13120180-VOIDCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20916 HOMESTEAD RD STE F
CONTRACTOR: SMI CONSTRUCTION PERMIT NO: 13120180
INC
OWNER'S NAME: OAKMONT INVESTMENT GROUP LLC
595 MONTAGUE AVE DATE ISSUED: 03/12/2014
OWNER'S PHONE: 4084465117
SAN LEANDRO, CA 94577 PHONE NO: (510)351-3288
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
MOO MOO TEA HOUSE T.I. TO REMODEL SERVICE
Q
License Class_Lic. #
COUNTER,
RELOCATE 3 COMPARTMENT SINK WITH & GREASE
Contractor S�u Date
TRAP.
I hereby affirm that I am licensed under the provisio of Cha ter 9
(commencing with Section 7000) of Division 3 of the usiness & 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: $20000
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of Code, for the performance of the work for which this
APN Number: 32609052.1`0
Occupancy Type:
u
permit is is7APPLICANT
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 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize -representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS F LE SPECTION.
indemnify and keep harmless the Cityof Cupertino against liabilities, judgments,
expenses which may accrue against said City in consequence of the
costs, and
granting of this permit. Additionally, app icant understands and will comply
Issue `
e, ec ion
with all non -point sourc re ula�trs he upertio Municip7's
9.18.
RE -ROOFS:
SignatureDate IV
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.
I G
El OWNERS -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
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 d vis 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 uariity Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: 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 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(4088) 777-3228 • FAX (408) 777-3333 • building0cupertino.org
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❑ OWNER OWNER --BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT
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LICENSE NUMBS
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BUS. LIC #
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ARCHITEC16GINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
es
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Tl uC GLV✓'
EXISTING USE
PROPOSED U
CONSTIL TYPE
# STORIES
_
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA : I-
NEW FLOOR
AREA I
DEMOTOTAL
AREA 2-
NET AREA
)VIA
S/
v
BATHROOM JKITCHEN
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REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
I
❑ ATTACH
# DWELLING UNITS:
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 TOT VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO ^y,,�-�,c�"+,,
26 c, U ^^
By my signature below, I certify to each of thyi gz I am the property owner or authorized agent to act on t erty owner's behalf have read this
application and the information I have providrect. I have read the Description of Work an�verify it is ac te. I agree to comply with all applicable local
ordinances and state laws relating to buildingt' .. author representatives of Cupertino to enter the above-identilly property for inspection purposes.
Signature of Applicant/Agent: rDate:
SUPPLEMENA F RMATION REQ1 JTRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER -THE COUNTER
❑. BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
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 DisclosureSTANDARD
❑ 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
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 20916 HOMESTEAD RD # F
DATE: 12/20/2013
REVIEWED BY: MELISSA
PC FEE ID
APN: 326 09 052
4: ff
VALUATION: $20,000o
1
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
Corn
IBTIPLNCK
PENTAMATION 113TI
PERMIT TYPE:
7P11
USE:
$0.00
PME Plan Check:
WORK
MOO MOO TEA HOUSE T.I. TO REMODEL SERVICE COUNTER, RELOCATE 3 COMPARTMENT
SCOPE
SINK WITH & GREASE TRAP.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
(s.f.)
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
11-B,111-B,1V,V-B
200
$2,036.00
IBTIPLNCK
$571.00
IBTIINSP
$0.00
PME Plan Check:
-
$0.00
Permit Fee:
$571.00
Suppl. Insp. Fee.(j) Reg. 0 OT
10.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
200—
$2,036.00
_FT
$571.001
1
MECH, HOURLY 0 Yes G No
PLUMB, HOURLY 0 Yes (F) No
ELEC, HOURLY 0 Yes 0 No
MISC ITEMS
Plan Check Fee:
..
Select a Misc Bldg/Structure
or Element of a Building
Lj
LJ
0.0
-, - 1.
hrs
$0.00
NOTE. This estimate does not include fees due to other Departments (i.e. nanning,,Pubuc works, fire, Sanuary5ewer"turictachout
___'r--,... 1._-1 __ .1- "vail"hip and ore only an Pstimate- Contact the Dent for addn'l info.
IU13 t' vt". liL -1-
FEE ITEMS (&e Resolution 11-053 Eff /7%1/13)
--------
FEE
-- ---
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,036.00
Select a Misc Bldg/Structure
or Element of a Building
A
Suppl. PC Fee: Reg. 0 OT
(D
0.0
-, - 1.
hrs
$0.00
PME Plan Check:
-
$0.00
Permit Fee:
$571.00
Suppl. Insp. Fee.(j) Reg. 0 OT
10.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_FT
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
I
E)
0
Travel 19o1;'1W"cM'0"1 . 011 11'('T8'-
Strong Motion Fee: IBSEISMICO
$4.20
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2,612.20
)0
, $0. 00
E:
1 TOTAL FEE:
$2,612.20 1
Revised: 10/01/2013