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11020085 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:DEVCON PERMIT NO: 11020085 CONSTRUCTION INC OWNER'S NAME: LANE PARTNERS 690 GIBRALTAR DR DATE ISSUED:02/23/2011 OWNER'S PHONE: MILPITAS,CA 95035 PHONE NO:(408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class ,, Lic.4 l� Uc _3 IST-3RD FLOOR-- INTERIOR DEMO 91,000 SQ FT PARTITION,ASSOCIATED W/POWER/DATA OUTLETS, Contractor llC�� Qµ ➢ate Z- Z3 PLUMBING, EXISTING CEILING GRID,TILES, LIGHT 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. 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. Sq.Ft Floor Area: Valuation:$200000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work forwhi h APN Number:36901019.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue agams id City in consequence of the granting of this permit. Additionally,th pplic t understands and will comply Issue b -rte—✓`— Date: t= with all non-points a regulations the C ertino Municipal Code,Section 9.18. �� ( RE-ROOFS: Signature Date 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. ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Mo ement District I performance of the work for which this permit is issued. will maintain compliance with the Cuper ino Municipal de, hapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 5,25533,and 534. Section 3700 of the Labor Code,for the performance of the work for which this Z Z l Owner or authorized agent permit is issued. 1 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,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,l must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CITY OF CUPERTINO DEMO .PERMIT APPLICATION FORM CUPERTINO APN# Date: Building Address: 2- o -sco Mailing Address (if different from building address): Owner's Name: M c-v-V, J\A Phone: &S C) Contractor: Phone Fax: 2 Contractor License #: Cupertino Business License Contact: P h o n e: 1- 0 �-3 C,(> V C CJ C Fax/e-mail: Residential F] Sq Footage Commercial Sq Footage <"S_ octC4,01�, Job Description: Pe_,wo T' 1'�AJ-eln0,1._ o- V4-d-1/(qA/ (_s I P Valuation: ZOO/ Project Size: Counter Express ❑ Standard F-1 Large F] MaJorF] 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 IDEMOPRES Pool Demo Residential B 1SFP00L-DEM IBCBSC . Cal Bldg Standards B ALL PERMIT Commission Fee TYPES IBSEISMICRE Seismic Residential B Revised 12/06/10 DEMOLITION CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20300 stvns crk blvd. 1 st-3rd DATE: 02/23/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$200,000 PERMIT TYPE: Demolition Permit PLA A/CIIEC7< I'YPG: PRIMARY Commercial Building PENTAMATION 1COMMLDEM USE: PERMIT TYPE: a WORK demo comm. offices ace non structural. SCOPE FEE ID FLR AREA s.f. 1 DEMOCOM 91,000 ill<eclt. Playa(711cck Plumb. I'lcru Check Ple�c.Plop Chuck klech. Permit Fee., 1,111mh. Pennil 1 cO, flee. Pc niit Fec Olhw•Alech.hasp. Other Pl imb lisp. Other Elec.hasp, ticch.Insp.Fee: Phnub. hrsp. Pee: Glee Iazsp,Fee: NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS ('Fee Resolution 09-051 E , 7/1/10 FEE QTY/FEE MISC ITEMS Plan Check.Fee: Suppl. PC Fee i P/rnnh Alech./Flee Plait Check: Permit Fee: $8,097,00 Suppl. Insp. Fee'0 Reg. 0 OT T 0.0 hrs $0.00 Phtit?h.Alec;h,/Elec Urtil Fee: Phtnih,lkfech./Elec Permit Feer: ConsInIclion Tax Acoitslical Rcvie. Fee: I'Yorl,: YYilhocil Permit? Plallitin"; pores: Trmwl Docriiineniolioii Fees: Strong Motion Fee: IBSEISMICO $42.00 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $8,00 SUBTOTALS: $8,147.00 $0.00 TOTAL FEE: 1 $8,147.00 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 I Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR SUBCONTRACTOR LIST JOB ADDRESS: 0�0 0 Vw PERMIT# ✓ OWNER'S NAME: dnll��c,VL � - PHONE# 4 50 GENERAL CONTRACTOR: e°, I„ ( ►.� BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses worldng in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) 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: SUBCONTRACTOR 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 r 9 Owner/Contractor Sign tune Date i