11030012CITY OF CUPERTINO BUILDING PERMIT
i'I-1)/--//
BUILDING ADDRESS: 21666 STEVENS CREEK BLVD CONTRACTOR: PORTFOLIO REAL ,11030012
MANAGEMENT
OWNER'S NAME:
SAN JOSE, CA 95117 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r 1—Ir
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. q
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that 1 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.
1 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
1 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 stale 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 licant understands and will comply
with all non -point source regulations pert Cupertino Munic' a de, Section
9.18.
Signature
1 hereby affirm that 1 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,
wit l 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).
1 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 which this permit is issued.
l 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 [ have read this application and state that the above information is
correct. [ 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 -
! —��
JOB DESCRIPTION: STANLEY SQUARE (NO BUSINESS NAME YEr)COMM'L
TI-
ADD ACCESSIBILITY TOILET, ENLARGE REAR DOOR PER
ACCESS REQURMNTS, ADD 200AW 3 PHASE SERVICE
?-Z I.1"o I I_ 2 -, J J4 I a-"•--K 0 k
f I�Srr-
Sq. Ft Floor Area: I Valuation: $10000
APN Number: 35717012.21666 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
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 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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code,
Sections5, 25533, and 25534.
i-, //
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance of %ork'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.
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 21666 STEVENS CREEK BLVD CONTRACTOR: PORTFOLIO REALTY PERMIT NO: 11030012
MANAGEMENT
OWNER'S NAME:
SAN JOSE, CA 95117 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. q
Contractor
Date
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.
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: STANLEY SQUARE (NO BUSINESS NAME YET)COMM'L
TI-
ADD ACCESSIBILITY TOILET, ENLARGE REAR DOOR PER
ACCESS REQURMNTS, ADD 200AMP 3 PHASE SERVICE
Sq. Ft Floor Area: Valuation: $10000
APN Number: 357I7012.21666 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date I Issued by:
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 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 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.
certify that in the performance of the work for which this permit is issued, 1 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 permi dditionally, the applicant understands and will comply
with all non-poin regulations per the Cupertino Municipal Code, Section
9.18.
s 40//
Signature Dat
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
1 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
Date: 046A
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CITY OF CUPERTINO
Fm-7- FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21666 scb
DATE: 03/02/2011
REVIEWED BY: Is
APN:
BP#:
`VALUATION:
j$10,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1B TI
PERMIT TYPE:
WORK
add 85 sq ft rest room accessible. add 200 amp service
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
85
$1,856.00
IBTIPLNCK
$520.00
IBTIINSP
TOTALS:
85
1 $1,856.00
1
1 $520.00
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes 0 No
ELEC, HOURLY 0 Yes Q No
,bfech. ('fan Check
Plumb. Plun ( h,ckT-T
Llec. Plan Cheek
L11 1,. Permil Fee:
Phmd). Permit Fce:
li/ec Ponlit V c
Other ;L1erh. Imp.
01he). I rr.r;Li I
Other L, :.
ET
Urch. Imp. 1;'ae:
1'lumh, hasp. Fec.
l:1ec. Insp. I-ce
NOTE: These lees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: ISUPPKFEE
4 856,
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
4.0
hrs
$504.00
PME Plan Check:
$0.00
Permit Fee:
$520.00
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conslmciion Tax
Acoustical Fee: 0 Yes G No
$0.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential •
Building or Structure X
i
Travel Documentution Fees.
Strong Motion Fee: IBSEISWCO
$2.10
Select an Adm tratiYe I e
(`�J
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2,883.10
$0.00 TOTAL FEE:
I $2, 3.10
Revised: 03/01/2011
ww
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21666 stvns crk bled.
DATE: 07/21/2011
REVIEWED BY: bobs.
APN:
BP#:
'VALUATION: $3,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION
PERMIT TYPE: Cb
WORK
revise plans and scope of work ti show new sump pump
SCOPE
NOTE: These fees are bated on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/l/ll)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (E)Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Q Yes 0 No
$0.00
Suppl. Insp. Fee10 Reg,
O OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
O Yes E) No
$0.00
Q
0
Work Without Permit? 0 Yes (F) No
$0.00
Planning Fee:
$0.00
2 hours Inspections
$260.00 /sTINSP Inspection, Hourly
E)
0
Strong Motion Fee:
IBSEISMICO
$0.63
=hrs Admin./Clerical Fee
$41.00 IADMIN
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.63
$301.00
TOTAL FEE:
$302.63
Revised: 07/04/2011