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11050265 CITY OF CUPERTINO BUILDING PERMIT j BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:DPR CONSTRUCTION INC PERMIT NO: 11050265 OWNER'S NAME: PROMETHEUS REGROUP 1450 VETERANS BLVD DATE ISSUED:07/14/2011 i OWNER'S PHONE: 4088730121 REDWOOD CITY,CA 94063 PHONE NO:(650)474-1450 i ❑ LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# _ MECH RESIDENTIAL COMMERCIAL Contractor Date -t E t I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SUITE 350-TI RECONFIGURE 9,992 SQFT OF EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions HARDWALL OFFICE AND CONFERENCE ROOM SPACE TO OPEN Code and that my license is in full force and effect. OFFICE&WORK ROOMS.NEW ARCHITECTURAL FINISHES, I hereby affirm under penalty of perjury one of the following two decl rations: I have and will maintain a certificate of consent to self-insure for Worker Compensation,as provided for by Section 3700 of the Labor Code,for the 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 Sq.Ft Floor Area: Valuation:$791784 permit is issued. APPLICANT CERTIFICATION APN Number:36901027.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting is permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with alrnon-polflilsource regulations per the Cupertino Municipal Code,Section 9.18. Issued b�% Date: t Signature Date `� I ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I m become subject to the Worker's Compensation provisions of the Labor Code,I t On r orknrized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the j granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional 0 CITY OF CUPERTINO BUILDING PERMI 0 \ BUILDING ADDRESS: 20450 STEVENS CREEK BLVD coN"raACT'oR; DPR PER 65 CONSTRUCTION INC OWNER'S NANIE: CUPERTINO CITY CENTER BUILDINGS 1450 VETERANS BLVD DATE ISSUED:07/14/2011 OWNER'S PHONE: 4088730121 REDWOOD CITY, CA 94063 PHONE NO:(650)474-1450 LICENSED CONTRACT'OR'S DECLARATION BUILDING PERNIIT INFO; BLDG ELECT!^ PLUMB Lic�Llass�_ Lic.N - 0� NIECH RESIDENTIAL CONINIERCIAL Contractor T� Date 1 JOB DESCRIPTION: SUITE 350-TI RECONFIGURE 9,992 SQFT OF EXISTING hereby affirm that lam licensed under the provisions of Chapter 9 HARDWALL OFFICE AND CONFERENCE ROOM SPACE TO OPEN (commencing with Section 7000)of Division 3 of the Business&Professions OFFICE&WORK ROOMS.NEW ARCHITECTURAL FINISHES, Code and that nny license is in full force and effect. I hereby aflirrn under penalty of perjury one of the following two declara7/20/2011-DEF#1-DEFERRED PATH OF TRAVEL DRAWING tions: EXTERIOR AND INTERIOR-ISSD 9/13/1 I 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;$791784 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:3690]027.00 Occupancy Type; permit is issued. APPLICANT 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 m Toned property for inspection purposes. (We)agree to save 180 DAY F M LAST CALLED INSPECTION, indemnity and k ep nannless the City of crtino against liabilities,judgments, costs,anPexpee vhich may accrue a aim t said City in consequence of the rr 4?,eranungit. A itionally,t e ap licantunderstands and will comply Issued by: LDate:With all urce gulations er the Cupertino Municipal Code,Section 9 RE-ROOFS: . i"naturate ? -/3-// All roofs shall be inspected prior to any roofing ng maternal being installed. If a roof is installed Without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDS ,CLARATION Signature of Applicant: Date: he eby affirm that I am exempt fir n the Contractor's License Law for one of the 'ollonving 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS iNIATERIALS 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. 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 25.532(x)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 equi nt or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,Ibr the air contaminants as defined by the Bay re Air Quality Nlanagement District performance of the Work for which this permit is issued. will maintain compliance with the Cu rth o Mu ip ode,Chapter 9,12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 505, 5533 n 25. 4, Section 3700 of the Labor Code,for the performance of the Work for which this l permit is issued, caner o•authorized agent; Date: / 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 onnpensation laws of California. If,alter making this certificate ofexemption,I CONST UCTION LENDIN 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 W 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 indemnifi 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•dnis 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 FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20450 stevens Creek;ot�__50 DATE: 05/27/2011 REVIEWED BY: gs APN: J a� BP#: ZI "VALUATION: 1$791,784 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK 9992 s ft TI new paint, carpet ceiling tiles doors elect. mech. firesprinklers. SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) I-A,I-B 9,992 $3,587.60 IBTIPLNCK $8,717.60 1BTHNSP TOTALS: 9,992 $3,587.60 $8,717.60 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No Iia nl, t lw.,C`17 c4, t',leo,1'hn? ast r ,;i°it.I;ul;. 0!ho Crisp, NOTE. These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resohition 09-051 Ef. 7%1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,587.60 Select a Misc Bldg/Structure Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $8,717.60 Suppl.Insp.Feer Reg. 0 OT 0.0 his $0.00 PME Unit Fee: $0.00 I PME Permit Fee: $0.00 i Acoustical Fee: 0 Yes 0 No $0.00 Work Without Permit? 0 Yes G) No $0.00 PIaiming Fee: $0.00 Select a Non-Residential Building or Structure 0 Strong Motion Fee: IBSEISMICo $166.27 Select an Administrative Item i Bldg Stds Commission Fee: IBCBSC $32.00 SUBTOTALS: $12,503.47 $0.00 TOTAL FEE: 1 $12,503.47 Revised: 04/29/2011 I DEFERRED# ELICONSTRUCTION PERMIT APPLICATION j COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION DATE 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildingQcupertino.org CUPERTINO II j hh ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISIO !DEFERRED ORIGINAL PERMIT# 1 I D V G� PROJECT ADDRESS tf' / APN# 6 OWNER NAME lrr > PHONE _ } E-MAIL STREET ADDRESS CITY, STATE,ZIP ! FAX CONTACT NAME )L PHONEt 2- E-MAIL^^ STREET ADDRESS CITY,STATE, ZIP FAX Pte_ E- C- 4' /Z ❑OWNER ElOWNER-BUILDER 11 OWNER AGENT ugyONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRA OR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMP N n�A E MAIL /J�� FAX STREET ADDRESS L "F CITY,STATEC,ZIP PHONE (X L .?-, — ARCHIT CT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME �j E YIAIL FAX STREET,ADDRESSCITY,S ATE,ZIP P ONE -, '-/ - ti DESCRIPTION OF WORK 2C gr EXISTING USEPROPOSED USE CONSTR.TYPE #STORIES e USE TYPE 77 SQXT. VALUATION(S) EXISTG NEW FLOORDEMO ` TOTAL AREA AREA •- AREA NET AREA T_•L. l O GwU BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA; DETACH ❑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 RECEIVED BY: J� TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this application and the informationha 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 to b 'Iding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date:Te_o 1 SUPPLEMENTAL QU=D PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER In lu—MlING 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 9_99_NDARD El 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 E3 MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH 1 BldgApp_2011.doe revised 06/21/11 j i