10070061CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10123 N WOLFE RD FC14 CONTRACTOR: MG/SOMA CONSULTING PERMIT NO: 10070061
INC
OWNER'S NAME: VALLCO SHOPPING CENTER ( 2535 W WINTON AVE STE 4G I DATE ISSUED: 09/24/2010 1
OWNER'S PHONE: 4087773081 1 HAYWARD, CA 94545 1 PHONE NO: (510) 781-0500
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 11 ,�— 9 Lia #
Contractor A ,&,�y(� y�y yfr 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 corder 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
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
indemnify an eep harmless the City of Cupertino against liabilities, judgments,
costs, a expense which may accrue against said City in consequence of the
granti of this pe 't. Additionally, the applicant understands and will comply
W. al non -point so rce regulations r t e Cupertino Municipal Code, Section
9.18. a o
Signature Date T %J
❑ OWNER -BUILDER DECLARATION
I 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm corder penalty of perjury one of the following three
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.
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, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
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, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature,
Date
BUILDING PERMIT INFO: BLDG r- ELECT F PLUMB
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: FOOD COURT #14(360 GOURMET BURRITO);ADD
KITCHEN
HOOD & NON-STRUCTURAL,DEMISING WALL.ADDING
ELECTRICAL WORK TO PROVIDE POWER FOR EQUIPMENT;NO
Sq. Ft Floor Area: Valuation: $52000
APN Number: 31620100.FC14 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date: -2 c r 6
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
I have read the hazardous materials requirements corder Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and tire Health &
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additimrall should I use equipment or devices which emit hazardous air
cmrta 'ants as defined by the Bay Area Air Quality Management District I will
ma' ain co liance wi i th upertino Municipal Code, Chapter 9.12 and the
III & Sa ty Code, ions 25505, 25533, and 25534.
caner or a lior' d a ent:
\ y1 Date: lj(J
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
F&A- 72 FEE ESTIMATOR — BUILDING DIVISION
r
ADDRESS:
DATE:
QTY
REVIEWED BY:
BP FEES
APN:
BP#:
*VALUATION: 1$52,000
PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE:
Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Tt?TIL
FL0OR ,4RE,1
APPLICATION 1R3SFDADD/REM
TYPE:
1
W
Other Appliance/Equip
PLO
o�
1BAPPLOT
4
U
$252
APPLIANCE / EQUIP TYPE
CAPACITY
FEE ID
QTY
Plon ("heck Fce:
BP FEES
Hood, Mech. Exhaust
1MCHOOD
1
PME Plan Check:
$126
Refrigeration Unit
1MCRAA
1
$126
Other Appliance/Equip
$504.00
1BAPPLOT
4
$252
#tott;;ticcrr �cr-ietil cre:
TOTALS:
Travel Documentation Fee: ITUVDOC
$504.00
`iirrms, ii'/(atoll Feer:
Mech. Plan Check0.0 hrs $0.00
Mech. Permit Fee: IMPERMIT
Other Mech. Insp. 0.0 hrs $42.00
Pl/onb. N(w 01("'k
phl o ), Peron/ Fco:
Oiher Plww6 n,ap.
l�l<-c. Pko)i Chcclr
Elec. Pci laii Fcc:
CJrttar (Yc�t. hnq��.
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 into.
FEE ITEMS (Fee Resolution 09-051 E f 711109)
FEE
QTY/FEE
MISC ITEMS
Plon ("heck Fce:
S'u1�pl. PC Fee
PME Plan Check:
$0.00
,�`illp/7l, 11LS/t f'C('
PME Unit Fee:
$504.00
PME Permit Fee:
$42.00
#tott;;ticcrr �cr-ietil cre:
h1(11whIg Fees:
Travel Documentation Fee: ITUVDOC
$42.00
`iirrms, ii'/(atoll Feer:
3.0 hrs Standard Hourly Rate
$378.00
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS: '
$591.001
$378.00 TOTAL FEE:
$969.00
Revised: 6/30/2010