101100810
CITY OF CUPERTINO BUILDING PERMIT
PERMIT NO: 10110081 CONTRACTOR: DEVCON CONSTRUCTION BUILDING ADDRESS: 10400 RIDGEVIEW CT
INC
OWNER'S NAME: A
ILPITAS, CA 95035 PHONE NO: (408)942-8200
0
License Class
LICENSED CONTRACTOR'S DECLARATION
1>~ Lie. # :5N I (03
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH I RESIDENTIAL I COMMERCIAL r contl1lctor~ ~~Date~
JOB DESCRIPTION: ADDITION OF NEW CHAMBER, LAB, NEW AMBIANTI hereby affirm that I am licensed under the provisions of Chapter 9 TESTING(commencing with Section 7000) of Division 3 of the Business & Professions ROOM TP EXISTING LAB SPACE IN CENTRAL CORE OF 1STCode and that my license is in full force and effect. FLOOR. lNCLUDES DEMO OF EXISTlNG OFFICES, LAB,
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 ofthe 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: $200000 ~_.~-~
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information i APN Number: 31606046.00 Occupancy Type:
correct. I agree to comply with all city and county ordinances and state laws rating
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 STARTEDcosts, and expenses which may accrue against said City in consequence of the
granting of this permit. Ad~itionally. the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
w'ili ,11""1' 000= ",,"""~ "', tho Co""'M Moo"'''''' Cod', S~tioo 180 DAYS FROM LAST CALLED INSPECTION.
9.18. f
ate~ Issued~~ ? z~-Date: ,?-/ .?-/4!
'-./ \ '\ \.\
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 all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection.
Business & Professions Code)
Signature of Applicant: Date:I, as owner ofthe property, am exclusively contracting with licensed contl1lctors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "An OR BElTERI 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 ofthe 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
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.
permit is issued. Additionally, should I use equipment or devices which emit hazardous air
I 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 win
not employ any person in any manner so as to become subject to the Worker's ~o "mpll'" with ili' Cop"ti" Moo'dp. Cod, Ch.p'" ',12 "d ili,
th & Sa~ y C~ e, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
Compensation laws of California. If, after making this certificate of exemption, I
o 0
APPLICANT CERTIFICATION CO~UCTION LENDI:G 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 work's
to building construction, and hereby authorize representatives ofthis city to enter
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.)
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 DECLARATION9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
fI FEE ESTIMATOR -BUILDING DIVISION
ADDRESS: 10400 ridgeview ct. I DATE: 11/12/2010 REVIEWED BY:
APN:6 \ (P 9P D-1(P I BP#: I OII{X)fS I *V ALUA TION: 1$200,000 1
*PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building I J)Ti/ PENTAMATION 18 TIUSE: 1100i' ,ii! !. PERMIT TYPE:
WORK
SCOPE
OCCUPANCY TYPE: TYPE OF
CONSTR.
FLRAREA
(s.f.) PC FEES PC FEE ID BP FEES BP FEE ID
8 (Tenant Improvements) II-B,III-B,IV,V-B 1,450 $1,911.92 1BT/PINCK $1,246.12 1BTIINSP
TOTALS: 1,450 $1,911.92 $1,246.12 I
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 09-051 Etf 7//10) FEE QTYIFEE MISCITEMS
Plan Check Fee:
Supp!. PC Fee: o Reg. o OT I 0.0 I hrs
$1,911.92
$0.00
Select a Mise Bldg/Structure
I or Element of a Building
....
PME Plan Check: $0.00
Permit Fee:
Supp!. Insp. Fee:€> Reg. o OT I 0.0 I hrs
$1,246.12
$0.00
I
PME Unit Fee:
PME Permit Fee:
$0.00
$0.00
I
i \
Acoustical Fee:
Work Without Permit?
Planning Fee:
I I
o Yes 0No
o Yes 0No
PLLONGRNGC
$0.00
$0.00
$0.00
I
I
Select a Non-Residential
I Building or Structure
0
0
0
0 ....
Strong Motion Fee:
Bldg Stds Commission Fee:
IBSEISMICO
IBCBSC
SUBTOTALS:
$42.00
$8.00
$3,208.04 $0.00
Select an Administrative Item
I
TOTAL FEE: I $3,208.04
Revised: 11/08/2010