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13110128CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6 RESULTS WAY CONTRACTOR: XL CONSTRUCTION PERMIT NO: 13110128 OWNER'S NAME: ECI TWO RESULTS LLC 951 BUCKEYE CT DATE ISSUED: 11119/2013 OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 11 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL® License Class,& Lic. # APPLE- 2ND FLOOR - ADDING TO WALLS WITH CARD Contractor 114- -/111 Date READER SECURITY DOORS 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $49000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35720041.6 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to 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 FROM LAST CALLED 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 Issued by: Date: X47,�� 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, RE -ROOFS: Signature __&4�— Date--//,/�-�p ed 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. E3 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, 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 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. 1 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 Day 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 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. Ze-fDate: Owner or authorized agent: permit is issued. ell I certify that in the performance of the work for which this permit is issued, I shall V not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AG ENCY 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 VVV V.4QTI'1,,r AL T+1? - V.1 TIIA)IVG _101VIS1141V A RESS: 6 RESULTS WAY DD DATE: 11119/2013 REVIEWED BY: Mendez APN: I *VALUATION: $0.00 *PERMIT TYPE: Building Permit Plan Check, Hourly ISTPLNCK PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingI USE: I P NTAMATION 1GENCOM11 PERMIT TYPE: $0.00 APPLE- 2ND FLOOR - ADDING TO WALLS WITH CARD READER SECURITY DOORS $0.00 Plann (,"heck I I I Perwif Fee' Olffer'lfech. Imp, ,11&,ch, Insp. Fee: 11hwib, Plan Check IMuni& 01her Plumb lnsp Alunib, E"'ec, Plan Check blec, Pci"Miy Fee: Other lnspL_J Elec, lnsp. Fee: NOTE. This estimate does not include fees due to onter vepartments (ie. manning, iruvuc ryuris, etre, 5artitury ocwrr u t' 4-11.____1.' - - _­nAtn -.,I n —A, .. ort;mato Cnnlatt tho Dent for addn 11 info. - ..- ­ --- ____ I - -------- -- - FEE ITEMS FeeResolution-1 L-0-53LEAff-7-1-111-31 FEE QTYJFEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q) No $0.00 [_ 2 hours $278.001 Plan Check, Hourly ISTPLNCK Suppl.PCFee: (E)Reg.hrs OOELO.0j $0.00 _ PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes 0 No $0.00 Suppl.. Insp. Feer Reg. .0 OT 10.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 A dininistralive.1' ce: 0 G Work Without Permit? 0 Yes No $0.00 Advanced Planning —Fee. $0.00 Select a Non -Residential E) Building or Structure 0 I A TrOv�,,d Documentation P'ees: Strong Motion. Fee: IBSEISAffCO $10.29 4A hrs $556.00 Inspections ISTIAISP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $2.00 1_7 SURTOTALS: $12.29 $834.00 TOTAL FEE,-, $846.290 Revised: 10/0112013