13100164 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 13100164
INC
OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 12/03/2013
OWNER'S PHONE: 5103316719 MILPITAS,CA 95035 PHONE NO:(408)942-8200
❑ LICENSED CONTRACTOR'S DEEC/L/A�RA?TION BUILDING PERMIT INFO: BLDG F ELECT r— PLUMB I—
License Class Lic.# 9111& / r— r_ MECH RESIDENTIAL COMMERCIAL
Contractor �L U ly Date I;—?
Z 3 –� r
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions JOB DESCRIPTION:
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: APPLE-T.I PREP 22,065 SQ FT(INTERIOR DEMO)
t. 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.
2. 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
permit is issued. Sq.Ft Floor Area: Valuation:$37000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35720020.00 Occupancy Type:
zorrect.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,
.osts,and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED
granting of this permit. Additionally,the applicant understands and will comply with WITHIN 180 DAYS OF PERMIT ISSUANCE OR
all non-point sourcZretio!�per the Cupertino Municipal Code,Section 9.18.Signature Date 1� ,J� 180 DAYS FR LED INSPECTION.
��
Iss ate• Z 3
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is installed
i. I,as owner of the property,or my employees with wages as their sole without first obtaining an inspection,I agree to remove all new materials for inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant: Date:
2. I,as owner of the property,am exclusively contracting with licensed contractors
to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the California
performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with
2. I have and will maintain Worker's Compensation Insurance,as provided for by the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section
Section 3700 of the Labor Code,for the performance of the work for which this 25532(a)should I store or handle hazardous material. Additionally,should I use
permit is issued. equipment or devices which emit hazardous air contaminants as defined by the Bay Area
3. 1 certify that in the performance of the work for which this permit is issued,I shall Air Quality Management District I will maintain compliance with the Cupertino
Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and
not employ any person in any manner so as to become subject to the Worker's 25534.
Compensation laws of California. If,after making this certificate of exemption,I J
become subject to the Worker's Compensation provisions of the Labor Code,I Owner or authorized agent: Date:
must forthwith comply with such provisions or this permit shall be deemed
revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's for
APPLICANT CERTIFICATION which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
-orrect.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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
;ranting of this permit.Additionally,the applicant understands and will comply with I understand my plans shall be used as public records.
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10300 BUBB RD DATE: REVIEWED BY:
APN: BP#: ` t 'VALUATION: 1$37,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1TIPREP
USE: PERMIT TYPE:
WORK APPLE-T.I PREP 22,065 SQ FT INTERIOR DEMO
SCOPE
Li
El El
1"V
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 addh 7 in o.
FEE ITEMS (Fee Resolution 11-053 E f 7%1:13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 7 # Tenant Improvement Prep
Suppl. PC Fee: Q) Reg. OT 0.0 hrs $0.00 $405.00 ITIPREP
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(."ou,fruc[1;017
Work Without Permit? C) Yes (D No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Building or Structure
Stronj;Motion Fee: IBSEISMICO $7.77 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $2.00
SUBTOTALS: $9.77 $405.00 TOTAL FEE.-- $414.77
Revised: 10/01/2013