10070100I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10123 N WOLFE RD
OWNER'S NAME: VALLCO SHOPPING MALL
OWNER'S PHONE: 4087773081
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor Date
1 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.
1 hereby affirm under penalty of perjury one of the following two 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.
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 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 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,
Ism
OWNER -BUILDER DECLARATION
k . eby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code). 4le—
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.
1 certify that in the performance of the work for which this permit is issued, 1 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 rev oked.P�
APPLICANT CERTIFICATION
I certify that 1 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
grating of this permit. Additionally, the applicant understands and will comply
!I non -point source r latio per the Cupertino Municip 1 Cod ,Section
5.
Signature —
CON
Date
TRACTOR: VALLCO SHOPPING MALL PERMIT NO: 10070100
10123 N WOLFE RD STE 1095 DATE ISSUED: 08/31/2010
CUP ?RTINO, CA 950141-: PHONE NO:
BUI DING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH'r RESIDENTIAL COMMERCIAL r
JOB DESCRIPTION: BY AMC THEATRE - STAIRS & HANDRAIL @ EXISTING
UTILITY AREA
Sq. Ft Floor Area: Valuation: S4500
APN Number: 3162008LMALL 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: 0
RE -ROOFS:
All n rofs shall be inspected prior to any roofing material being installed. If a roof is
insta led without first obtaining an inspection, 1 agree to remove all new materials for
inspt ction.
Sign,dure of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
i
1 hai a read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety'' Code, Sections 25505, 25533, and 25534. I will maintain
coml diance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safel y Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
mail tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Se 'ons 25505, 25533, and 25534.
Owne th r e t;:
Date:. vl 1
CONSTRUCTION LENDING AGENCY
I her :by affirm that there is a construction lending agency for the performance of work's
for m hich this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I unc erstand my plans shall be used as public records.
Lice rsed Professional
PERMIT EXPIRES IF WORK IS NOT STARTED
'WITHIN 180 DAYS OF PERMIT ISSUANCE OR
-180 DAYS FROM LAST CALLED INSPECTION.
Issued by:: /` Date: 0
RE -ROOFS:
All n rofs shall be inspected prior to any roofing material being installed. If a roof is
insta led without first obtaining an inspection, 1 agree to remove all new materials for
inspt ction.
Sign,dure of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
i
1 hai a read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety'' Code, Sections 25505, 25533, and 25534. I will maintain
coml diance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safel y Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
mail tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Se 'ons 25505, 25533, and 25534.
Owne th r e t;:
Date:. vl 1
CONSTRUCTION LENDING AGENCY
I her :by affirm that there is a construction lending agency for the performance of work's
for m hich this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I unc erstand my plans shall be used as public records.
Lice rsed Professional
CITY OF CUPERTINO
r. FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
,
DATE:
REVIEWED BY:
APN:
BP#: 0 `7 �'% l
kVALUATION: 1$16,220
YPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
COVER THE OUNTER? 0 Yes
0 No
APPLICATION 1 R3SFDADD/REM
TYPE:
MECHANICAL 0 Yes 0 No
PLUMBING 0 Yes
0 No
ELECTRICAL 0 Yes 0 No
�W
a.
cc
U
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s .ft.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
A (Tenant Improvements)
II-B,III-B,IV,V-B
0
$0.00
$0.00
TOTALS:
0
$0.00
$0.00
A,lcc:h, Platl C /wcl,
FBCh. Pcrmif 11LR"
U/hc r 'kh, h, hish,
Plwnh, Plao Check
Phwp b, l' eoni7Fce,-
Clthcr Phuilh. hisp,
L7ce. Mon Ot ck
E'.lC(`, h(1!'Rt(l t`cc,
0/hcr Elec. hzsp,
NOTE: These fees are Based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7 1;'09)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$1,457.00
Stairs
]STAIRS (Specify # of of Stairs)
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:G Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C'
-FT
Acoustical Fee: 0 Yes F) No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
Trvvvl Clracrrnrcrf/Iuiiolr Fc'/rs:
Strong Motion Fee: IBSEISMICR
$1.62
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.62
$1,457.00
TOTAL FEE:
1 $1,459.62
Revised: 6/30/2010