15100209CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19333 VALLCO PKWY
CONTRACTOR: DEVCON
PERMIT NO: 15100209
CONSTRUCTION INC
OWNER'S NAME:. CAMPUS HOLDINGS INC
690 GIBRALTAR DR
DATE ISSUED: 10/30/2015
O ER'S PHONE: 4083105791
MILPITAS, CA 95035
PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL Q
License Class ": Lic. # j e (r, 3
BUILDING C: INSTALLATION OF HIGH DENSITY STORAGE RACKS IN
Contractor .�?EVeC2 Date f Ci G Lt
ROOM C128 (30 L.F).
_5-
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 if is: in full force and effect.
I 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
ormance of the work for which this permit is issued.
I
Sq. Ft Floor Area:
Valuation: $6000
ave 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: 31620075.00
Occupancy Type:
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 laws
PERMIT EXPIRES IF WORK IS NOT STARTED
and state relating
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
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 Additionally,
Issued b �vi
permit. the applicant understands and will comply
Y� Date:
with all non -point rce regulations per the Cupertino Municipal Code, Section
9.18.
Signature /° Date fisc /,
RE -ROOFS:
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: '
I, as owner of the property, or my.employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
will do the work, and the structure is not intended or offered for sale (See. 7044,
Business & Professions Code) .
I, as owner of thp`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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations: ' �
I have andwillmaintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
a Air Quality Management District I
air contaminants as defined by the Bay 9-g
performance of the work for which this permit is issued.
will maintain compliance with the C r no Municipal Code, Chapter 9.12 and
l 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
the Health &Safety Code, Sectio , 2 25534.
Owner or authorized agent Date: S'� f
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,6f 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 lead 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
9.18.
Signature ' Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 19333 Vallco Parkway DATE: 10/26/2015 REVIEWED BY: Sean
APN: BP#:*VALUATION: 1$6,000
PERMIT TYPE: Building Permit PLAN CHECK T E: Alteration I Addition / Repair
PRIMARY Commercial Civil / Religious activities PENTAMATION
USE al Building in BQ zone? 0 Yes No PERMITT -PF, 1 GENCOM
WORK
SCOPE
l -le jt. PI"t?itl r't'(2:P'iv b. c'711Zt .C'£ l'11 C. I Cr rfllt F'ee:
04hei" 4,e IP. ftnj,J,
Inrr). Fee:
Other- Nwnt? bisp.
I'himb. Insp. Fee:
!JlF'eF' I:tec. 1J1 tit �.
Eh'-'. Insp. Fee.
lvul.L. lllls estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
nistl'irt. atr )_ Thoca foot nro hncad n» iha nraH-i.— it fn rwani-. hl., nwd n -1" n nofias.nfn j"—#-,# fl.n of 0 A— -.4,1" l i"fn
FEE ITEMS (Fee Resolution .11-053 E . 7/1/13
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
0 hours
$0.001
Plan Check, Hourly
1
Suppl. PC Fee: (j) Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.19 Reg. Q OT
Rflhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
A&'ntnisirc€th"e 1 ee:
0
Work Without Permit? O Yes No
$0.00
Advanced Planning Fee:
$0.00
= l.f. Storage Racks
$359.00 ISRACKS<=8 0-8' High
1 rccvel Doctrrnsrrftudon fees:
Strong Motion Fee: IBSEISMICO
$1.68
Select an Administrative
Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SrBTrAiy,_='
$2.68
$359.00
$361.68
Revised: 10/01/2015