Ti
USE: Commercial Building PERMIT TYPE: i
WORK
SCOPE `
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR s.E
B (Tenant Improvements) 11-B,111-B,1v,v-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
mmcH HOt7Y e ; Nc 11 ,00m, ' Yes .No ELICI{71Y e n.
alec°dt. 1'7exraht: h lhtrs.h.Ic€ Crr�<.1; 771,11-1
P � iFWech.Pertllhl bI �rrrat dee: m "e'e:
l ��<�
Other iWerch.Insp. Other Ph4 mb fr sqr. 0;her Eke,Imp,
He'&ln.sj. ('¢:e: I'1<rrrlr, Ir?.glr.#'exe: fTC<c.bars"
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fare,Sanitary Sewer District,School
District,etc , These ees are based on the relimina in ormation available and are only an estimate Contact the Det or addn'l in o.
FEE ITEMS(Lee Resolution 11-053 E .. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes * No $0,00 2 hours Plan Check,Hourly
Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $266.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes00, No $0.00
Suppl.Insp.Feer Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $Q•00
C onsln,tction iiax.
Adlninistrayti,�,e Fee:
Work Without Permit? ® Yes 0 No $0.00
Advanced Planning Fee: $0.00 4 hours Inspections
Ia�r 3it Documentation 1"c��} : $532.00 ISTINSP Inspection,Hourly 0
Strong_Motion Fee: IBSEIS.A tCO $2.10 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.001
SETT
$3.101 $798.00 ' i F : $801.10
Revised: 04/2912013
t?
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION rLC�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3285 �b
CUP k C tl�CC3 (408)777-3228• FAX(408)777-3333•buildingCa?oupertino.org � ?
[:1NEW CONSTRUCTION ElADDITION 91 ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS. r APN# to
OWNERNAME cam? PHONE F EMAIL
opiea
STREET ADDRESS 9, CTrY STATE ZIP FAX
le— L-212fc-A
CONTACT NAME PHO + i E-MAIL
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STREET ADDRESS C€ ESTATE, IP FAX
I/tiNle— V1
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONPRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR N � � ,q �{ LICENSE t7I EE r LICENSE TYPE BUS.LIC#
COMPANY NAME j�V+ E_ f -
C3� tit-E"` ��K.Ca;1•-'�°C�'i.a``I'C"Ci
STREET ADDRES CITY,STATE,ZIP PHONE
0 b r-° f I (40%)S
ARCHITECT/ENGINEER NAME t LICENSE NUMBER BUS.LIC#
COMPANY NAME ILFAX
Glue Int. �h t,9 At, +y1 '
STREET ADDRESS CITY,STATE,ZIP PHONE
DEscRIPTIaN aF Wa
EXISTING USE PROPOSED USE CflNST'R TYPE #STORIES
tc
0 . �' I{� js USE TYPE OCC. SQ.FT. VALUATIONS)
EXIST_G t ' NEW FLOOR �/�DEMO e f° TOTAL
AREA AREA 0 [AREA NET AREA
BATHROOM MCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
RWI
❑ATTACH
4DWELLINGI.MS: dSASECONDUNIT ❑YES SECONDSTORY [ YES
BEING ADDED? (]NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN 0 YESTO
� r � T VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ®NO
O \/r/
By my signature below,I certify to each of the following: I am the property owner or authoriz ag t to act on the property owner's behalf. I havJ 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 relatin t b ing constructio .. I au representatives of Cupertino to enter the above-identified property for inspection purposes.,
Signature of Applicant/Agen /fes '" , Date:
SUPPLEMENTAL INFORMATION REQUIRED °raNcITYrE, t: a 9Xt ,. I Rtitrit� S.Lr;< . sg, .,
NTew SFD or Multifamily dwellings: Apply for demolition permit for
L7i fivERI caI R E k BUILI}In PLAItEFIET � ,
existing building(s). DemOlitIOn permit 1S required prior t0 issuance Of building
permit for new building.
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTAI�DzD , rD Ptrs�Ict�Izs �
form if any Hazardous Materials are being used as part of this project. ' £
Er�`r2 � aur o
_Copy of Planning Approval Letter or Meeting with Planning prior to
b
submittal of Building Permit application. x 113A3O2 v ' ` § r � TIIY SEEBJISTRIfiF �+
BldgApp 201 Ldoc revised 06121111
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT 1 N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE# 14C)S--
GENERAL CONTRACTOR-: BUSINESS LICENSE# !
ADDRESS: CITY/ZIPCODE: ' t +
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) 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 Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets &Millwork
Cement Finishing
Electrical C t
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood77r
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper s vAi ,d^s -
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock 1 (-
le
Owner/Contractor Signature Date