15110060CITY OF CUPERTINO BUILDINGPERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15110060
10050 N WOLFE RD CUPERTINO CA 95014 (316 20 086)
OWNER/BUILDER
OWNER'S NAME: I&G DIRECT REAL ESTATE 27 LP
DATE ISSUED: 05/16/2016
OWNER'S PHONE: 408-982-8433
PHONk NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:'
License Class Lic. #
Contractor OWNER/BUILDER Date
—BLDG _ELECT _PLUMB
MECH RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
UPGRADE NON-COMPLIANT(E) ACCESSIBLE
PARKING STALLS
I hereby affirm under penalty of perjury one of the following two declarations:
AND ACCESS AISLES; REPAVE 720 SF IN PARIK
ING LOT.
1. 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
performance of the work for which this permit is issued.
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
Sq. Ft Floor Area:
Valuation: $8000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that l have read this application and state that the above
APN Number:
Occupancye:
Type:
information is correct. I agree to comply with all city and county ordinances
316 20 086
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
PERMIT EXPIRES H WORK IS
NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE
OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED
INSPECTION.
Signature Date 5/16/2016
Issued by: AbbyA nde
Date: 05/16/2016
DECLARATION
OWNER -BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material
3eing installed. If a roof is
followingo reasons:
i I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove
all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
G I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code),
Date: 5/16/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "
" OR BETTER
s 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.
HAZARDOUS MATERIALS DISC
I have read the hazardous materials requirements ui
SURE
der Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 2
533, and 25534. I will
t! Section 3700 of the Labor Code, for the performance of the work for which this
maintain compliance with the Cupertino Municipal C
de, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I st
re or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or de
,es which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the B Area Air Qua
ty Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with ;the o Municip.9
Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety C cd ns 25505, 2
5533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized age
'Date: 5116/2016
APPLICANT CERTIFICATION
CONSTRUCTION E A
EN Y
certify that I' have read this application and state that the above information is
I hereby affirm that there a construction lending
ency for the performance
correct. I agree to comply with all city and county ordinances and state laws:
mit is issued (Sec. 3097,
of work's for which this per ,
iv G.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, co d expenses which may accrue against said City in
consequent f the ranting of this permit. Additionally, the applicant understands
ARC E T' ECL
and will c I w' a I non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public recon
Is.
Code, S n
'
ignat Date 5/1612016
Licensed
Professional
u
CONSTRUCTION PERMIT APP1,1CATION
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ft existing building(s). ildiing( ). LTernolititin perittlt is required prior to i-gsuartce of building
perrmit fbt-new building.
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farm if any Ha rdous Materials are beim used as part of this projei t.
COPY Of Off'IMmi tg approval Letter or Meeting with Planti prior to a
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CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
ADDRESS: 10050 N Wolfe Road DATE: 11/10/2015
APN: 316 20 086 BP#:
REVIEWED BY: A
'VALUATION: $
nold H.
,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE:. Tenant Improvement
0
PRIMARY
Commercial BuildingEIT
USE:
El
Suppl. PC Fee: (j) Reg. 0 OT
PENTAMATION
PERMIT TYPE:
1 B T�
WORK
PME Plan Check:
0
SCOPE
Permit Fee: Hourly Only? fYes 0 No
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEE 3 BP FEE H)
CONSTR. (s.f.)
B (Tenant Improvements) E, 11-B,111=B,IV,V-B 0 0 0
E
El -
TOTALS: 0 0 0
evh, .P w C`heck t,'w. lh, per{ i.. Elecflan Check
Lj I
. F�'F,. 1F3Sp}.. F';?: Ph?,
"rFb, In-4t—F"c'L'>
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, File, Sanitary Sewe° District, School
ll:..s..:..s ,.f- 1 Tl..,�., f;.„ ...._ 1......,.7-- fl.., .,U.,li..,iz,...�, iref r. nfins..n nilnhlo /Y n/7 — ../,Inn actir»nfo C'nntart tho Dat fnl^ / dd" '1 7HFn:
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? O Yes (E) No
0
hours Plan Check, Hourly
$143.00 ISTPLNCK
El
Suppl. PC Fee: (j) Reg. 0 OT
0
hrs
PME Plan Check:
0
Permit Fee: Hourly Only? fYes 0 No
0
Suppl. Insp. Feer Reg. Q OT
1 0
1 hrs
El
PME Unit Fee:
0
PME Permit Fee:
0
El
(. onstI7,{ction Tax
Adnfinistrative Fee:
El o
E
Work Without Permit? 0 Yes (j) No
0
Advanced Planning Fee.-
0
hours Inspections
$286.00 1STZNSP Inspection Hourly
El E)
N 0
Strong Motion Fee: IBSEISMICO
Select an Administrative
Item LZI
Bldg Stds Commission Fee: 1BCBSC
$1.00
SutTOTALS
$1.00
$429.00 TO EE
$430.00
Reprised: 07/02/2015