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15050032CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20823 STEVENS CREEK BLVD CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 15050032 OWNER'S NAME: STEVENS CREEK OFFICE CENTER ASSOC 1460 O'BRIEN DR DATE ISSUED: 05/06/2015 OWNER'S PHONE: 6507841440 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] --/Z Z/ APPLE - STRUCTURAL REINFORCEMENT FOR FUTURE License Class Lic. # �U MECHANICAL UNITS (FOR PERMIT # 15040135) / Contractor O% O 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 C mpensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $12000 e. formance 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 APN Number: 32632053.20823 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. I agree to comply with all city and county ordinances and state laws relating WITfIIN 180 DA T 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 DAY CALLED INSPEC IO . 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 comp Date: / with all non -point source regulations per the Cupertino Municipal Code, Sectio 918. RE -ROOFS: Signature-� Date_75 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I 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 I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I 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 Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this ��—�- /61 S Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I 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 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, ARCHITECT'S DECLARATION 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 918. Signature Date CUPERTINO V1 NF.w rnw.4TRur -rTCIN CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228• FAX (408) 777-3333 • building(cDcuoertino.org I AT)T)TTTnN F7 AT.TFRATTnN/-FT n RFVTCTnN/T)FFFRRF.T) nRT(-.MAT. P7PMTT ii PROJECT AIS S /AP N .32 2 G S �7,. ` L p 1 'Z -3 `// Oe -r hA(7 a- (J OWNER N ( �! ��• - ��CJZI l STREET ADDRESS - CITY, STATE, ZIP FAX U / CCIVqT N 1 5�L �"(-G PH 11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION I - ADDRESS: 20823 STEVENS CREEK BLVD DATE: 05/06/2015 REVIEWED BY: MELISSA APN: 32632053.20823 BP#: 50500C3� *VALUATION: $12,000 ^PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building Civil / Religious activities inBQzone? Yes Q No PENTAMATION PERMIT TYPE: 1GENC0 WORK APPLE -STRUCTURAL REINFORCEMENT FOR FUTURE MECHANICAL UNITS FOR PERMIT # SCOPE 15040135) NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Tflorks, Fire, Sanitary Server District, School District, etc.). These fees are based on the prelindnar information available and are only an estimate. Contact the Det for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 0 hours $143.00 . Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Q Reg. Q OT —0. 0 hrs $0.00 PME Plan Check: $0.00 Pennit Fee: Hourly Only? Q Yes Q No $0.00 Supp/. Insp. Fee -.(D Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Pennit Fee: $0.00 Construction Tax: 1BCONSTAYC $0.00 0 Work Without Pennit? 0 Yes) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential 0 Building or Structure 0 e :t rr.-ci.L)t,c=rr,re� r tifsn 1-:e(?S Strong Motion Fee: IBSEISMICO $3.36 3.0 his $429.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS k $4.36, $5 72.00 TOTAL FEE $576.36 Revised: 04/01/2015