130801384
CITY OF CUPERTINO BUILDINtG PERMIT
BUILDING ADDRESS: 19925 STEVENS CREEK BLVD
CONTRACTOR: DEVCON
PERMIT NO: 13080138
CONSTRUCTION INC
OWNER'S NAME: STEVENS CREEK fNVRS LLC
690 GIBRALTAR DR
DATE ISSUED: 10/09/2013
OWNER'S PHONE: 4084990223
MILPITAS, CA 95035
PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DgECLARATION
JOB DESCRIPTIION: RESIDENTIAL 0 COMMERCIAL
License Class 57 Lic. # 3 < l b
APPLE- 2ND FLOOR EAST VYING- COMM. T.I 12,216 SQ
1�91AfbA
FT, NEW INTERIOR WALL CONSTRUCTION, FINISHES
Contractor Date &
CONFERENCE ROOMS AND BREAK ROOM
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. .
I hereby affirm under penalty of perjury one of the following two declarations:
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: $922777
performance of the work for which this permit is issued.
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.
APN Number: 31621089.00
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. 1 agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FR LED 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
AA
granting of this permit. Additionally, the applicant understands and will comply
Iss �� -3
with all non=point source regulations pg the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date
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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the property, or my employees with wages as their sole compensation,
wil I 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.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 the Labor Code, for the of the work for which this
the Health & Safety Code, SeVen 25505, 25533, a 25534.
of performance
Owner or authorized age Dater
permit is issued.
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, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the. Labor Code, l 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 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 representativcs 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
1 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
A"17MTU trh TP tn1TTTrbTn TfMrM1TT\Ttrh
OCCUPANCY TYPE:
\L111j1 11 \LV -W \L., IU 11 1Lltt ll 1L1 V \Ur '
FEE ESTIMATOR - BUILDING DIVISICN
IFLR AREA
s.l
ADDRESS: 19925 SCB DATE: 08/19/2013 REVIEWED BY: MEIVDEZ
PC INSEE IID
APN:
BP#: Z %
*YAILUATIION: 1$922,777
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
=,PERMIT
PIENTAMATION 1B TI
USE:
1BTIINSP
TYPE:
WORK
APPLE- 2ND FLOOR EAST WING- COMM. T.I 12,216 SQ FT TO INCLUDE INTERIOR DEMO OF
SCOPE
NON STRUCTURAL ELEMENTS, NEW INTERIOR WALL CONSTRUCTION, FINISHES
OCCUPANCY TYPE:
TYPE OF
CONSTR.
IFLR AREA
s.l
PC FEES
PC INSEE IID
IBP FETES
BP FEE IID
B (Tenant Improvements)
II-B,111-B,IV,V-B
12,216
$2,745.38
1BTIPLNCK
$7,209.38
1BTIINSP
Flee. Insp. Fee:
$7,209.38
Suppl. Insp. Feer Reg. COT
Q Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construe ion Tar:
�drnrl'rl ti7r'QtJVL' .F@E'.:
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
12,216
$2,745.38
Travel Documentation Fees:
$7,209.38
Strong Motion Fee: IBSEISMICO
MECH, HOURLY ( Yes (E) No
PLUMB, HOURLY O Yes (j) No
ELEC, HOURLY Q Yes E) No
Mech. Plan Check
Phanb, Plan Check
Elec. Plan Check
Meth. Perini! Fee:
Plrrmh. Permit Tee:
L;lec. Permit Fee:
Orher :Tech.. Insp.
Other Plumb Insp.
Usher Elec. Insp.
tlech. Inds. Fee:
Ptumb. hup. Fee:
Flee. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
bi.ntrict. etc 1 Thene leen are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef{' 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,745.38
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: C) Reg. OT
Q,Q
hrs
$0.00
PME Pian Check:
$0.00
Permit Fee:
$7,209.38
Suppl. Insp. Feer Reg. COT
Q Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construe ion Tar:
�drnrl'rl ti7r'QtJVL' .F@E'.:
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure 0
A
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICO
$193.78
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$37.00
SUBTOTALS:
10,185.54
$0.00
TOTALFEE: 1
$10,185.54
Revised: 07/0112013