11020008CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10450 BUBB RD
CONTRACTOR: DICKINSON CAMERON
PERMIT NO: 11020008
CONSTRUCTION CO
OWNER's NAME: MISSION WEST
6184 INNOVATION WAY
DATE ISSUE D: 03/15/2011
OWNER'S PHONE: 4089741126
CARLSBAD, CA 92009
PHONE NO: (760) 438-9114
E] LICENSED CONTRACTOR'S DECLARATION
r F r—
License Class t?;:, Lie.# ;�qc�_7�
BUILDING PERMIT INFO: BLDG ELECT PLUMB
-
MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date �!)/[
L
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: EXTERIOR IMPROVEMENTS AT EXISTING LEASED SPACE
(commencing with Section 7000) of Division 3 of the Business & Professions
STRUCTURAL MODIFICATINS FOR NEW DOOR, SITE GRADING
Code and that my license is in full force and effect.
PAVING, CURB WORK ACCESSIBLE PATH TO PUBLIC WAY
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
Sq. Ft Floor Area:
Valuation: $40000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 35720037.10450
Occupancy Type:
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
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 LAST CALLED INSPECTION.
with all non -point sour e re ulations per e Cupertino Municipal Code, Section
9.18.
Signature_ Date A�56/
Issued b I Date:.
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
1, 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:
1, 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. 1 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 die 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
�a
He Ith 'y Co e, Sections �&W, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
a&s
become subject to the Worker's Compensation provisions of the Labor Code, I must
0 w in) r
_ShEi/11
forthwith comply with such provisions or this permit shall be deemed revoked.
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 -,Wrles
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (See. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Leader'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,
Leader'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.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
NOM.- Tki e fpov arp havpd nn thp prPliminary hiformatioti available and are onlv ati estimate. Contact the Dept for addn'l info.
FEE ITEMS (Lee 1?esoliaimi 09-051 Eff. 711110)
ADDRESS: 10450 bubb rd.
DATE: 02102/2011
REVIEWED BY: bobs.
Ale c h. Permil Fee.,
APN:
r1cc. Permit re
*VALUATION: 1$40,000
,-PERMIT TYPE: Building Permit —TPLANCHECKTYPE:
Tenant Improvement
PRIMARY Commercial Building
PhImh /ayp.
PENTAMATION 1GENCOM
USE:
PME Plan Check:
PERMIT TYPE: A
womc
Add new rollinq door at existing dock location at rear of commercial bldg. Exterior accessible path of
SCOPE
travel upgrades.
NOM.- Tki e fpov arp havpd nn thp prPliminary hiformatioti available and are onlv ati estimate. Contact the Dept for addn'l info.
FEE ITEMS (Lee 1?esoliaimi 09-051 Eff. 711110)
A,fech, Plwi Chcrk
PhImb. Phil/ Chec/`
Elc(-,. Plan Owk
Ale c h. Permil Fee.,
PernO rce.
_L_
r1cc. Permit re
Other Alech, hisp. F-1 I
0111cr PhImh Insp. F-1
0/herrIc�Jasp,
Alech, rce'.
PhImh /ayp.
I Elcc� hmp, P cc.,
NOM.- Tki e fpov arp havpd nn thp prPliminary hiformatioti available and are onlv ati estimate. Contact the Dept for addn'l info.
FEE ITEMS (Lee 1?esoliaimi 09-051 Eff. 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes E) No
$0.00
hours
$ 2 5 2. 0 01
Plan Check, Hourly
1 STPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
�0. 0
1 hrs
$0.00
PME Plan Check:
$0.00
= #
$380.00
New Door Opening
Shearwall Masonry
Permit Fee:
$0.00
Suppl. Insp. Fee. -O Reg. 0 OTFo7o]
hrs
$0.00
PME Unit Fee:
$0.00
PNM Permit Fee:
$0.00
C017S11-110i011 I'M -
Acoustical Fee: 0 Yes (F) No
$0.00
0
Work Without Permit? 0 Yes E) No
$0.00
Plaq!��
$0.00
Select a Non -Residential
Building or Structure
I
G
0
A
FceS"
Strong Motion Fee: IBSEISWCO
$8.40
hrs
$126.00
–
Inspections
LLPW��s Standard Inspections
Bldg Stds Commissioii Fee: IBCBSC
$2.001
SUBTOTALS:
$10.401
$758.001
TOTAL FEE.
F $768.401
Revised: 01/15/2011