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15100156CITY OF CUPERTINO BUILD1114G PERMIT BUILDING ADDRESS: 10050 N WOLFE RD CONTRACTOR: i C & J CONTRACTING INC PERMIT NO: 15100156 OWNER'S NAME: I&G DIRECT REAL ESTATE 27 LP 331 COMMERCIALC ST DATE ISSUED: 10/20/2015 OWNER'S PHONE: 4089288433 SAN JOSE, CA 5112 PHONE NO: (408)374-6025 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL License Class Lic. # P �` RICOH - T.I. TO ACCESSIBILITYIUPGRADES(OF ONE (E) RESTROOM ON 2ND FLR FOR TWO TOTAL RESTROOMS) - b Contractor Date 114 S.F. I hereby affirm that I am licensed tfuder 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: t I have and will maintain a certificate of consent to self -insure for Worker's Sq. Ft Floor Area: Valuation: $21500 Compensation, as provided for by Section 3700 of the Labor Code, for the APN Number: 3620086.00 Occupancy Type: 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. PERMI EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is WITHI I, 180 DAYS OF PERMIT ISSUANCE OR correct. I agree to comply with all city and county ordinances and state laws relating 18 ED INSPECTION. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ;s7sued 12_ indemnify and keep harmless the City of Cupertino against liabilities, jud b ; Date: � O � costs, and expenses which may accrue against said City in consequence of the granting of tilis permit. Addit4linally, the applicant understands and will comply with all non- i sou regulatMpe-rtino Municipal Code, Section 9.18. RE -ROOFS: Signature LDate % Z ��' All roofs shall belinspected 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 App icant: Dater 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 t. 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) HAZARDOUS MATERIALS DISCLOSURE 2. I, as owner of the property, am exclusively contracting with licensed contractors to I have read the I azardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Healt & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty f perjury one the following three declarations: Safety Code, Sec on ashould I store or handle hazardous material. ' 25532() 1. I have and will maintain a Certificate of Consent to self -insure for Worker's e Additionally, shouldl I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the performance of the work for which this permit is issued. Health & Safety Code.Sections 25505, 25533, and 25534. 2. 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 w er autho permit is issued. Date: 3. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name ' revoked. Lender's Addre�s APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my dans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMCNT - SUILDlDIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-8255 CUPERTINO (408) 777-3-228 - FAX £408,1, 777.<3,333 LJ REVI.'SjQ\.,.;DEFFRRED ORK' j1NAL ft,,B0v:IJT 9 MtW( F wnk;SCt r-, N VNI F NAkf! I & 13, DIRL-'.CT REAL E-Sl*Al'-,27 . . ..... MOM- f�ld��AUDEAUX@ IVERROCKREG. 'ONO N kQ HO ft�'W^ 30'A �—ll I IT EAUX GOUDEAUXOPIVERROCKREG-, A Ok ........... . . .......... . ..... . . ..... CUPER TNOX CA 5&314 rRX As, tt0 rOP, MANI' rlCWEX 0'-K*FT4ACV0R NAMIE VERN PITTS IJCRNSr• TYPE 6 7 UNANT 7697 & ING, Ir . . ........... . ...... ............ . 331 GOMMERICIALST 0;1`Y. 59AIll,i'lP SAlii J0SE,l,'Aej5l'l2 406,992,1073 NAME KELI Y A SHArox CP -1062 STUDIOGARGIlITECTSWC, SIRkA�"ANAM;SS 299BAS8E-I-S-T,4250 . . . . ..................... . ...... ....... ... .M<.,83 i, ND M:St:ROYTDN OF WORK UPRRADE "0 EXl$-'T1kj NON-COMH1 fANFACCES1 ---if P" CORF' IT!- - ) �H.3 b )ON (YbOR�', I,STALL jN, T01t;E; k pt _LE -ombbolls-rac' & R&AIC1,VE �E,l TOR ET PART;TION,5 I S HMIT 184,woR ' ' - "RRY . ...... . ..........GV ?1REVIOVE R USE d0i'�) K)N, P46VIM-11" A— 8,'(D IMPLY WIT, ACCESSIBILITY NIC)UNTErl ONT k 0 TH 8 E) 01 L E T Y WHFfRF- RY N i i"r I I r, TOIL5T CORE VALUVfION. (S) ........... . . . . ................. -Tr TV I tt--,T 14 SF 1 NEI 1R 4 F it= A Wm"m . ....... 114 2z - MRS MMINt AREA RENUME ;�i;l I '- WNA)u- A T .. . .. ....... .. ..... ... Wy s is , I ,LkS -ANNiNt; ANN- TIN NO by Ey sigmaure, im"ow, 1 ccni'�t 41 �a t.� OV;ncl it W Ilmicle, s ti -incl it ;,4(7urnmir oeiti 0rdi:vinVu,,. and lumi rela+le to,,1�6 k �� go -nslnjm� on I mpg�sal.-,five,� -uve of A, svu- pri.ca, -a"t I �-:k ,;JCis Now SFD or MukifatrldY kkvfijqp, ApplyfbIr dernolifion permit fbi. 'I -zg building0s]), Demolition pemiit is requiredprior to issivance,ifld permit ffir nets building, bwiing ExpRrLss BldgsProvide if cGlTlpk'W'd STANDM 1'o;rrft if ally Hamardous Material, as bein x used p n nftl il; pi- I g a, s a Capy of"Plamit, Approval Lew r or Mveting with Plantlirl, p .Si: i '— littald Bmuilding llerlinit ap I px2 ALUATION; 21 I Fgmc to mmply wi&h allar,tis ablu ioctal pr-mrzy for m-,;pcmion purpose& 0 MWIDING PLAN REVIM D PLANNING P1,AN "WIEW 0 rugutc wolms 0 FIRL DEPT El SANl-.1-AlkVW,-WFtt DIS-IAICT -81 4pp_201 j.do� ?vvi'sed 0,6,2V71" t CITY OF CUPERTI�I O FFF. F.CTTM A TnID — 72TTTT "TATd" "TA 7TcrTllxT ADDRESS: 10050 N WOLFE RD TYPE OF CONSTR. lAJ1V DATE: 10 20/2015 l REVIEWED BY: MELISSA Ila APN: 31620086 BP#: BP FEE ID `VALUATION: [$21,500 -1 II-B,111-B,IV,V-B 114 $2 097.00 1BTIPLNCK --PERMIT TYPE: Building Permit PLAN CHECK TY�E: Tenant Improvement USE: Commercial Building PENTAMATION Suppl. Insp. Feer Reg. 0 OT PERNIIT TYPE: 113 T� WORK RICOH - T.I. TO ONE E RESTROOM ON 2ND FLR FOk ACCESSIBILITY/UPGRADES(OF TWO SCOPE TOTAL RESTROOMS) - 114 S.F. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA sl PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 114 $2 097.00 1BTIPLNCK $588.00 IBTIINSP Permit Fee: $588.00 Suppl. Insp. Feer Reg. 0 OT 0,fl hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C. Ons't`!"2 edon Tax: t�C�777Zf71S'?`t"1Xtli%£' ['E'G: - - ®. Work. Without Permit? 0 Yes I No $0.00 TOTALS: 114 $2 097.00 1 if•e�l �r3£�trzta<�xtrctttr��r I�'c>e:>.�°; $588.00 Strong; Motion Fee: IBSEISMICO MECIi, HOURLYYep, No 4AWB, ITOURLY . a Ye EEE 3 HOUR[:Y ,Yes leciz. N •z Check 1'llinib. Platy ("fleck I'It<€. Nan C'htUk 1fe'l, f'e;zrtit Fee: E'I rml;. /'c J ;zztC'ce>.: 1 t'tc_ perms=! Fee. Other _446c,J 1`11 (1°herr 1111wlb imp"t1th�,' Alec. ftas/a. L F i.?<>ch. Irasr;. 1, vnz'9. Trtspee: t !e Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planni , Public Works, Fire, Sanitary Sewer District, School n7.Q/Pirt_ otr- )- Thaw foot nrn h—d — ihn _4 ...7.. -a , - /"--s7 n- C -- FEE - FEE ITEMS (Fee Resolution .11-033 ff 7/1/13) FEE QTY/FIEE MISC ITEMS Plan Check Fee: $2,097.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (E) Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $588.00 Suppl. Insp. Feer Reg. 0 OT 0,fl hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C. Ons't`!"2 edon Tax: t�C�777Zf71S'?`t"1Xtli%£' ['E'G: - - ®. Work. Without Permit? 0 Yes I No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure � 0 1 if•e�l �r3£�trzta<�xtrctttr��r I�'c>e:>.�°; Strong; Motion Fee: IBSEISMICO $6.02 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 SUBI'OTAb $2,692.02 $0. 0 TIfiAI.IT� $2,692.02 Revised: 10/01/2015