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13100082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N BLANEY AVE CONTRACTOR:GOWAN PERMIT NO:13100082 CONSTRUCTION OWNER'S NAME: PACIFIC GAS AND ELECTRIC CO 15 W 8TH ST DATE ISSUED:11/07/2013 OWNER'S PHONE: 4082827133 TRACY,CA 95376 PHONE NO:(209)836-2482 0 LICENSEDCONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIALO COMMERCIAL® LicenseLicense Class Lie.# PG&E T.I.FOR OFFICE MODIFICATIONS,INCLUDING �rqqtRECONFIGURATION OF(E)OFFICE SPACE&ADA Contractor Date / qs PARKING I hereby affirm that I am licensed under the provisions of Chapter 9 UPGRADES (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:$77500 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:31603045.00 Occupancy Type: permit is issued. I 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.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS 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 DAY ROM 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 Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-poi source regulations per the Cupertino Municipal Code,Section 9.18. '1 -7 RE-ROOFS: Signature t Date _/0 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. 13 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 L 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) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to 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 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-Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25505, 573 and 25534. an111-7113 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: V- Date* permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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(See.3097,Civ C.) Lender's Nam 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 ADDRESS: 10800 N BLANEY AVE 11 DATE: 10/11/2013 REVIEWED BY: MELISSA A.PN: 316 03 045 BP#: l *VALUATION: $77,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION 1 B TI USE: Commercial Building PERMIT TYPE: WORK PG&E T.I. FOR OFFICE MODIFICATIONS INCLUDING RECONFIGURATION OF E OFFICE SCOPE SPACE &ADA PARKING UPGRADES OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTIL a B (Tenant Improvements) 11-B,tN-8,6v,V-S 258 $2,036.00 1BTIPLNCK $571.00 IBTIINSP TOTALS: 258 $2,036.00 $571.00 1 C )URJ ' ' s N Puma ��X Mech. Plan(;7tecA, C'hunh.Plan t 6teeA Phan Check � <e<'tr. f'a.rrait Fc;€>. d It xn1�.1 t r �t Fee: 1?lec- hermit Fee': (Jthcr°;l7�rcr t.lrasi. �)iber 'himb Insp. (),,her L lcc.fr s1�, El NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School Districtetc. . These ees are based on the Edi:ndna information available and are onl an estimate. Contact the De t or addn'l in o. FEE ITEMS(Tee Resolution 11-053 Z:fl: 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,036.00 Select a Misc Bldg/Structure Suppl.PC Fee: iq Reg. 0 OT 0:0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $571.00 Suppl.Insp.Feer Reg. 0 OT 070hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ContmuctionTax: Ll Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 1 r av l Documentation c•rrrnc�ntation��ee : Building or Structure � s Strong;Motion Fee: 1BSEISMICO $16.28 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $4.,00 $2,627.28 $0.00AL $2,627.28 Revised: 10/01/2013