13070184 CRTY OF CUPERTRNO BUILDING PERMIT
BUILDING ADDRESS: 10201 N DE ANZA BLVD CONTRACTOR:DEVCON PERMIT NO: 13070184
CONSTRUCTION INC
OWNER'S NAME: NMSBPCSLDHB 690 GIBRALTAR DR DATE ISSUED:07/30/2013
OWNER'S PHONE: 4088624397 MILPITAS,CA 95035 PHONE NO:(408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL .
License Class Lic.# .IM1 f 0) COMM.T.1-TO INCLUDE INTERIOR DEMOLITION OF
►O�r�d�C S ° NON-STRUCTURAL ELEMENTS ENTS INCLUDING INTERIOR
Contracto_ ®h1 ���%l Date PARTITIONS,FINISHES,CEILINGS,IM[,L,1P'S 1,535 SQ
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:$175000
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:32634070.10201 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IFF WORK IS NOT STARTLED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN IS®DAYS OF PERMIT ISSUANCE OR
building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 IDA lF ®IMI 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
granting of this permit. Additionally,the ap is understands and will comply Issued by: Date: 7 U
with all non-point source regulations p r th C ert o Municipal Code,Section
9.18.
RE-ROOFS:
Signature ate 0 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
I,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(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 Mu 'ci al Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5505,25 3, 5534.
Section 3700 of the Labor Code,for the performance of the work for which this 0',-301'permit is issued.
Owner or authorized agent• Date:
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,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 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
cClTY OF cCUP EgRTM
FEE IESTIIyiIATOR—BUIILDING DIVISION
ADDRESS: 10201 H De Anza Blvd DATE: 07/30/2013 REVIEWED BY: Mendez
APN: I$1P#: /J� 'VALIDATION: $175,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
]PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B TIS
Womm. T.I-to include interior demolition of non-structural elements includin interior artitionsfinishes, ceilings, M,E,P's 1,538 sq ft
OCCIJPANCY TYPE: TYPE 011—PLR AREA PC]FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.P.
B (Tenant Improvements) II-B,III-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY 0 Yes E) No PLUMB,HOURLY Q Yes (F) No ELEC,HOURLY Q Yes Q No
Xlech. Plan Check Plumb. Plan Check Elec. Plan(.'heck
FIV1ecla. Permit Fee: Plumb. Permit Fee: F.,lec. Permit l ee:
Other dlech.Insp. Other Plumb Insp. Other Elec.Lu[y.
,11ech.Insp.Fee: Phunb. hasp.Fee: Elec.Insp.Fere:
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 file prelimina information available and are onLy an estimate. Contact the De t or addn'l in o.
FEE ITEMS(Fee Resolution 11-053 Eff 711112) FEE I QTY/FEE I MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes E) No $0.00 hours Plan Check,Hourly
Suppl. PC Fee: O Reg. ® OT 0.0 hrs $0.00 $278.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: (dourly Only? 0 Yes (D No $0.00
Suppl. Insp. Feer Reg. C) OT F0.011hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee: 0
Work Without Permit? 0 Yes E) No $0.00 E)
Advanced Planning_Fee: $0.00 10 hours Inspections O
Travel Docrunentation Fuses: $1,390.00 ISTINSP Inspection,Hourly 0
Strong Motion Fee: IBSEISAffCO $36.75 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $7.00
SUBTOTALS: $43.75 $1,668.00 TOTAL FEE: $1,711.75
Revised: 07/01/2013
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT.DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE^CUPERTINO, CA 95014-3255
e (408)777-3228^FAX(408)777-3333^buildingna.cupertino.orgCUPERTINO 0
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINALSgPERMIT#
PROJECT ADDRESS m * APN# 3 2} � q d;<)--
OWNER NAME �.�p I/� PH NE Wn1_\JVP,,0Pe
`� _ ^
STREET ADDRESP CITY, STATE ZIP 50t FAX
ONTACT (NAME v, e PHO I aE-I`�A 'v ,
STREET ADDRESS •' � r ^ 9,ST TE ZIPY)10 O FAX L W
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❑OWNER ❑ OWNER-BUILDER OWNER AGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ ,DEVELOPER ❑ TENANT
CONTRACTOR NAMED.,W,^ WV,� ChO hICENSE NUMBER ^�1 I^� LICENSE TYPE A/yam BUS.LIC#
COMPANY NAME �� /`A r ^�1,^„o p& E-MAIL 1 l ^_I f f,^`�, eU Nr 1-V`��J{ F v v
STREET ADDRESS__ q V �V1.5;1 j 1_ GI'AY,i STATE,ZIP r P 1 v V 9 15 P N n_ ,� ,_
ll
ARCHITECT/ENGIINN/_EER N E O ! LICENSE NUMBER BUS.LIC# C/-1•"
ol
COMPANY NAZ�Md , .� Q E-MA FAX
I G_ A Vf G11� _ A Sfi11�I C7S. LO M
STREET A ��1� ��. Sul r��• CITY,STATE,ZIP I P IONS
O V °'J yiV�l p 'r l ('� p 5 1312n 5 C?
DESCRIPTION OF WORK Minor o V� I n 1 ylv r 1,mo VA V Y 1
rl �
C'�AZJMV 1R+ C[Vd1VtJ lnr-eV& PAk-hfiunS -fimsh f C'e iI�l � nvl9
6 e(, `cc/A pu 4 �-M2�n�� rC� . I G ucamf Wnor L�' vV��k. o jvl
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($) J
EXISTG NEW FLOORDEMO TOTAL
AREA AREA AREA NET AREA 1533
BATHROOM KITCI IEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH
[]ATTACH
#DWELLING UMTS: 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 RECEIVED T LUATION:
PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME?
By my signature below,1 certify to each of the following: I am the property own or authorized agent to ac n the erty owner's behalf. I have read this V ,
application and the information I have provided is correct. I have re d the escription of Work and verify it is accurate. 1 agree to comply with all applicable local'
ordinances and state laws relating o bu'di construction. I utho i re entatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Agen Date: 7-ZA '1
SUPPLEMENTA fNFORMA ION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TIIE-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 ❑ 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 1:1 MAJOR El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
� Building Department
���� City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: (f720� N•(a(j G�N� I�I.V� PERMIT# I?J O I�
OWNER'S NAME: l.Q, PHONE# � ' 'QJQ�I
GENERAL CONTRACTOR:,�(�/(�V1 CiOI�s�G bVI BUSINESS LICENSE#�, `:
ADDRESS: (p (� (pj Vp( ��/ CITY/ZIPCODE: � �I U r'J
*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 Date
Please check applicable subcontractors and complete the following information:
�/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
✓ Electrical ���/J00 �(�1I�C (ijV9 `J � �
Excavation
Fencing
Flooring/Carpeting V��� ` �Yl S S -Q YKS 2'� �p
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Lathing
Masonry
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Paving
Plastering
Plumbing
Roofing
Septic Tank
heet Metal
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Own /Contractor ignatu Date