13010047CITY OF CilJP EIEB'll INO BUILDING NG PERMIT
BUILDING ADDRESS: 20686 STEVENS CREEK BLVD
CONTRACTOR: W.L. BUTLER PERMIT NO: 13010047
CONSTRUCTION, INC
OWNER'S NAME: BYER PROPERTIES LP
204 FRANKLIN ST DATE ISSUED: 03/13/2013
OWNER'S PHONE: 4152034625
REDWOOD CITY, CA 94063 PHONE NO: (650) 361-1270
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class Lic. 4 IRS-6-3J3
1PHI LZ COFFEE - DINT. T.R. FOR (N) CAFE/COFFEE SHOIP
y1
Contracto rAAL rJyl(GY� S'/` Date 03-13 -2-01`3
W/IN NEWLY CONSTRUCTED BLIlDG 11367 SQ FT
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 undcr.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 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.
APPLICANT CERTIFICATION
I certify that 1 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 pe Additionally, t plicant understands and will comply
with ail non-po- so rce regulati per a Cupertino Municipal Code, Section
9.18.
Signature Date
❑ �% 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)
1, 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 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 -point source regulations per the Cupertino Municipal Code, Section
9.18.
Sq. Ft Floor Area: 11 Valuation: $130000
11 APN Number: 35908020.20686 �� Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT T ISSUANCE OR
180 DAYS IFI[ OMIA5ZZA11i2IID IINSIFIECTION.
Date: 31 f 3 10
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 Applicant: 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 I store or handle hazardous
material. Additionally, should I use equipment or devices which emifhazardous
air contaminants as defined by the Bay Area Air Quality Management. District ➢
will maintain compliance with uper'ino icipal Code, Chapter 9.12 and
the Health &Safety Code, Se io 25505, 2 3 ,and 25534.
Owner or authorized agent: Date
CONSTRUCTION LENDING AGENCY
1 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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
CITY OF cCUPER71NO
FEE ESTIMATOR — BUILDING DlVffSION
ADDRESS: 20686 STEVENS CREEK BLVD DATE: 01/08/2013 REVIEWED BY: MELISSA
APN: 359-08-020.20686 BP#: / J *VALUATION: 1$130,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1A TI
USE: PERMIT TYPE:
WORK I PHILZ COFFEE - INT. T.I. FOR N CAFE/COFFEE SHOP W/IN NEWLY CONSTRUCTED BLDG
SCOPE 11367 SO FT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
F1LR AREA
PC FEES
FPCIFEEffD
HP FEES
BF FEE ID
A (Tenant Improvements)
II-B,III-B,IV,V-B
1,367
$2,297.69
1ATIPLNCK
$897.05
]ATHNSP
TOTALS:
1,367
$2,297.69
$897.05
MECH, HOURLY Yes (F) No
PLUMB, HOURLY Q Yes (F) No
ELEC, HOURLY ® Yes E) No
Ll<ech. Plan Check
Phanh. Plan Cheek
Elec. Plan Check
Llech, Perinil Fee:
Plumb. Permit Mize:
Flec. Permit Fee:
Otherhlech. Imp.Lj L_
Other Plumb Insp.
OtherEke. Insp. C
Afe& fu•sp. Fee:
Plutuh. Inrp. Fez:P_
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Metrirt_ otr ) Thoco foot aro haeod an tho nroliminare infnrmatinn available and are nnly an octimatn_ Cantart the Dent far addn'l info.
FEE ITEMS (Fee Resolution 11-053 Cff. 711112)
FEE
TY/1FEE
MISC ITEMS
Plan Check Fee:
$2,297.69
Select a Misc Bldg/Structure
or Element of a Building
u
Suppl. PC Fee: (E) Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$897.05
Suppl. Insp. Fee-.0 Reg. 0 OT
EEhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conslr notion _Tcrr.
A din inistrative.Fee:
E)
Work Without Permit? Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential C
Building or Structure
G
Travel Documentation, Fees:
Strong Motion Fee: 1BSEISMICO
$27.30
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$6.00
SUBTOTALS:
$3,228.04
$0.00
TOTAL FEE:
$3,228.04
Revised: 10/01/2012