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12080284CITY OF CUPERTINO BUILDING PERMIT ' BUILDING ADDRESS: 6 RESULTS WAY CONTRACTOR: XL CONSTRUCTION PERMIT NO: 12080284 OWNER'S NAME: ECI TWO RESULTS LLC 851 BUCKEYE CT DATE ISSUED: 12/14/2012 OWNER'S PHONE: 4084901641 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION f— r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L— ) O Lic. # 3 y 3 ; _ F / Contractor �►rJcva �1 fic,T&. . +Date MECH RESIDENTIAL COMMERCIAL I lereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: APPLE - COMMERCIAL OFFICE TENANT IMPROVEMENT (ummencing with Section 7000) of Division 3 of the Business & Professions (72738 SQFT) NEW INTERIOR PARTITIONS, DOORS, FINISHES,CEILINGS,LIGHTING AND 12/18/12-REV#1-INSTALLATION OF (4)DUAL Ode and that my license is in full force and effect. EV CHARGING STATIONS AT BLDG 6-REV#1 ISS'D 12/18/12 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 ;ompensation, as provided for by Section 3700 of the Labor Code, for the )erformance 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 Sq. Ft Floor Area: Valuation: $6227750 permit is issued. APPLICANT CERTIFICATION APN Number: 35720041.6 Occupancy Type: 1 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature/ .----' Date ! Z led—/Z Issued by: �,�r�%/1� �% mil Date•/- ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec. 7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). - 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. 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. PY P P Owner or auth rued agen ti- Date: lZ r--7' APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEW FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 6 Results Way DATE: 12/18/2012 REVIEWED BY: Sean APN: BP#: 12080284 *VALUATION: 1$45,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building USE: Suppl. PC Fee: Q Reg. Q OT PENTAMATION SOLAR -COMM PERMIT TYPE: WORK Revision #1: Installation of 4 dual EV charging stations at building 6. SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Aictrirt_ otn )_ Thoco foot aro hacod an tho nroliminary infnrmatinn availahlo and aro nn1v an octimato_ C'antart tho Rent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef: 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $408.00 Alternative Energy System ICHRGSTA EV Charging Station Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction I'Lix: Adminisiratity Fec: Q 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i Tnfr ;cl 1"C(Is. Strom Motion Fee: IBSEISMICO $9.45 Select an Administrative Item Bidg Stds Commission Fee: IBCBSC $2.00 ` SUBTbTALr $11.45 $408.00TQ'TAL;FEE:,� $419.45 Revised: 10101/2012 CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 6 RESULTS WAY I CONTRACTOR: XL CONSTRUCTION I PERMIT NO: 12080284 I OWNER'S NAME: ECI TWO RESULTS LLC 851 BUCKEYE CT I DATE ISSUED: 12/14/2012 OWNER'S PHONE: 4084901641 1 MILPITAS, CA 95035 ! PHONE NO: (408) 240-6000 K_ LICENSED CONTRACTOR'S DECLARATION License Class_ _:Y� Lic. # Contractor )CL l ,oh CJ f� 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. 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 ermit. Ad ition ly, the applicant understands and will comply with all non -p source r gulag s per the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following thrce 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. [ 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, I 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. BUILDING PERMIT INFO: BLDG ELECT r PLUMB r— MECH r RESIDENTIAL COMMERCIAL r JOB DESCRIPTION: APPLE - COMMERCIAL OFFICE TENANT IMPROVEMENT (72738 SQFT) NEW INTERIOR PARTITIONS, DOORS, FINISHES, CEILINGS, LIGHTING AND Sq. Ft Floor Area: I Valuation: $6182750 APN Number: 35720041.6 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by:f'���%` Date: /-I -% T/ -/" 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 it the Cupertino Municipal Code, Chapter 9.12 and the Healt Safety Co e, -to 25505, 25533, and 25534. Ow or autho g nt: 'j Date: ,[ //11//2 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date I Licensed Professiona CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 6 Results Way DATE: 08/28/2012 REVIEWED BY: Sean PC FEES APN: BP#: / WaO2 Ll 'VALUATION: $6,182,750 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: $7,688.68 PENTAMATION 16 TI PERMIT TYPE: WORK Office tenant im rovemet 72738 s ft). new interior partitions,doors finishes ceilings, lighting and SCOPE M,E,P's RWkZAA M OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 72,738 $7,688.68 1BTIPLNCK $27,307.28 IBTIINSP $27,307.28 Suppl. Insp. Feee. Reg. Q OT 10-07hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 'r C rJ? /I IIIYi(W7 ! tIX Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: TOTALS: 72,738 $7,688.68 $27,307.28 $1,298.38 NOTE: This estimate does not include fees due to other Departments (Ie. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $7,688.68 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $27,307.28 Suppl. Insp. Feee. Reg. Q OT 10-07hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 'r C rJ? /I IIIYi(W7 ! tIX Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Q Building or Structure 0 A 7i'<r'rt'l 1�rr`t!tTc'r7'ui;il,a l'e'C'i: Strong Motion Fee: 1BSEISMICo $1,298.38 Select an Administrative Item Bldy, Stds Commission Fee: 1BCBSC $248.00 .BTO`I'AI,S: 36,542.34 $0.00 ;TOTAL FEEi 1-. $36,542.34 Revised: 07/0112012