11090144 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:DPR CONSTRUCTION INC PERMIT NO: 11090144 3
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 1450 VETERANS BLVD DATE ISSUED:09/20/2011 f
OWNER'S PHONE: 4088730121 REDWOOD CITY,CA 94063 PHONE NO:(650)474-1450
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
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License Class__.= Lic.# F, ( "
�r� MECH RESIDENTIAL COMMERCIAL
Contractor �-'� \2_ C e Date�Lhappter
I hereby affirm that I am licensed under the proviJOB DESCRIPTION:8TH FLOOR-TI PREP,INTERIOR DEMOLITION OF
(commencing with Section 7000)of Division 3 of the Business&Professions EXISTING
Code and that my license is in full force and effect. FINISHES&WALLS.
I hereby affirm wider 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.
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:$52000
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 of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LA T CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
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Issued by: �' � / Date:
Signature Date d -Z j
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❑ WNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that 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: HAZARDOUS MATERIALS DISCLOSURE
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 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 all-
permit
irpermit 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
become subject to the Worker's Compensation provisions of the Labor Code,I mustOwner or au d age t:
forthwith comply with such provisions or this permit shall be deemed revoked. tc:_c(/ZL4/
APPLICANT CERTIFICATION
CONSTRUC"TION 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
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
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20450 stvns crk blvd.#8th DATE: 09/20/2011 REVIEWED BY: bobs.
APN: ' k C �10� "2 BP#: ��) CM/ � VALUATION: $52,000
rPERMIT TYPE: Building Permit PLAN CHECK TY E: Alteration /Addition/Repair
PRIMARY Commercial Building PENTAMATION
USE: PERMIT TYPE: 1TIPREP
wORK t.i./prep comm. space non structural interior only.
SCOPE
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�,irgr(, d._r:.:'F'tt•: <'ittraf7,I' t,Y.. 1 dL'.; t 3 aL. ' .,,.
NOTE: This estimate does not include fees dire to other Depts(he,Public Works,Sanitary Sewer District,School District,etc.).
Thesefees are based on the preliminary inform tion available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resohition 11-053 Elf. 7Il/1IJ FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Tenant Improvement Prep
Suppl.PC Fee: 0 Reg. 0 OT 0.0 his $0.00 $380.00 1TIPREP
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee-.0 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
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("<-adFf'nlcfion TCi,a;
Work Without Permit? 0 Yes Q No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
71;-avv/ i3L-171 t(:1^7t i r;)t1 "r't':1':
Strong Motion Fee: IBSEISMICO $10.92 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $3.00
SUBTOTALS:' $13.92 $380.00 TOTAL FEE: 1 $393.92
Revised: 09/02/2011
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