13060191 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 13060191
INC
OWNER'S NAME: SVF CUPERTINO CITY CENTER CORP 690 GIBRALTAR DR DATE ISSUED:07/08/2013
OWNER'S PHONE: 6505205483 MILPITAS,CA 95035 PHONE NO:(408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic.P / IV
7 MECH r RESIDENTIAL COMMERCIAL
Contractor ��fd Z!� Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APPLE TENANT IMPROVEMENT ON SECOND FLOOR(5555
(commencing with Section 7000)of Division 3 of the Business&Professions SQ
Code and that my license is in full force and effect. FT).
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.
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:$100000
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is APN Number:36901019.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
withall non- ' t r e regulations er the C ino Municipal Code,Section 180 DAYS FROM ]LAST CALLED INSPECTION.
9.18. 7/�//
Signa re Date Issued by:, a Date: e
❑ OWNER-BUILDER DECLARATION
1 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 rooting material being installed.If a roof is f
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
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
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the health&
Safety Code,Section 25532(a)should 1 store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,l Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:
Date: �
l
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with a6no ,s urce regulations p r the Cupertino Municipe, ection ARC111TECT'S DECLARATION
918i understand my plans shall be used as public records.
Signa Date
Licensed Professional
CI'T'Y OF CU P1ER' INO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20300 STEVENS CREEK BLVD DATE: REVIEWED BY: MELISSA
APN: 369 01 019 BP#: , �0�9� 'VALUATION: 1$100,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1B TI
USE: PERMIT TYPE:
WORK APPLE -T.I. RECONFIGURE OPEN OFFICE AREA INTO 10 N STUDIO OFFICES 2 MEETING
SCOPE ROOM AND 1 LARGE OFFICE AREA
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-A,111-A,V-A 5,555 $2,873.20 IBTIPLNCK $5,515.54 1BTHNSP
TOTALS: 5,555 $2,873.20 $5,515.54
MECH,HOURLY Q Yes O No PLUMB,HOURLY Q Yes (!) No ELEC,HOURLY Q Yes Q No
14edi. I-Van Check Phrnih. Plug Chet-A Elec, Plait Check
;Llech. Permit Fee: Phcmh, Permil Fee: Dec. Permit Fee:
L11c,
Afech. InspE17- Othur Plumh Insp. Odter Elec.Insp. Li.Insp. Fre Plamh.Insp.lee: Elce. Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These Les are based on the relinuna information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 C . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,873.20 Select a Misc Bldg/Structure
Suppl. PC Fee: E) Reg. Q OTFo-ol hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $5,515.54
Suppl. Insp. Fee:Q Reg. Q OT p,p 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Con,so-uction Tax:
Adminislrolive Fee: O
Work Without Permit? Q Yes E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Truvel Documentation Fees: Building or Structure Q
Strong Motion Fee: IBSEISMICO $21.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $8,413.74 $0.00TOTAL FEE: $8,413.74
V.Revised: 04/29/2013