13020005I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD I CONTRACTOR: GIDEL, AND KOCAL PERMIT NO: 13020005
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS
574 DIVISION ST I DATE ISSUED: 03/01/2013
OWNER'S PHONE: 4088730121 1 CAMPBELL, CA 95008 1 PHONE NO: (408) 370-0287 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class /
(/ Lic.9 `r1a_1 M
Contractor/Gk'C/��IW,4 Date` — 1— 1_3
1 hereby affirm that 1 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.
1 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 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 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. Additional plicant understands and will comply
with all non -point source re ions per th Cupertino Municipal Code, Section
9.18.
Sign re Date — 0 ' /3
❑ OWNER -BUILDER DECLARATION
hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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 (Sce.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).
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, 1 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.
Signature Date
BUILDING PERMIT INFO: BLDG ELECT r PLUMB
MECH r RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: SUITE 350 -T.1. FOR NEW PARTITIONS, DOORS &
RECONFIGURE (E) OFFICE SPACE WITH LIGHTING
FIXTURES AND HVAC MECHANICAL CHANGES
Sq. Ft Floor Area: I Valuation: $55600
APN Number: 36901028.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM ]LAS'S' CALLED INSPECTION.
Issued by: ��/`� �� 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 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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Ownor aut zed ag nt:
CONS UCTION 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 Ad
ARCHI'TECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profession
FM--7
CIT Y OF �CtUP ERTIIYO
FEE ESTIMATOR - BUILDING DEWSHON
OCCUPANCY 'TYPE:
20400 St. Creek Blvd.
IFILR AREA
(s.f.
DATE: 02/04/2013
REVREWEID BY: jsg
IlaADDRESS:
APN:
BP#:45
000 5
1,654
*VALUATION: 1$55,600
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Tenant Improvement
PRIMARY
USE: Commercial Building
$1,459.36
Suppl. Insp. Feer Reg. COT
Q,Q
PENTAMA'TION
PERMI'T'TYPE: 1BTI
W®RK Commercial TI new partitions, doors
reconfigure existing lights
and HVAC.
SCOPE
PME Permit Fee:
$0.00
OCCUPANCY 'TYPE:
TYPE OF
CONSTR.
IFILR AREA
(s.f.
PC (FEES
PC FEE ID
BP (FEES
3P FEE M
B (Tenant Improvements)
II-B,111-B,IV,V-B
1,654
$2,035.90
1BTIPLNCK
$1,459.36
1BTIINSP
EIC(. Insp. Fee:
$1,459.36
Suppl. Insp. Feer Reg. COT
Q,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee.-
ee.Work
WorkWithout Permit? 0 Yes (F) No
$0.00
TOTALS:
1,654
$2,035.90
Trm-el Documentation Tees:
$1,459.36
,I
MECH, HOURLY Yes (E) No
PLUMB, HOURLY Q Yes (E) No
ELEC, HOURLY 0 Yes (E) No
—_
;Meeh. i'lan Check
Phuub. Plan Cheek7_7
Elec. Plan Check
: fech. Permit Fee:
Plumb. Permil Fee:
Elec. Permit Fee:
Other Meeh. Insp.
Other Plumb Insp.
Other Elec. Insp.
Aleeh. Imp. Fee:
Phnnb. /nsp. Fe ..
EIC(. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (4e. Planning, Public Works, Eire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711112)
FEE
QTY/FEE
MISC U TEMS
Plan Check Fee:
$2,035.90
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. OT
Q,Q
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,459.36
Suppl. Insp. Feer Reg. COT
Q,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee.-
ee.Work
WorkWithout Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure O
G
Trm-el Documentation Tees:
Strong Motion Fee: IBSEISMICO
Bldg Stds Commission Fee: IBCBSC
$11.68
$3.00
Select an Administrative Item
SUBTOTALS:
$3,509.94
$0.00
TOTAL FEE:
$3,509.94
38
° Revised: 01/01/2013