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11050252CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18900 STEVENS CREEK BLVD OWNER'S 12, LICENSED CONTRACTOR'S DECLARATION License Class 6 Lic.# 94-1 440 Contractor A �5kyy%U W*-WL Date_ ►in _(V — 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 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. CONTRACTOR: TEAMWRKX 1691 OLD BAYSHORE HWY SAN JOSE, CA 95112 PERMIT NO: 11050252 DATE ISSUED: 10/06/2011 PHONE NO: (408) 287-2700 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r- MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRWTION: COMM T.I OF 8,999 SQ FT CONVERT OFFICE BUILDING TO DAYCARE & LEARNING CENTER, MODIFY PARKING -SANITARY IS SUNNYVALE'S JURISDICTION. Sq. Ft Floor Area: I Valuation: $500000 APN Number: 37511073.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. / � Date Issued by: ❑ OWNER -BUILDER DECLARATION 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) I, as owner of theproperty, 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 thF a -. declarations: 1 1 have and will maintain a Certificate of Consent to self -insure fo}=X6rker's Compensation, as provided for by Section 3700 of the Libor Cede' for the performance of the work for which this permit is issue4. I have and will maintain Worker's Compensation Insura ,rovided for by Section 3700 of the Labor Code, for the performance of h ork for which this permit is issued. I certify that in the performance of the work for whrch 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, 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 Applicant: 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 Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Date: / --6 —/ t CONSTRUCTION LENDING AGENCY [ hereby affirm that there is a construction lending agency for the performance of Hork'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. Signature Date I Licensed REVISION Ili= CITY OF CUPERTINO BUILDING PERMIT DATE ' BUILDING ADDRESS: 18900 STEVENS CREEK BLVD CONTRACTOR: TEAMWRKX PERMIT NO: 11050252 OWNER'S NAME: a ' ,,r� ,t License Class 1J Lic. # � I- ( 4-`t 0 BUILDING PERMIT INFO: BLDG ELECT PLUMB J RESLDENTIAL r— Contractor ; ti,2t�„ J IrNK—X Date 1 — 1 C(— 1-7-- MECH COMMERCIAL'S 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: COMM T.I OF 8,999 SQ FT CONVERT OFFICE BUILDING TO (commencing with Section 7000) of Division 3 of the Business & Professions DAYCARE & LEARNING CENTER, MODIFY PARKING -SANITARY Code and that my license is in full force and effect. IS SUNNYVALE'S JURISDICTION I hereby affirm under penalty of perjury one of the following two declarations: 12/21/201I- REVISION #I- REVISE HVAC DRAWING, EXITCORRIDOR AND RAMP - 1/19/2012 REV#1 [SS'D 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: $500000 permit is issued. APPLICANT CERTIFICATION APN Number: 37511073.00 Occupancy Type: [ 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of Utis permit. Additionally, the applicant understands and will comply WITHIN ISO DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. ���� Date / —/Z- (� Issued by: Date: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove al I new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: [ 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the [ have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air [ certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, [ must forthwith comply with such provisions or this permit shall be deemed revoked. . / /9 /z Date APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY [ 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 I hereby affirm that there is a construction lending agency for the performance of Hork's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO IM-7, FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 18900 stevens crk blvd. DATE: 12/20/2011 REVIEWED BY: bobs. APN: BP#: 11050252 "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise hvac drawing,exit corridor, and ramp. SCOPE il:. i, r'Lr :: '+.. I'hrnrh. Plan C cs% Lk-c'. Plan C/;c'ch 07her ,lk':.'h. _v, (')Iher P101"J", 1)Ysp. O/her lfl�c. /nsp.Li .1lcci�. lr'.p. Fee Phunh h: p , . ".. F!, c. In.sp, I cc. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District' School District. eta). These fees are based on the Dreliminary information available and are onlv an estimate- Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 F-27 hours Plan Check, Hourly $260.00 1STPLNCK Suppl. PC Fee: Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. © OT Fo,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constriiction Tt7X. T_r ;t «ir, ini.ctrc five f ire: Q Work Without Permit? 0 Yes Q No $0.00 Advanced PlanningFee: $0.00 Select a Non -Residential Building or Structure 0 i Dy el Doc((nricalolion FLTS. Strong Motion Fee: $0.00 Select an Administrative Item Bldg, Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $260.00 TOTAL FEE: $260.00 LJ Revised: 12/04/2011