11050119CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20735 STE'VENS CREEK BLVD I CONT ALCTOR: MALONEY AND BELL I PERMIT NO: 110501 19
OWNER'S NAME: HK INVESTMENTS I 11390 SUNRISE-' GOLD CIRCLE #700 1 DA-rE ISSUED: 07/05/2011
I OWNER'S PHONE: 7078870383 I RANCI-IO CORDOVA, CA 95742 PHONE NO: (916)635-7600
LICENSED CONTRACTOR'S DECLARATION
License Class Lica#
Contractor ap Date -7
1 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
I I have and will maintain a certificate of consent to self -insure for W'orker's
Compensation, as provided for by Section 3700 of the Labor Codc, fix the
performance of the work for which this permit is issued.
z 1 have and will maintain Worker's Compensation Insurance, as provided or by
Section 3700 of the Labor Code, for the performance of the work for c} (iis
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 -point source u ions per upertino Municipal Code, Section 9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
-reby affirm that 1 am exempt from the Contractor's License Law for one of
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 ofii:red lir
safe (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).
hereby affirm under penalty of perjury one of the following three declarations:
1 have and will maintain a Certificate of Consent to sell' 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.
2 1 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.
3 1 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, 1
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall he 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
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
SIT D-GAMESTOP'fENNANI' IMI'ROVEMEN-r(1264SOF'T')
MERCANTILE, SPACE INCLUDES ACCESS, RESTROOM
UPGRADES, NEW RECEPTACLES, T -BAR CEILING, SUB
Sq. Ft Floor Area:
ANN Number: 32632054.00
Valuation: $55000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by Date: 7-- �
RE -ROOFS:
All roofs shall be inspected prior to any rooting material being installed If a roofis
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Appli t:_'_
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
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(x) should I 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sectti"s 25505, 25533, and 25534.
�n 4L
Date: J
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 Addres
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed I'rofessiona
CITY OF CUPERTINO
1AL4,' OR - RTTIT D1NG DIVISION
OCCUPANCY TYPE:
ADDRESS: 20735 stvns crk blvd. suite d
DATE: 05/16/2011
REVIEWED BY: bobs.
IMN
APN:
BP#:
"VALUATION: 1$55,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
IMTIPLNCK
PENTAMATION 1 M TI
PERMIT TYPE:
WORK
t.i. comm. mercantile space includes access. restroom upgrades, new receptacles, t -bar ceiling, sub
SCOPE
panel, lighting, modify existing walls and partitions.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
M (Tenant Improvements)
II-B,111-B,IV,V-B
1,264
$2,611.00
IMTIPLNCK
$1,099.20
IMTHNSP
PME Plan Check:
$0.00
Permit Fee:
$1,099.20
Suppl. Insp. Fee.40 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
1,264
$2,611.00
''
$1,099.20
M
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY Q Yes Q No
MISC ITEMS
Plan Check Fee:
$2,611.00
Select a Mise Bldg/Structure
or Element of a Building
El
Suppl. PC Fee: 0 Reg. 0 OT
o.i-f"
1 hrs
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (fee Resolution 09-051 F, jf. 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,611.00
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,099.20
Suppl. Insp. Fee.40 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
£.<,*' r,*ltc,, on Pc'O".
Acoustical Fee: 0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes (F) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
i
Strong Motion Fee: IBSEISMICO
$11.55
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$3,724.75
$0.00
TOTAL FEE:
$3,724.75
Revised: 04/29/2011
der
This Certificate is issued cei
inspected for compliance
rdinances of the City regulati
ilding Permit Number(s): 11
dress of Building: 20
Portion of Building: T
Use: Retail
Tenant Floor Area: 1264 s.f.
Sprinklers System Required: YE
Current Property Owner: HKzti
Current Owner Address: 6700
Final Inspection By: Larry
Filnal Inspection Date: 8-031
tt"On
1 ' vim. lure described below has been
ietions and with the various
n for the oc ,. of;cupancy and the use for which
Blvd. -
(1264 s.f.) -
ECIAL STIPULATIONS OR CONDITIONS:
:rt Salvador, P.E., :B. ., Bilding ffr Date- ed
,
NOTICE. No changes shall be made in the character of 666upancy of the building 0xcepi by the'authorty of the Building Official.
Issuance Date(s): 7-05-2011
Load: 34
onstruction: 11-13