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14120100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20650 HOMESTEAD RD CONTRACTOR:B D LAFEVER PERMIT NO: 14120100 ENTERPRISES INC OWNER'S NAME: SOBRATO INTERESTS I ETAL 1504 MELANIE WAY DATE ISSUED:02/24/2015 OWNER'S PHONE: 9259654400 LIVERMORE,CA 94550 PHONE NO:(925)456-0708 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ROSS-INSTALLATION OF SHELVING/RACKING,CASH License Classes_C_) _ Lic.# g Z z© WRAPS AND FITTING ROOMS. Contractor V->D 4A�e i e �- LA Date j1 ZV 2o0S� 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 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 APN Number:32610066.20650 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 D 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 F AST 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 granting of this p rmit. Additionally,the applicant understands and will comply Issued by: Date: with all -on source regulations aeeti, o Municipal Code,Section 9.18. '1 r1 �� RE-ROOFS: Signature Date c� E.�t 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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). 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 Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino N14nicinal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se s 25505,255 �234. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent Date 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 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 FEE ESTIMATOR- BUILDING DIVISION WPERMIT DDRESS: 20650 Homestead Square DATE: 12/19/2014 REVIEWED BY: Sean PN: BP#: ( "VALUATION: $50,000 PE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 GENCO WORK Ross - Installation of shelving/racking, cash wraps and fitting rooms. SCOPE Ll NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District, etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn 7 info, FEE ITEMS (Fee Resolution 11-053 E . 7''1.'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 3 hours Plan Check,Hourly Suppl. PC Fee: Q Reg. 0 OT0,0 hrs $0.00 $429.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (D No $0.00 Suppl. Insp. Feer Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee: $0.00 hours Inspections E) $429.0 01 ISTINSPInspection,Hourly 0 Strong Motion Fee: IBSEISMICO $14.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 1 1 SUBTOTALS: $16.00 $858.00 TOTAL FEE: $874.00 Revised: 10/01/2014