12110113BUILDING ADDRESS: 20540 STEVENS CREEK BLVD CONTRACTOR: = PERMIT NO: 12110113
OWNER'S NAME: MARDESICH CO CROSSROADS LLC
S K, t / 1 DATE ISSUED: 01/02/2013
I OWNER'S PHONE: 4082553042 II . 1 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class - C--
I Lic. # .S 1 �3�
Contractor ,C LAeQyti ,rAC.. Dater Z_ % -
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
performance of the work for which this permit is issued.
I have and wil I 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.
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
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- poin sour regulatio s per. the Cupertino Municipal Code, Section
9.18.
Signature Date I -Z- ► 3
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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) ,
i, as.owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
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
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
Section 3700 of the Labor Code, for the performance of the work for which this
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 of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify. that l 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
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.
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
SALO SA1LON- COMMERCIAL 7IENAN7 IIM]PROVEIy[i ]EN7
(5424
SQ F7)
Sq. Ft Floor Area: Valuation: $700000
APN Number: 35908018.20540 Occupancy Type:
]PE]I81Yi[17 (EXPIRES IF WORK IS N07 STARTED
W17HII 1180 DAYS OIF PERMIT ISSUANCE OR
180 IlDA O�I,�yhI�LAST CALLED )< iSP EcC7RON.
Issued by: V L Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of App
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. ➢ will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should ➢ store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Mu cipal Code, Chapter 9.12 and
s$ the Health & Safety Code, Section05, 25533,Ind 25534.
Owner or authorized agent:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCH➢TECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
cCRTY OF CN]FERUNO
FEE IEMMATOR — IBUI[ILMN G MVISRON
iaADDRESS:
20540 Stevens Creek Blvd
DATE: 11119/2012
REVIEWEDBY: Sean
APN:
1BP#: MIJ1011 :�)
"VALUATION:
1$700,000
'PERMIT TYPE:. Building Permit
P1LAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
=?P
I�TAMIATION 1B TI
RMIIT TYPE:
WORK
Tenant improvement for Sala Salon 5424 sq ft .
SCOPE
OCCUPANCY TYPE:
TYPE OlF
CONS' t 1[i.
1LIIi AREA
s.f
PC FEES
PC FEE IIIID
BP ]FEES
FBPFEE IIIID
B (Tenant Improvements)
II-B,III-B,IV,V-B
5,424
$2,295.00
1BTIPLNCK
$4,335.75
1BTYArSP
707A1LS:
5,424
$2,295.00
$4,335.75
vI�//IIEC}IIl[, IEII0 R1L�C Yes No
' PLUMB, HOURLY, I� Yes (D No
1E111LIEC, HOURLY Q Yes � No
CI:2i.tu
P11"Woh. ! hvi (.leek
:aim, 0,"n. )"""'.:
:�4CC;'t. 17err,:t( 1'ee:
Ffwnol. Fc'�'?7ilt 1`ee:
Liles, llP!wliz I°c'c:
hteh Insp. Fee:
Float(, imp. F m,:
Elea ;lt,:i. fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, ,Sanitary ,Sewer District, SC1}001
District, etc). These fees are based on the Dreliminary information available and are onlv an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 1.1-053 E . 7,/1/12�
FEE
QT'Y/1F1ElE
MIIISC I[T'lEMS
Plan Check Fee:
$2,295.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. C OT
Q.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$4,335.75
Suppl. Insp. Fee-.C) Reg. C) OT
0.0 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C()ti.4Iraction IlZI":
AGlirin6:iirtflit,eFee:
(`
Work Without Permit? 0 Yes No
$0.00
Advanced Planning,Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
1 "avel Documentafhm 11`et,s,
Strong Motion Fee: IBSEISHICO
$147.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$28.00
SUBTOTALS:
$6,805.75
$0.00
_TOTAL FEE:$6,805.75
Revised: 10/01/2012