12010054I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19400 SORENSON AVE CONTRACTOR: CORNERSTONE SELECT PERMIT NO: 12010054
BUILDERS
OWNER'S NAME: FONTAINBLEU LLC 3490 UNION ST STE B DATE ISSUED: 07109/2012
OWNER'S PHONE: 4084469898 FREMONT, CA 94538 PHONE NO: (510)490-7911
❑ LICENSED CONTRACTOR'S DECLARATION
License Clas R> k is #
Contractor 41110-11211 Date
I hereby form 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.
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
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 -p t source regulationspe the Cu,pertino Municipal Code, Section
9.18. .
Signature
BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB
MECH I RESIDENTIAL r— COMMERCIAL I.
JOB DESCRIPTION: CONSTRUCTION OF NEW STORAGE AND UTILITY
BUILDING
1,190 SQ FT.
Sq. Ft Floor Area: I Valuation: $119000
APN Number: 37503005.5 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Dates ' -2 2!- l Issued by:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the 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 offered for sale (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).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
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 be 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
Date:
RE -ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I 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
Heo* & Safety Code, Section 5505, 25533, and 25534.
or authot``h�e�l age J �/
f� Date: wJ
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professi
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19400 SORENSON AVE
CONTRACTOR: LEON CONSTRUC"CION
PERMIT NO: 12010054
OWNER'S NAME: FONTAINBLEU LLC
10285 STERN AVE
DATE ISSUED: 07/09/2012
OWNER'S PHONE: 4084469898
CUPERTINO, CA 95014
PHONE NO: (408) 209-1272
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE]
License Class Lic. it
CONSTRUCTION OF NEW STORAGE AND UTILITY
BUILDING
Contractor Date
1,190 SQ FT.
I hereby affirm that 1 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 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: $119000
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
APN Number: 37503005.S
Occupancy Type:
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
��� jG/ 7
Issued by: � pate:/ %
granting of this permit. Additionally, the applicant understands and will comply
C
with all non-point source regulations per 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,
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).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
1 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 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should 1 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 whichthis 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
the Health &Safety Code, Se t 55415, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
.--�
Owner or authorized agen Date:
AA1
permit is issued.
I certify that in the performance of the work for which this permit is issued, l 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, [
CONS._
CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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 so ce regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
i 1,
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: aE3�t>e. l DATE: 0110612012 REVIEWED BY: bobs.
API I3P#: (� "VALUATION: $119,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY Multi-FamilyDwellin Buildina is PENTAMATION 1U1
USE: g >3 Stories 0 Yes E) No PERMIT TYPE:
WORK construct new storage and utility bldg.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
U (Private Gar/Ag Bldg)
II-B,111-B,IV,V-B
1,190
$3,611.92
1 UIPLNCK
$3,451.44
1 UIINSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,451.44
Suppl. Insp. Fee -.0 Reg. C) OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
1,190
$3,611.92
Construction Tax: IBCONSTAXR1
$3,451.44
# new
units
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (f ee Resolution 11-053 E '. 7/1,-11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,611.92
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j)Reg. ® OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,451.44
Suppl. Insp. Fee -.0 Reg. C) OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR1
# new
units
$583.80
G
Work Without Permit? 0 Yes (2) No
$0.00
Advanced Planning Fee: PLLONGRNGC
$309.40
Select a Non -Residential
Building or Structure
0
0
Strong Motion Fee: IBSEISMICR
$11.90
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$5.00
SUBTOTALS:
1 $7,973.46
$0.00
TOTAL FEE.
$7,973.46
Revised: 1/01/2012