11110133CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20750 STEVENS CREEK BLVD CONTRACTOR: W.L. BUTLER PERMIT NO: I t t 10133
CONSTRUCTION, INC
OWNER'S NARIE: BYER PROPERTIES LP 204 FRANKLIN ST DATE ISSUED: 03/06/2012
ONVNER'S PHONE: 4156262937 REDWOOD CITY, CA 94063 PHONE NO: (650) 361-1270
® LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. # '`� j I..
MECH RESIDENTIAL COMMERCIAL
Contractor l�v, Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(co€nittemcing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm tinder 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 tine
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
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
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,
costs, and expenses which may aceruc against said City in consequence of the
granting of this permit. Additionally, (lie applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date -
® OWNER -BUILDER DECLARATION
I hereby aftir€u that I a€n exempt front the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do die 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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm tinder penalty of perjury one of the following three
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 (lie
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
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
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
forthwith comply with such provisions or this permit shall be deemed revoked.
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
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,
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 (lie Cupertino Municipal Code, Section
9.18.
JOB DESCRIPTION: CUPERTINO CROSSROADS - PAD F - NEW
RESTAURANT(THE
ISLANDS)CORE & SHELL BLDG(5,600SQFT). SEPARATE
PERMIT FOR TENANT MIPROVEMENT#1111Ot32
Sq. Ft Floor Area: I Valuation: $1000000
APN Numher: 35908013.00 1 Occupancy Type:
Issued bye
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements tinder Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section, 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit Hazardous air
contanduants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9A2 and the
Health & . afety Code, Sections 25505, 25533, and 25534.
Owner o "ed ag tt:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Nwrles
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
Signature
Date
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
11 1�Jl1 VP1W 1W QTI'M A TCIR _ RITH .-111 "N'r 151VI,441ON
ADDRESS: 20750 Stevens Creek Blvd. DATE: 10113/2011
ial
REVIEWED BY: A. Salvador
APN: 359-08-006
*'VALUATION: 1$1,000,000
,'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? 0 Yes No
PENTAMATION 1 SHELLBLDG
PERMIT TYPE:
WORK
New Restaurant core & Shell Bid 5 600 s.f.. Under separatepermit: TI rough grading, site utilities
SCOPE
I associated site work, hardscape and preparation of finished pads.]
OCCUPANCY TYPE:
TYPE -OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
Shell Bldgs
II-B,III-B,IV,V-B
5,600
$8,505.38
IOSPLNCK
$5,412.24
1OSINSP
TOTALS:
5,600
$8,505.38
-":---;:'- u-_-
$5,412.24
,ilech, Phan C.`heelr
Mich. Penidl ree.
Nuirth. Platt Check
Plumb. Pennit pee:
, - _ Plug Check
Other Meek lisp. I ' t)tker Phunb lush. L� Orh4r Ele r::. hall}. !I j L_
Alech. hisj.). Pic: Phunb.InsP. Fee: Elec. hrsp.. [,e
NOTE: This estimate does not Include -fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Disd4 etc I These foac are based on the reltminar in orotation available and are only an estimate. Contact the Dept for aaan't tat o.
FEE ITEMS (Fee Resolution 11-053 G 7/1/111
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$8 505.38
Select a Misc. Bldg/Structure
or Element of a Building
Suppl. PC Fee: � Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$5,412.24
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constr. Tax: IBCONSTAXC
$14,000.00
.Adminisirralive .Fcv:
t
E)
Work Without Permit? O Yes (j) No
$0.00
Advanced Planning Fee: PLLONGRNGC
$1,456.00
Select a Non -Residential E)
Building or Structure 0
1 rcrv�l DocumentationFz es:
Strong Motion Fee: 1BSElswco
$210.00
Select an Administrative Item
Bldg Stds Commission Fee: MCBSC
$40.00
�UB't?L,;
29 623.62
0.00
$29,623.62
Revised: 10/01 /2011