14120088 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10080 N WOLFE RD STE SW3-350 CONTRACTOR:APPLIED PERMIT NO: 14120088
CONSTRUCTION TECH
OWNER'S NAME: I&G DIRECT REAL ESTATE LP 1230 OAKMEAD PKWY DATE ISSUED:01/13/2015
OWNER'S PHONE: 4089828433 SUNNYVALE,CA 94085 PHONE NO:(408)252-9990
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
/
,, ) t [`� NEC- 3RD FLOOR;ANCHORING OF(3)COMPONENTS IN
License Class � 7 Lic.#_ Gd o — (J- EM
LAB
Contractor Date
Date
I hereby affir n 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:52000
,j 1 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:31620086.3350 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that l 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 F 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 18 O LAST 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 permit. Additionally,the applicant understands and will e y Issued b Date: iii
with all non-point source regu s er e Cupertino Municipal Code,Secti
9.18.
r RE-ROOFS:
Signature Date 1 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[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(See.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. 1 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 1 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 compli=ON
nicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety 3 534.
Section 3700 of the Labor Code,for the performance of the work for which this /
permit is issued. Owner or authorizedDate:
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 DING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a cofstruction 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. l 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 l 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: 10080 n wolfe rd DATE: 12/17/2014 REVIEWED BY: Mendez
APN: BP#: -VALUATION: 1$2,000
`PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1GENCOM
i
WORK nec- 3rd floor anchorin of 3 components ine em lab
SCOPE
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn'l info.
FEE ITEMS (Fee Resolulion 11-053 Fff 711:732 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes Q No $0.00 1 hours Plan Check, Hourly
Suppl. PC Fee: (2) Reg. Q OT 0.0 hrs $0.0 $$143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ()Yes Q No $0.00
Suppl. Insp. Fee:(j) Reg. OOT 1 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C)
Work Without Permit? 0 Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
i
Strong Motion Fee: IBSEISMICO $0.56 2.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $286.00 ISTINSP Inspection,Hourly
SUBTOTALS: $1.56 $429.00 TOTAL FEE: $430.56
Revised: 10/01/2014