14100168I�4
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10050 N WOLFE RD
CONTRACTOR: TF MCGUCKIN INC
PERMIT NO: 14100168
OWNER'S NAME: I&G DIRECT REAL ESTATE 27 LP
777 FOLSOM CIR
DATE ISSUED: 10/28/2014
OWNER'S PHONE: 4088928433
MILPITAS, CA 95035
PHONE NO: (408)263-5614
DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S
SUGAR CRM - 2ND FLR T.I. TO RECONFIGURE OFFICE
License Clea-sss__z _ Lic. # 4
SPACE (2,748 S.F.)
Contractor ' r ) C- (:; U. C 1L , ' , T f Y- Date
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: $67500
ave and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31620086.00
Occupancy Type:
%Skc—tion 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,0 P ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
_ -
18 SFR INSPECTION.
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
Issued bate: l0 Z
granting of this permit. Additionally, the applicant understands and will comply
with all non- int source regulations per the Cupertino Municipal Code, Section
ROOFS:
9.18. I
1
SignaturALADate 1
All roofs shall be inspected prior to anyy roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER-13UILDER 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Scc.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 Bay Area Air Quality Management District 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sech n 25+15,25533, an"21134.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: c: �aa
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 relatinL,
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
11�+W1�.1 VV V Ti cTTM A TnR _ RI III ,DINE: DIVISION
OCCUPANCY TYPE:
1' 1'J •'L 1J Al t
FLR AREA
s.f.
PC FEES
PC FEE ID
ADDRESS: 10050 N WOLFE RD # 281
DATE: 10/28/2014
REVIEWED BY: MELISSA
II-B,III-B,IV,V-B
APN: 316 20 086
BP#:
"VALUATION: 1$67,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
Commercial Building
PME Plan Check:
rTAMATION 1BTI
MIT TYPE: Al
USE:
WORK
SUGAR CRM - T.I. TO RECONFIGURE OFFICE SPACE (2,748 S.F. 'Fir.
$2,453.03
Suppl. Insp. Fee:Q Reg. 0 OT
SCOPE
hrs
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BI' FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
2,748
$2,348.98
IBTIPLNCK
$2,453.03
IBTIINSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,453.03
Suppl. Insp. Fee:Q Reg. 0 OT
0,0 I
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
2,748
$2,348.98
1011.rrlictioil Lry
$2,453.03
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes 0 No
ELEC, HOURLY 0 Yes 0 No
ET -L-1
LLJ--I-
r
I -I
NOTE: This estimate does not include fees due to other Departments (tie. Planning, Public works, rlre, Sun[lury Sewer "WrICy aV.i
mL _ _ X-_- _ - L,_- J,... •L.... ,.1:.....:.,...,, :..0 r nfinn nvnilnhla and nre nnty an estimate. Contact the Dept for addn'l info.
tiistrIci, era . mese era ure uuSeu on s.ac ...
FEE ITEMS (Fee Resolution 11-053 E . 7111131
... ....».. .. „.»___---
FEE
---- ---
QTY/FEE
---- -- -- --
MISC ITEMS
Plan Check Fee:
$2,348.98
Select a Misc Bldg/Structure
or Element of a Building
i
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,453.03
Suppl. Insp. Fee:Q Reg. 0 OT
0,0 I
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
1011.rrlictioil Lry
stnxtire Fee:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
.rr,tveI 1?t,c f'
Strong Motion Fee: IBSEISMICO
$18.90
Select an Administrative Item
BldgStds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
1 $4,823.91
$0.001
TOTAL FEE:
$4,823.91
Revised: 08/20/2014