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15070140CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10601 S DE ANZA BLVD CONTRACTOR: GROUP ONE PERMIT NO: 15070140 CONSTRUCTION INC OWNER'S NAME: CAMPBELL, CA 95008 PHONE NO: (408) 378-8900 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 0 License Class_ o S DE ANZA PROFESSIONAL CENTER - T.I. TO RENOVATE Lic. # EXTERIOR ONLY - FRONT BLDG - REPLACEMENT OF 25 Contractor 4yeLy'vae; ew- 5q Date 00.x. 6_ DOORS, 84 WINDOWS, ROOF SCREENS, 28 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 Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $300000 erformance 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. APN Number: 35918061.00 Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITfIIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence o Z� J� granting of this permit. Additionally, the applicant understands and will co _ Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �g .�. �� 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 I hereby affirm that I 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 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) 1, 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, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this e Date: permit is issued. Owner or authorized agent: 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 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 CUPERTINO RM -7 FEE ESTIMATOR — BUILDING DIVISION Other Hech, Irrsp. 14ech. 112.sh. Fee.. Other Plumb Insp. Phanh. lrrsp. Fee: Other Liles. Ins.,. Elec. Insp. hie: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ►_ These fees are ha.ced an the nreliminary fnforsnadan availahle and are nnly an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) ADDRESS: 10601 S DE ANZA BLVD DATE: 07/20/2015 REVIEWED BY: MELISSA 1191 APN: 35918 061 BP#: *VALUATION: 1$300,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: hrs PENTAMATION 1 GEN PERMIT TYPE: A WORK DE ANZA PROFESSIONAL CENTER - T.I. TO RENOVATE EXTERIOR ONLY - FRONT BLDG - SCOPE REPLACEMENT OF 25 DOORS, 84 WINDOWS, ROOF SCREENS, 28 CANOPIES/AWNINGS & p Other Hech, Irrsp. 14ech. 112.sh. Fee.. Other Plumb Insp. Phanh. lrrsp. Fee: Other Liles. Ins.,. Elec. Insp. hie: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ►_ These fees are ha.ced an the nreliminary fnforsnadan availahle and are nnly an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS ,tech. Plan (.'{reek $0.00 © hours $858.00 Plan Check, Hourly ISTPLNCK Phinrh. Plug Check Suppl. PC Fee: Reg. 0 OT0.0 hrs hlec..Plan Chedr $0.00 Li09 # $2,290.00 Window / Sliding Glass Door 1WINREP Replacement Afech. Per•ntit fee: $0.00 Suppl. Insp. Fee. -(q Reg. 0 OT Plrvnth. Permit Fee: hrs $0.00 KleePermit Fee: Other Hech, Irrsp. 14ech. 112.sh. Fee.. Other Plumb Insp. Phanh. lrrsp. Fee: Other Liles. Ins.,. Elec. Insp. hie: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ►_ These fees are ha.ced an the nreliminary fnforsnadan availahle and are nnly an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 © hours $858.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Li09 # $2,290.00 Window / Sliding Glass Door 1WINREP Replacement Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee. -(q Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constrctc•tion Tax A,hninisirative Fee: L 0 E) Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 i TrC'We?l Docurne ivalion T'e>eS: Strong Motion Fee: IBSEISMICO $84.00 6.0 hrs $858.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $12.00 ' SUBTOTALS';:.= $96.00 $4,006.00 TOTAL T EE $4,102.00 Revised: 07/02/2015