14100181 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:SC BUILDERS INC PERMIT NO: 14100181
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 910 THOMPSON PL DATE ISSUED: 10/29/2014
OWNER'S PHONE: 4089338836 SUNNYVALE,CA 94085 PHONE NO:(408)328-0688
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
APPLE-T.I PREP TO 1ST,4TH AND 5TH FLOOR.
License Class Lie.#747f),6 INTERIOR DEMO NON-STRUCTURAL
Contractor NC_ 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:$50000
1 li n II maintain Worker's Compensation Insurance,as provided for by
Sec on oft Labor Code,for the performance of the work for which this
APN Number:36901027.00 Occupancy Type:
pe i iss
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 1 AYS O ERMIT 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 FR LAS ALLED INSPECTION.
indemnify and keep har ss the City of upertino against liabilities,judgments,
costs,and expenses may accru st said City in consequence of the
granting of this p Addition e applicant understands and will comply Issued by: Date:
with all non- c u er the Cupertino Municipal Code,Section
9.18.
ROOFS:
Signature Date All roofs shall be inspected prior to anyny 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:
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALI,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(See.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(See.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
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 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 equ' ent or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined bABa ea Air Management District I
performance of the work for which this permit is issued. will maintain compliance witno pal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Send 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued. 1
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 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 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
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20450 scb DATE: 10/29/2014 REVIEWED BY: Mendez
APN: BP#: 0 `VALUATION: 1$50,000
nPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1TIPREP
USE: PERMIT TYPE:
WORK apple-t.i prep to 1 st 4th and 5th floor. interior demo non-structural
SCOPE
E]_L_ Lj _L_
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . These-fees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 in o.
FEE ITEMS (Fee Resolution II-053 Ef 7i1%13� FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Tenant Improvement Prep
Suppl. PC Fee: Q Reg. 0 OT Q.Q hrs $0.00 $417.00 ITIPREP
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes Q No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure 0
Stroh Motion Fee: IBSEISMICO $14.00 Select an Administrative Item
Bld- Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $16.00 $417.00 TOTAL FEE: F$433.00
Revised: 0711012014