11100194CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20572 HOMESTEAD RD CONTRACTOR: DEVCON PERMIT NO: 11100194
CONSTRUCTION INC
OWNER'S NAME: CAMPUS PARK ASSOCIATES
OWNER'S PHONE: 4084460700
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. 4 �" 1167 3
Contractor De-U C.y C� Date 10 - 2A • l.3
I hereby affirm that I am licensed under the provisions of Chapter 9
(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.
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 ay accrue against said City in consequence of the
granting of this pe di onally, the applicant understands and will comply
with all non -point r g lotions per the Cupertino Municipal Code, Section
9.18.
Signature Date D"['
rn
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for whichthis 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 the Cupertino Municipal Code, Section
9.18.
690 GIBRALTAR DR I DATE ISSUED: 10/28/2011
MILPITAS, CA 95035 PHONE NO: (408)942-8200
JOB DESCRIPTION: RESIDENTIAL u COMMERCIALU
DEMO COMM. ASPHALT PARKING LOT, WHICH WILL
INCLUDE TREE PROTECTION AND FENCING....
Sq. Ft Floor Area: I Valuation: $40000
APN Number: 32610063.20572 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
lD-Zd' Li
Issued by Date:
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
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under 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 contaminants as defined by the Bi AirQuality Management District I
will maintain compliance with the ounicipal Code, Chapter 9.12 and
the Health &Safety Code. Sectioug05533. and-25534.
Owner or authorized agent:
Date:
I hereby affirm that there is a constriction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
��,,--��,,,,,,��� CITY OF CUPERTINO
Ili FF,F, ESTIMATOR - BUILDING DIVISION
ADDRESS: 20572 homestead rd.
DATE: 10/28/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$40,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
PENTAMATION 1 GENCOM
PERMIT TYPE:
WORK
Demo commercial asphalt parking lot which will include tree protection, and fencing.
SCOPE
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the Orelininary information available and are on1v an estimate. Contact the Dent for addn'l info.
FEE ITEMS (I,ee Resolution 11-053 Gff. 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
2 hours
$260.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes 0 No
$0.00
Suppl. Insp. Fee-.0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
Strong Motion Fee: IBSEISMCO
$8.40
F 4 0-1 hrs
$520.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$2.00
::................::>..•.,_.;:.:::,:
$10.40
$780.00
$790.40
Revised: 10/01 /2011