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14090177CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14090177 10111 N FOOTHILL BLVD (342 32 070) SBI BUILDERS 1064 ALMARIDA DR SAN JOSE, CA 95128 OWNER'S NAME: FOOTHILL AUTO SERV & DETAIL INC DATE ISSUED: 01/04/2016 OWNER'S PHONE:. PHONE NO: 408-203-4397 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CONTRACTOR - GENERAL Lic. #860997 Contractor SBI BUILDERS Date 02/29/2016 —BLDG _ELECT —PLUMB I hereby affirm that T am licensed under the provisions of Chapter 9 (commencing MECH _ RESIDENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: LOT'S - CONSTRUCT (N) DETACHED OFFICE / WORK SPACE I hereby affirm under penalty of perjury one of the following two declarations: (452 S.F.) 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. REV # 1 - ALL BUILDINGS/OFFICES (14090172-14090182) - REVISE z 1 have and will maintain Worker's Compensation Insurance, as provided for by 'CEDAR SIDING TO FIBER CEMENT -ISSUED 8/11/16 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 Sq. Ft Floor Area: Valuation: $56500.00 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 APN Number: Occupancy Type: may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point 342 32 070 source regulations per the Cupertino ricipal Code, Section 9.18. SignatureDate PERMIT EXPIRES IF WORD IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER -BUILDER DECLARATION 180 DAYS FROM LAST GALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by: MELISS 1. I, as owner of the property, or my employees with wages as their sole Date: 01/04/201 compensation, will do the work, and the structure is not intended or offered for sale (See.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed RE -ROOFS: contractors to construct the project (See.7044, Business & Professions Code). 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 I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date: 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER permit is issued. 3. 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 HAZARDOUS MATERIALS DISCLOSURE Worker's Compensation laws of California._ If, after making this certificate of I have read `the hazardous materials requirements under Chapter 6.95 of the exemption, I become subject to the Worker's Compensation provisions of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous be deemed revoked.: material. Additionally, should I use equipment or devices which emit hazardous APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I 1 certify that I have read this application and state that the above information is will maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and correct. I agree to comply with all city and county ordinances and state laws the Health & Safety Code, Sections 25505, 25533, and 25534. relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree Owner or authorized agent: to save indemnify and keep harmless the City of Cupertino against liabilities, Date: judgments, costs, and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY consequence of the granting of this permit. Additionally, the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non -point source regulations per the Cupertino Municipal of work's for which this permit is issued (Sec. 3097, Civ C.) Code, Section 9.18. Lender's Name Lender's Address Signature Date ARCHITECT'S DECLARATION CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10111 N FOOTHILL BLVD CONTRACTOR: SBI BUILDERS INC PERMIT NO: 14090177 OWNER'S NAME: FOOTHILL AUTO SERV & DETAIL INC 1515 THE ALAMEDA STE 300 DATE ISSUED: 01/04/2016 OWNER'S PHONE: 4083994950 SAN JOSE, CA 95132 PHONE NO: (408) 549-1305 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL License Class LOT 3 - CONSTRUCT (N) DETACHED OFFICE / WORK Lic. #_ % SPACE Contractor AUd - 3S n,( Date (452 S.F.). 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 Sq. Ft Floor Area: Valuation: $56500 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. APN Number: 34232070.10111 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS OlYl LAST E-A ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the f granting of this permit. Additionally, the applicant understands and will com - Date: with all no p int source regulations per the Cupertino Municipal ode, Section 9.18. I q Signature J Date ) - OOFS: All roofs shall be inspec o any roofing in being installed. If a roof is installed without -first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by will maintain compliance with t Cupertino Municipal Code, Chapter 9.1 and the Health & Safety Code, Se '0 505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this y j D Owner or authorized agent: Date 7 / 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code; Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO IFM- I FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10121 N FOOTHILL BLVD LOT 3 DATE: 09/25/2014 REVIEWED BY: MELISSA PC FEE ED APN: 342 32 070 BP#: *VALUATION: 1$56,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? ® Yes (E) No PENTAMATION PERMIT TYPE: 1 BOFF WORK CONSTRUCT N OFFICE BLDGB / DETACHED WORK SPACE 452 S.F. SCOPE p 0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ED BP FEES BP FEE ID B (Offices) II-B,111-B,IV,V-B 452 $5,979.00 1B0PLNCK $1,824.00 IBOINSP Permit Fee: $1,824.00 Suppl. Insp. Fee:Q Reg. Q OT p 0 lirs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXCF--] $1,306.28 11minisirative. 1--ee.: O Work Without Permit? © Yes (D No $0.00 TOTALS: 452 $5,979.00 71,avel Documentation k'ees: $1,824.00 Strong Motion Fee: 1BSEISMICo 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 oreliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E�' 711/13) irebi. Pion tnztt", i ;rii>. Plaa C. r,eK MISC ITEMS :l tech. Permit I•ee: Plrm b. Permit l=ee: I lec. P;,rniit F, h, Insp. Other I'lumb Insp,Li 1 Other Elec. . Invp. _ �r;z Fey: Phanb. Insp. Fee: Elea liup. I ee: 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 oreliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E�' 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,979.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT0.0 firs $0.00 PME Plan Check: $0.00 Permit Fee: $1,824.00 Suppl. Insp. Fee:Q Reg. Q OT p 0 lirs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXCF--] $1,306.28 11minisirative. 1--ee.: O Work Without Permit? © Yes (D No $0.00 Advanced Planning IPLLONGC $131.08 Select a Non -Residential 0 Building or Structure 0 i 71,avel Documentation k'ees: Strong Motion Fee: 1BSEISMICo $15.82 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $9,259.18 $0.00 TOTAL FEE: $9,259.18 Revised: 08/20/2014