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