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13100109CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10815 N WOLFE RD CONTRACTOR: ROBERTS MANAGING PERMIT NO: 13100109 CONTRACTORS INC OWNER'S NAME: CUPERTINO VILLAGE LP 5045 E MCKINLEY AVE DATE ISSUED: 10/21/2014 OWNER'S PHONE: 6507467504 FRESNO, CA 93727 PHONE NO: (559) 252-6000 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATION RETAIL A - CONSTRUCT SHELL BUILDING 15,267 SQ FT n License Class / Lic. 4 INCLUDES UTILITIES/SITE WORK ON PLANS. —�� DEF # I - TRUSSES - ISSUED 4/29/15 Contractor ? Date DEF # 2 - METAL STUD SYSTEM - ISSUED 4/29/15 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: $2379000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31605056.10815 Occupancy Type: ection 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 ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, against said City in consequence of the L costs, and expenses which may accrue Issue Date: granting of this per it. ditionally, the appli t understands and will comply ' with all non -poi sourc regu ns er th pertino Municipal Code, Sec n 9.18. / Signature , 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. ❑ WNER-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 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 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. I 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 PflyArga Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the up r uio icipal Cod , 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, Sectio s 5 , 533, ndIO Owner or authorized agent: Date. 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 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 FF 11 . F CTTM A TnR — RI TII ,DING DIVISION LZADDRESS: 10815 N WOLFE RD DATE: 04/10/2015 REVIEWED BY: MELISSA APN: 316 05 052.10869 BP#: 13100109 `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? 0 Yes (F) No PENTAMATION 1 GENCOM PERMIT TYPE: WORK BLDG A - DEFERRED # 2 FOR METAL STUD SYSTEMS SCOPE u---------- NOTE: NOTE: This estimate does not include fees due to other Departments (i.e. Fianning, runuc worKs, rare, aanrrary newer "rsrricy aunvv/ Cnntart tho Aunt For addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711.113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F -T-1 # $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 1, , t f, ,, . P _ E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE: $286.00 Revised: 04/01/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10815 N WOLFE RD CONTRACTOR: ROBERTS MANAGING PERMIT NO: 13100109 CONTRACTORSINC OWNER'S NAME: CUPERTINO VILLAGE LP 5045 E MCKINLEY AVE DATE ISSUED: 10/21/2014 OWNER'S PHONE: 6507467504 FRESNO, CA 93727 PHONE NO: (559) 252-6000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL RETAIL A - CONSTRUCT SHELL BUILDING 15,267 SQ FT License Class Lic. # 4ZI - INCLUDES UTILITIES/SITE WORK ON PLANS. DEF # 1 - TRUSSES - ISSUED 4/29/15 — Contractor ate(usiness DEF # 2 - METAL STUD SYSTEM - ISSUED 4/29/15 I hereby affirm that I am licensed under the provisiohapter 9 (commencing with Section 7000) of Division 3 of the & 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 Sq. Ft Floor Area: Valuation: $2379000 performance of the work for which this permit is issued. ave 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: 31605056.10815 Occupancy Type: permit is issued. APPLICANT CERTIFICA ION I certify that I have read this application and state that a above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordi ances 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 pu oses. (We) agree to save CALLED INSPECTION. indemnify and keep harmless the City of Cupertino ag riA liabilities, judgments, costs, and expenses which may accrue against said Ci in consequence o�the granting of this permit. Additionally, the applicant un erstands and, 11ply Issued Da with all non -poi o rce regulations per th Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date _2 - 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 DECLARAT ON Signature of Applicant: Date: I hereby affirm that I am exempt from the Contra loris License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with w ges 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 contracti g with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professi ns 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 t e 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 toelf-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of a Labor Code, for the air contaminants as defined by the Ba rea Air Quality Management District I performance of the work for which this permit is '. ed. will maintain compliance with the p no Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation urance, as provided for by the Health & Safety Code, Section 2 , 2 , a d 255 . Section 3700 of the Labor Code, for the performan of the work for which this Owner or authorized agent: Date: 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 beco a subject to the Worker's Compensation laws of California. If, after making is certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation pro isions 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 pe it shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFI ATION Lender's Address I certify that I have read this application and state at the above information is correct. I agree to comply with all city and county rdinances and state laws relating to building construction, and hereby authorize rep sentatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertin against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against sai City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applican understands and will comply with all non -point source regulations per the Cup ino Municipal Code, Section Licensed Professional 9.18. Signature Date ���j CITY OF CUPERTINO IIl�Y"'�(f/J1 FFF F.CTIN4A TnU — RI TTI ,)INC: DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, etre, sanitarysewer vistr/ct, scnoo/ n.*-.-: TG f G . d » tL , ». ,1:.»:» .. , :»£ r olio» n niln6/v nad ora nn/v nsr oclimnlo ('nrntnrt tho t)ont for oddn't info. FEE ITEMS (Fee Resolution 11-053 E/J1 7,,,VQ 10815 WOLFE RD 7 DATE: 04/10/2015 REVIEWED BY: MELISSA PAADDRESS: APN: 316 05 052.10869 BP#: 13100109 "VALUATION: Iso TPERMIT TYPE:Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial BuildingCivil USE: / Religious activities in BQ zone? © Yes O No PENTAMATION 1 GENCOM PERMIT TYPE: WORK BLDG A - DEFERRED # 1 FOR TRUSS SYSTEMS SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, etre, sanitarysewer vistr/ct, scnoo/ n.*-.-: TG f G . d » tL , ». ,1:.»:» .. , :»£ r olio» n niln6/v nad ora nn/v nsr oclimnlo ('nrntnrt tho t)ont for oddn't info. FEE ITEMS (Fee Resolution 11-053 E/J1 7,,,VQ FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $286.00 Deferred Submittal 1DEFS1IBM 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. ® OT O.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXCEJ $0.00 E) Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.001 $286.001 TOTAL FEE: $286.00 Revised: 04/01/2015 CITY OF CUPERTINO r FFF ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10869 N Wolfe Rd DATE: 10/15/2013 REVIEWED BY: Mendez PC FEE ID APN: BP#: VALUATION: $2,379,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? Yes No PENTAMATION 1 SHELLBLDG PERMIT TYPE WORK Retail A- construct shell building 15,267 sq ft SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID Shell Bldgs II-B,111-B,IV,V-B 15,267 $10,071.96 IOSPLNCK $12,405.20 10SINSP $0.00 PME Plan Check: $0.00 Permit Fee: $12,405.20 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 15,267 $10,071.96 Construction Tax: IBCONSTAXC $12,405.20 ixn tf•:ch. Plan C'hcck Plumb. Plan Chc=cl, Nc , Platt (.`hack Llecfs_ P I'eE�: t,�,rt�_�< _".. ... F"C l>Cc°r. Pcrtni" Fee: ether A,rcr �h. lrts;>Other Plumb Inv?,ED %�rhet� 1;1<�c lnst�. Suppl. PC Fee: (F) Reg. OT 0.0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Fire, Sanirmy newer Dwzrici acaout TL f h .L �d n" fbn nro/iminnro ininrLnniinn availahlo and are only an estimate. Contact the Dept for addh 7 info. l/LJLL LIL, CLI.. Z. lLLcuc clJ ....... FEE ITEMS (Fee Resolution 11-053 EA.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $10,071.96 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $12,405.20 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $43,052.94 Adinlnlsiralrve 1, ec: 0 Work Without Permit? 0 Yes No $0.00 Advanced PlanningFee. IPLLONGC $4,274.76 Select a Non -Residential Building or Structure 0 0 7r<wel Doclonclitall a /"(T.5. Strong Motion Fee: IBSEISMICO $499.59 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $96.00 SU TOTALS: ; 70,400.451 $0.00 TOTAL FEE: $70,400.45 Revised: 10!01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10815 N WOLFE RD CONTRACTOR: ROBERTS MANAGING PERMIT NO: 13100109 CONTRACTORS INC OWNER'S NAME: CUPERTINO VILLAGE LP 5045 E MCKINLEY AVE DATE ISSUED: 10/21/2014 OWNER'S PHONE: 6507467504 FRESNO, CA 93727 PHONE NO: (559) 252-6000 DE LARATION JOB DESCRIPTION: RESIDENTIAL EJ COMMERCIAL LICENSED CONTRACTOR'S RETAIL A - CONSTRUCT SHELL BUILDING 15,267 SQ FT License Class Lic. # Contractor �der I hereby affirm that I am licensedprovisions 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 I have and will maintain a certificate of consent to self Compensation, as provided for by Section 3700 of the performance of the work for which this permit is issue 3 have and will maintain Worker's Compensation Insu Section 3700 of the Labor Code, for the performance c permit is issued. I certify that I have read this application and state that ti correct. I agree to comply with all city and county ordir to building construction, and hereby authorize represen upon the above mentioned property for inspection purp indemnify and keep harmless the City of Cupertino ago costs, and expens hich may accrue against said Cit} granting of this e . Additionally, the applicant and with all non -p int ce regula€is per the Cupertino 9.18. / }` Signature i � " I ❑ OWNER -BUILDER DECLARAI 1 hereby affirm that I am exempt from the Contra the following two reasons: 1, as owner of the property, or my employees with w will do the work, and the structure is not intended or Business & Professions Code) 1, as owner of the property, am exclusively contracti: construct the project (Sec.7044, Business & Professi I hereby affirm under penalty of perjury one of the declarations: I have and will maintain a Certificate of Consent to se Compensation, as provided for by Section 3700 of the performance of the work for which this permit is issue I have and will maintain Worker's Compensation Inst Section 3700 of the Labor Code, for the performance permit is issued. I certify that in the performance of the work for whict not employ any person in any manner so as to become Compensation laws of California. If, after making thi become subject to the Worker's Compensation provis forthwith comply with such provisions or this permit I certify that I have read this application and state tf correct. I agree to comply with all city and county c to building construction, and hereby authorize repre upon the above mentioned property for inspection I indemnify and keep harmless the City of Cupertino costs, and expenses which may accrue against said granting of this permit. Additionally, the applicant i with all non -point source regulations per the Cupern 9.18. ling two declarations: for Worker's Code, for the nce, as provided for by the work for which this e above information is mces and state laws relating itives of this city to enter ses. (We) agree to save nst liabilities, judgments, in consequence of the :rstands and will comply Aunicival Code, Section Sq. Ft Floor Area: APN Number: 31605056.10815 PERMIT EXPIRES IF WITHIN 180 180 D Valuation: $2379000 Occupancy Type: IRK IS NOT STARTED ;RMIT ISSUANCE OR ALLED INSPECTION. C19 ROOFS: 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. Signature of Applicant: Date: s License Law for one of :s as their sole compensation, fered for sale (Sec.7044, with licensed contractors to Code). following three "-insure for Worker's I-abor Code, for the I. once, as provided for by f the work for which this this permit is issued, I shall subject to the Worker's certificate of exemption, I )ns of the Labor Code, I must hall be deemed revoked. ie above information is ances and state laws relating atives of this city to enter )ses. (We) agree to save inst liabilities, judgments, in consequence of the xstands and will comply Municipal Code, Section 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 25512,a)_,hould I store or handle hazardous material. Additionally, should I use u ment or devices which emit hazardous air contaminants as defined by the ay ea Air Quality Management District I will maintain compliance with the up ino pal Code, Chapter 9.12 and the Health &Safety Code, Sectio 25 0 , 533, a 2553 t0�� Owner or authorized agent: Date:ID 2� 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. Licensed Professional