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10080097CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20400 STEVENS CREEK BLVD STE 600 CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 10080097 OWNER'S NAME: CUPERTINO CITY CENTER 1042 HAMILTON CT DATE ISSUED: 08/26/2010 OWNER'S PHONE: 4088730121 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 ❑ LICENSED CONTRACTOR'S DECLARATION r r BLDG r '1`7 BUILDING PERMIT INFO: ELECT PLUMB License Class Lie. # q r r r � 'j l 1� Contractor / V�VLJ Date �- 1� `]o kd MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the. provisions of Chapter 9 JOB DESCRIPTION: TAKE DOWN 2 PARTITIONS & REPLACE MOVE OUTLETS (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 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: $8000 1 have and will maintain Worker's Compensation Insurance, as provided or by Section 3700 of the Labor Code, for the performance of the work for w APN Number: 36901028.600 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations the Cupertino Munici 1 Code, Section per Issued by: Date: 9.18. Signature Date 2 (� RE -ROOFS: ❑ OWNER -BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work, and the structure is not intended or offered for sale ($ec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self -insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & performance of the work for which this permit is issued. Safety Code, Section 25532(a) should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code, for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: Compensation laws of California. If, after making this certificate of exemption, I Date: 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. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address 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 ARCHITECT'S DECLARATION granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date wo CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: -VALUATION: 1$8,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: TOTAL FLOOR .4l LI. APPLICATION 1 B TI TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III B,IV,V-B 0 $0.00 $0.00 TOTALS: Fo $0.00 $0.00 MECHANICAL 0 Yes Q No PLUMBING Q Yes. Q No ELECTRICAL Q Yes Q No Wcch. Plan ('he(k Plemlh. Pion Check F7 1,/cc. Plan Chc.clr Fkcll. Perwil Pce: Numb. Pcr,+.ii Pee: Tle(. P,_ i mil (c�: Other Alerh, Insp.E1__L_ Other Plumb h"F Other h;lc c. Insp, Li Aloch. I11.1'p. I"eC' Phnnb. l sp. Pee: Elec. Insp. kce: NOTE: These fees are based on the vreliminary information available and are onlv an estimate. Contact the Devt for addn'l info. FEE ITEMS (Fee Resohrtion 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 57 l.f. $538.00 Interior Partitions IPARTICOMM Suppl. PC Fee: 0 Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 L.� # $759.00 New Door Opening IDOORNONST Non -Structural Permit Fee: $0.00 Suppl. Insp. Fee'O Reg. © OT 0.0 hrs $0.00 = $42.00 Electrical IBREMRECEP Recep/Switch/Outlets PME Unit Fee: $0.00 PME Permit Fee: $0.00 3 # $189.00 Mechanical IBAPPLOT Other Appliance/Equip Conso-fiction Tax Acoustical Fee: 0 Yes E) No $0.00 0 # $63.00 Electrical IBREMFIXT I Fixtures, Lighting 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure Q O i Travel Docuinentaliort Fues: Strong Motion Fee: IBSEISMICO $1.68 Select an Administrative Item Bldjz Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.68 $1,591.00 TOTAL FEE: 1 $1,593.68 Revised: 8/12/2010 U21l W0,4-C. UNREASONABLE HARDSHIP EXEMPTION FORM CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingtgcupertino.orq (For Tenant Imp'rovements'where the Cost of Construction does not exceed $128,410.90) ..TOTAL CONSTRUCTION COST (A 'J T'N following is a list of costs to provide access features in order to comply 100% with the current State Title-24 Disable Access Standards.(AII costs to be documented by actual bids or other information accepted by the Building Official.) Accessible Features Complies with If not, list required upgrades in order for Cost to make feature current standards? features to fully comply? fully accessible? 1. Path of travel to accessible entrance. `' L� z-�d�/,71 $ 2. Cost of providing a primary entrance. (Including but not limited to, thresholds, landings, door hardware, 00 1 ogZ-' a- i --5 `�'� $ �� max. door pull, etc. r'(J 6`V�`+ ���rM C'r`{..C. 3. Cost of providing the primary path of travel to the (� d specific area of alteration, structural repair, or �iil% $ addition. 4. Cost of providing accessible restroom facilities. y1►V5 J 691)LXV P) $ I & l D D -0J .FX li-WW 5. Cost of providing an accessible drinking fountain. (If j, r'* ® u A", OVA 6 IT, $ / r--h yV required or if a drinking fountain is provided.) _� D �yvv CJ 6. Cost of providing accessible public telephones (if $ provided) 1 7. Cost of providing other accessible features, including limited to, i x � ���� ?-co -re 1 $ but not parking, storage, alarms etc. TOTAL COST OF ACCESS FEATURES (B): S`✓� Has the same tenant performed work in the same tenants ace within the last three ears? OO�� V T Calculate (B / A) x 100% 2 % Des rilion o access f atures to e.prWJEJ�oyi���� `C7 I vt 7 /1 , S, - TOTAL COST OF PROPOSED UPGRADE f� $ ��v PERCENTAGE (20% minimum ex enditure is re uired) APPLICANT INFORMATION: I certify that the above noted information is t e and correct. Name (print): T aza LE26 I T1 Signature: C Date: Firm address: I � 6A%" 11112 f l(�,(�Q , lv'utle` V ,gyp Phone: yt- FOR DEPARTMENT`USE ONLY --- -- - •- - --- -- - -- ----- ❑ The above named project has been denied an unreasanal;�e hardship)Wmmption under 2007 CBC Section 1134B.2.1. O. The above named project has been grarited an unreasonable hardship exemption from the requirements of the State of Califomia CCR-Title 24 (Regulation for the Accommodation of the disabied) pursuant to 200Y CBC Section 1134B.2.1. HardshipEzemptionForm_2010.doc revised 04/12/10