11010068I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD STE 750 CONTRACTOR: GIDEL AND KOCAL PERMIT NO: 11010068
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 1 574 DIVISION ST DATE ISSUED: 01/11/2011
NER'S PHONE: 4088730121
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #—
Contractor el fes/{ 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
1 certify that I have read this application and state that the above information is
correct. 1 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, tIpepplicant understands and will comply
with all non -point source�ula ' s the Cupertino Municipal Codeection
'.1, /
9.18.
Signature.
OWNER -BUILDER DECLARATION
J
1 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)
1, as owner of the property, 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 three
declarations:
1 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.
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,
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
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 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,
—sts, and expenses which may accrue against said City in consequence of the
Ming of this permit. Additionally, the applicant understands and will comply
.,n all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
CAMPBELL, CA 950081; ' PHONE NO: (408) 370-0287
BUILDING PERMIT INFO: BLDG ELECT r PLUMB r
MECH r RESIDENTIAL (- COMMERCIAL r
JOB DESCRIPTION: STE 750 - 1300SQFT DEMO SPACE. DEMO UNDER GRID
WALLS STANDARDIZE SWITCHING, COMMERCIAL OFFICE
Sq. Ft Floor Area: Valuation: $32500
APN Number: 36901028.750 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued byr'' }� 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. 1 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or
Date:
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
ARCHITECT'S DECLARATION
I understand my plans shall he used as public records.
Licensed Professional
CI
CITY OF CUPERTINO
DEMO
CUPERTINO PE IT APPLICATION FORM
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APN# Date:
t
Building Address:
S C v/
Mailing Address (if different from building address):
Owner's Name: Phone:
•vo
Contractor: Phone :(!�/e 3 P00
Fax:
Contractor License #: 8 40YOSO
Cupertino Business License #: 8,7,0p
Co ct: Phone'
F ax/e-mail:
Residential ❑ Sq Footage Commercial Sq Footage /
Job Description: /200 d SPlke, MD U'`-' 6 e(-P
9 e
Valuation:V
Project Size: Counter Express [-, Standard ❑ Large ❑ Major ❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMORES Demo-Residential B 1SFDWL-DEM
1DEMOPRES Pool Demo Residential B 1SFP00L-DEM
1BCBSC Cal Bldg Standards B ALL PERMIT
Commission Fee TYPES
1BSEISMICRE Seismic Residential B
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Revised 12/06/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERT i ® Fax: 408-777-3333
CONTRACTOR SUBCONTRACTOR LIST
JOB ADDRESS: n [110 PERMIT#
OWNER'S NAME: /J 56"04 PHONE# —/
GENERAL CONTRACTOR: 46 J at) BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCON'T'RAC'T'OR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
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*Date
Owner/Contractor Signature
DEMOLITION
_ CITY OF CUPERTINO j
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20400 stvns crk blvd.#750 DATE: 01/11/2011 REVIEWED BY: bobs.
i
APN: BP#: `VALUATION: 1$32,500
YPERMIT TYPE: Demolition Permit
PL.4N Cl1ECK TYPE:
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1COMMLDE i
WORK demo commercial offices ace non structural
SCOPE
FEE ID FLR AREA
s.f.
1 DEMOCOM 1,300
Xk:h. Plan Check Plrrnrb. Plurr Chock Elec,Plan Clfcck
11-fec.-lr. Permit I ce: Plainh. Pemrit l%cc: Eke. Permit
011er A9ech, lnsp. El--L- Other Phnrtlr hisp. Li 011rer Elec.Insp.
AIcch. laNp.Fee: I Plronh. lisp. Fee: Dec. Irrsp,Fce
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS ('Fee Resolution 09-051 E f 7/1/10,) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Si ppl. PC'Fee
i
Plrmrb./111ech./Elec Plaii, Check:
Permit Fee: $507.00
Suppl. Insp. Fee.-O Reg. 0 OT 0.0 hrs $0.00
Plruub./111ech./Elec Unit Fee:
PlurnhJrllech,/Elec:Pe;rnrit Fecr:
Conslruciion Tax
Flcouslic al R(wielb'Fec:
Ifork Ifilhoui Perrarii?
Plainfing Fees;
Trin,el Docionenlution Fees:
Strong Motion Fee: IBSEISMICO $6.83 Select an Administrative Item
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Bldg Stds Commission Fee: 1BCBSC $2.00
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SUBTOTALS: $515.83 $0.00 TOTAL FEE: $515.83
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Revised: 12/07/2010