11110094-EXPIRED CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 11110094
INC
OWNER'S NAME: SVF CUPERTINO CITY CENTER CORP 690 GIBRALTAR DR DATE ISSUED:11/16/2011
OWNER'S PHONE: 4086666614 MILPITAS,CA 95035 PHONE NO:(408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
yy�� BUILDING PERMIT INFO: BLDG� ELECT� PLUMB r
License Class Lic.# C1MECH RESIDENTIAL COMMERCIAL
Contractor lu Date I I / 1(✓ /
I hereby affirm that I am licensed under the provisions of Cf Ch/hapter 9 JOB DESCRIPTION:APPLE-FLOOR 1-ADD T WO(2)CARD READER DOORS
(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:$48000
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
APN Number:36901019.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
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 source regulations per the Cupertino Municipal Code,Section Issued by: Date:
9.18.
Signature GG Date l/—/(d �
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety performance of the work for which this permit is issued.
Safe Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 Owne authp d7ent:
Compensation laws of California. If,after making this certificate of exemption,I /�i t 9 Date: e
become subject to the Worker's Compensation provisions of the Labor Code,I must C
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of N%ork's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
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
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
L4
CONSTRUCTION PERMIT APPLICATION
ELI CONIMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building a( cupertino.orq
CUPERTINO
❑NEW CONSTRUCTION —1ADDITION ALTERATION/TI ElREVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESSATN
OWNER NAME Y [ (� J PHONE(q � E-MAIL
STREET ADDRESS f tt CITY, STATE,ZIP !F v FAX
CONTACT NAME �L,� PHONE / E_
60)
STREET'ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OwNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ^r �` ` LICENSE NUMBER. `� LICENSE TYPE BUS.LIC#
COMPANY NAME j� ? V E-M J (� �'JUS• FAX
l/ C,�[f 1 i/L Z f C >
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHIIECT/INGINEERNAME At l LICENSE NUMBER BUS.LIC#
COMPANY NAME �j E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK y� p
1CC l �'G�U C (�
i
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EM TO NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA _ ',
r
BATHROOM KITCHEN OTHER
REMODELAREA REMODELAREA REMODEL AREA
PORCH AREA DECK AREATOTAL DECK/PORCH AREA GARAGE AREA: DETACH "
[]ATTACH
#DWELLING UNITS; ISA SECOND 1JN4T []YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? ❑NO
PRE-APPLICATION OYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TO AL VALUAON: '
PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �ua� TI
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 uildihig constructiauthorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: — t'?
SUPPLE AL INFO TION REQUIRED P -CHECK TYPE Ro G SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER d 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 ❑ PUBLI frKs
form if any Hazardous Materials are being used as part of this project. ❑ LARGE FIRE bIF121T
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR s aNTTARY SEWER DrsTRlcr
submittal of Building Permit application.
❑ ENVIRONMENTA,HEALTH.
j
Bldgflpp 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 R`f I N® Fax: 408-777-3333
CONTRACTOR SUBCONTRACTOR ITT
JOB ADDRESS: L46 3 0 0 6W k-, PERMIT#
OWNER'S NAME: PHONE# 5
GENERAL CONTRACTOR: . BUSINESS LICENSE#
ADDRESS: O)o , ��:( - K CITY/ZIPCODE:
your 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
illworkCement Finishing
V Electrical A
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
yr Glass /Glazing i'(d, c, �. �1 ,je= 'S S
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper C)
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner ISimtractor Signature Date
I
C
CITY OF CUPERTINO j
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20300 stvns crk blvd. DATE: 11/16/2011 REVIEWED BY: bobs.
E
APN: BP#: "VALUATION: 1$48,000
*PERMIT TYPE: Building PermitPLAN CRECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1 GENCOM
USE: Commercial Building PERMIT TYPE:
WORK add 2 card reader doors.
SCOPE
Yft'ir. #. r, 'r•�`�;n, I'ta 1f°>,1'�tr';,ifi S`fiC'. f'1a "c. nPir�f'f:'
j{'}tikts' tli#:tr'i;}it
llmj: 67i:p, f C'. .S'.lfty" , I'C'£',.
(t. r f-.
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelinina information available and are oidy an estimate. Contact the Dept-for addn'1 info.
FEE ITEMS,(Fee Resolution 11-0531Jff 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # New Door Opening
Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $520.00jIDOORNONST Non-Structural
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
Vcn
Work Without Permit? C)Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
77 _ Building or Structure 0 .,
i
Strong>,Motion Fee: IBSEISMZCO $10.08 Select an Administrative Item
i
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $12.081 $520.00 TOTAL FEE: $532.08
Revised: 10/01/2011