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12100158CITY OF CU PIERTI NO BUILDING PERMIT BUILDING ADDRESS: 20330 STEVENS CREEK BLVD CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO; 12100158 WC OWNER'S NAME: SVF CUPERTINO CITY CENTER CORPORATI 690 GIBRALTAR DR DATE ISSUED: 11/27/2012 OWNER'S PHONE: 5108613299 MILPITAS, CA 95035 PHONE NO: (408)942 -8200 ❑ LICENSED CONTRACTOR'S DECLARATION � r License Class1 Lic. # 9,91 BUILDING PERMIT INFO. RLOC ELECT PLUMB ldilECh][ RESIDENTIAL COla4fPd[lEI3C1iAL L Contractor. (%�arJ� a- �p�3 Y Date �hapter I hereby affirm that I am licensed under the provisio JOB DESCRIPTION: APPLE- 2ND FLOOR ADD TWO SECURITY DOORS AT THE (commencing with Section 7000) of Division 3 of the Business & Professions WEST WING ON EXISTING OFFICE SPACE Code and that my license 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $50000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36901020.00 Occupancy Type: 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 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 PERMIT EXPIRES IF W®If X IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WII')L']I-I ffN 1180 DAYS OF PERMIT ISSUANCE CIE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source r gulat' s er the Cupertino Municipal Code, Section 9.18. Issued IDate:�i'2 (/ Signatu Date /✓ lY,, L ❑ OWNER - BUILDER DECLARATION RE- ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professions Code) Signature of Applicant: Date: 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, l shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ'any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, l become subject to the Worker's Compensation provisions of the Labor Code, I must Ow t: forthwith comply with such provisions or this permit shall be deemed revoked. Date: NSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Liccnscd Professional CUP Ed'1il Ifg0 I NEW CONSTRUCTION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 48 i 408 buildinq-(•t upertino.org El ADDITION it O X ; ! i � _.i PROJECT ADDRESS `' � APN' (,, ci 6 ,-� ''"� OWNER NAME PHONE E-MAIL t I STREET ADDRES CIT , STATE, ZIP FAX CONTr� ACT NAME °'"" PHO E-MAIL _ lo'l es �9 STREET ADDRESS Cl; STATE, ZIP FAX ®OWNER Q OWNER- BUILDER ® O)V11MRAGENT ® CONTRACTOR 0 CONTRACTOR AGENT © ARCHITECT DE.G.,, 0 DEVELOPER ® TENANT CONTRACTOR NAME 1 LICENSE NUMBER p/ LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL, STREET ADDRESS CITY, ST TEr -ZIP PHONE A CHITECTdENGINEER NAML LICENSE NUMBER BUS. LIC k COMPANY NAME STRE ADDRESS CITY, TATE,ZIP� PHONEY DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE 4 STORIES 916F- I 111— A #� USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NfiT pJ� 1, t (� y 'l 0 lith A,f Ne LJC if BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTA1, DECKIPORCH AREA GARAGE AREA: DETACH I []ATTACH DW ELLiNG UMTS: ZS A SECOND UNIT ® YES SECOND STORY Q YES BEING ADDED? ONO ADDITION? ENO PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNNG APPL » ®NO PLANNING APPROVAL. LETTER IS THE BLDG AN F1 -,-IS EICHLER HObEE? Q NO � .0 "� .EEIVED j3ME By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I h e read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I'agree to comply with all applicable local ordinances and state laws relating ing construe ' I authorize representatives of Cupertino to enter the ove -ide tified property for inspection purposes. Signature of'Applicant/Agent: =Date :: ,// SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for I�avE 'rHi•C(}U existing building(s). Demolition permit is required prior to issuance ofbuilding E[S[I..UIhGPL �N Ill'tEiV permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosuresTANT}ARIS form if any Hazardous Materials are being used as part of this project.�<�� c3 "LALS.rsEWAX�� PUBLIC gzts ��� _ Copy of Planning Approval Letter or Meeting with Planning prior to " ©���� ©�AIiLTiSDIT%Ga submittal of Building Permit application. >h 7 ® ENVIRONN: ENT�SL''XEALrfi _ °n :4 yl w' IM-N (CIfTY OF cCNF]ERTM FEE ESTIMATOR — BUILDRN G DIVRSRON imADDRESS: 20330 SCB DATE: 10/22/2012 REVIEWED BY: MENDEZ Perrrril Fc >e. APN: DP #: *VALUATION: 1$50,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: Pirin't . (u p. Fee: P]ENTAMATION 1GENCOM PERMIT TYPE: w®RK APPLE— 2ND FLOOR— ADD TWO SECURITY DOORS AT THE WEST WING ON EXISTING OFFICE SCOPE SPACE 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 based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7/1/12) 1V1ec:h. Plan ('heck TT -1-h. Plumb. Plan Cheek flec. Plan C: heck Perrrril Fc >e. Plurnh Permit Fee: F.lec. Permit Fee: Other Mech. Insp. 07her• Plumb Irlsp, =7- Other Eler.. Ixtp, Vech. Insp. Fee: Pirin't . (u p. Fee: Elec. Insp. Fee: 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 based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7/1/12) 1F1F1E Q�TY/T1ElE MISC ITEMS Plan Check Fee: hourly Only? 0 Yes 0 No $0.00 hours Plan Check, Hourly $532.00 ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee :(F) Reg. Q OT 0.0 11 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (7onv1t- ucdion .Tux: ,4dininistrative Fee: 9 Work Without Permit? C) Yes 0 No $0.00 Advanced Plannin&jF I $0.00 hours Inspections $665.00 ISTINSP Inspection, Hourly T rm,el Doetrinentution Fees: Strong Motion Fee: IBSEISMICO $10.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $12.50 $1,197.00 TOTAL FEE: $1,209.50 Revised: 10/01/2012 CUTE FAT INO* ( (1> \ I I. •� ( I (1> I � ti I li. ( (U \ I I° •� ( I (1) I't I I ti I Bulifling Department City Of Cupertino 10300 Tone Avenue Cupertino, CA 95014 -3255 Telephone: 405- 777 -3225 Fax: 405- 777 -3333 JOB ADDRESS: YF® . QQl &k�-Z PERMIT # OWNER'S NAME: o PHONE # ° ° J-9V� GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: 0 0 laPa CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING (FINAL OR (FINAL OCCUPANCY INSPECTION(S) WILL EL SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ]I am not using any subcontractors: Signature Pllease check applicable subcontractors and complete the ffeflovying inffermz ion: Date c9 0//3 �/d ® ne ontractor Signature ate SUBCONTRACTOR BUSINESS NAME BUSINESS LE CIENSlE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 0//3 �/d ® ne ontractor Signature ate