11020045 I
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:BAY AREA BUILDERS INC PERMIT NO: 11020045
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OWNER'S NAME: LANE PARTNERS 318 MARTIN AVE DATE ISSUED:03/03/2011 j
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OWNER'S PHONE: 6508380100 SANTA CLARA,CA 95050 PHONE NO:(408)648-4500
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❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Classes Lic.#
n J,� MECH RESIDENTIAL COMMERCIAL
Contractor yC7y rc �� r'Uz�� Date 3 3� //
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RELOCATE FREESTANDING METAL AWNING @a FRONT
(commencing with Section 7000)of Division 3 of the Business&Professions ENTRANCE OF COMMONG BUILDING ENTRANCE ON STEVENS
Code and that my license is in full force and effect. CREEK BLVD-APPLE
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 Sq.Ft Floor Area: Valuation:$3800
permit is issued.
APPLICANT CERTIFICATION APN Number:36901019.00 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 LAST CALLED INSPECTION.
with all non-point source regulations per.the-Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signature Date d'
❑ 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
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:
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: 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 corder 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 air
permit 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,S,13ctions 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 must Owner or tor* a
forthwith comply with such provisions or this permit shall be deemed revoked. Y Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
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.
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Signature Date Licensed Professional
__ _ __ CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
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ADDRESS: 20300 stvns crk blvd. DATE: 02111/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$3,800 I
xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK relocate ex. metal awning at front entrance of comm. bldg.
SCOPE
Xrech. Plan Check P/ronb. Plan Chem, Dee, Plan Check
dtcclr. Petnrl!Fcc': Phrnrb. Penni!1"Ce: �'lcc. Per7ni7 1%ee:
Other Alech. hasp. 011ier•Phnnb hasp. E]__L_ OtherElec.Iny, Li
Alech,Inv).Fac: Plnn h. hap, h'ee: Elec. Insp.Fee:
NOTE: These ees are based on theprelindnary information available and are only an estimate. Contact the De t or addn 11 info.
FEE ITEMS (Fee Resohition 09-051 E' 7/1/10, FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes E)No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $126.00 ISTPLNCK
A
PME Plan Check: $0.001= # Awning/Canopy(Support'd by Bldg)
Permit Fee: $0.00 $317.00 IAWV,4TTBLD Canopy
Suppl. Insp.Fee.0 Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
COT1S11'11Clion /ax
Acoustical Fee: 0 Yes E) No $0.00
Work Without Permit? Q Yes E) No $0.00 G
Plamling_Fee: $0.00 Select a Non-Residential Q
Trcrve/Docionentutioll Fees: Building or Structure
Strong Motion Fee: IBSEISMICO $0.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.80 $443.00 TOTAL FEE: $444.80
Revised: 01/15/2011