14090189 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10450 BUBB RD ONTRA TOR: F PERMIT NO: 14090189
-1, (0- U t U 1��'1', l_.V
OWNER'S NAME: BERG FAMILY PARTNERS,L.P. DATE ISSUED:09/29/2014
OWNER'S PHONE: 4807839551 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
APPLE T.I. PREP-RECONFIGURE (E)AREA TO
License Class Lic.#
�7 �' DISMANTLE& RELOCATE MOCK UP STORE(2600 S.F.)
Contractor`'1l+ L0 t'IS�1��'I °°� Date 1 I
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
ompensation,as provided for by Section 3700 of the Labor Code,for the
Fe
of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:5200000
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:35720037.10450 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.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS IT 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 D LAST LED 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 permit. Additionall ,the applicant understands and will comply Issued by: ate:
with all non-point source re ulati upertino Municipal Code,Section
9.18.
OFS
Sign re Date f 7 All roofs shall be insp for 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). 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 I
performance of the work for which this permit is issued. will maintain compliance with the Cupertin al Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 3_ 35 d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent• t ate: [[
1 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,[ 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. 1 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
WPERMIT
DDRESS: 10450 BUBB RD DATE: 09/29/2014 REVIEWED BY: MELISSA
PN: 35720037.10450 BP#: /��9�� 'VALUATION: $200,000
PE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1TIPRE i
WORK APPLE T.I. PREP - RECONFIGURE E AREA TO DISMANTLE & RELOCATE MOCK UP STORE
SCOPE
Lj
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-for addn'l info.
FEE ITEMS (l ee Resolution 11-053 E�.' 7.'1%1.31 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Tenant Improvement Prep
Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $417.00 1TIPREP
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. Q OT TO.Ohrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (D No $0.00 G)
Advanced Planning hee.. $0.00 Select a Non-Residential 0
Building or Structure
Strong, Motion Fee: 1BSEISMICO $56.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $8.00
SUBTOTALS: $64.00 $417.00 TOTAL FEE: $481.00
Revised: 0812012014