13090171 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20705 VALLEY GREEN DR CONTRACTOR:NOVO CONSTRUCTION PERMIT NO:13090171
OWNER'S NAME: BERG FAMILY PARTNERS,L.P. 1460 O'BRIEN DR DATE ISSUED:10/10/2013
OWNER'S PHONE: 4099968208 MENLO PARK,CA 94025 PHONE NO:(650)701-1500
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class Lic.# -] f1 �✓ APPLE-1ST FLOOR COMM.T.I 655 SQ FT
Contractor 0 VO Date /0//0
I hereby affirm that I am licensed under the provisi ns 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:$80000
Pave 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:32610046.20705 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.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERT 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 RA LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, --
costs,
-costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will complysued by: Date:
with all non-point source regul 'ans per Cupe o Municipal Code,Section
9.18.
any
roofing
Signatu�`�� � U fff/// � Date D l n /_? 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
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
I,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)
I,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(x)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,Sections 25505,255 ,and 34,
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized age ate:
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
Compensation laws of California. If,after making this certificate of exemption,I 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.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
7A�PN:
ESS: 20705 VALLEY GREEN DATE: 09/23/2013 REVIEWED BY: MENDEZ
BP#: *VALUATION: $80,000
xPERMIT Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B T�
WORK APPLE- 1ST FLOOR COMM. T.I 655 SQ FT
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-B,111-B,IV,V-B 655 $2,056.44 IBTIPLNCK $836.48 IBTIINSP
TOTALS: 655 $2,056.44 $836.48
MECH,HOURLY 0 Yes E) No PLUMB,HOURLY ® Yes jQ No ELEC,HOURLY ® Yes 0 No
;LTeeh. Plan Check Plw;ih.Plan Check Elec:. Plan Chcck
itlech.Permit Fee: Plumb.Permit Fee: Elec_Permit Fee:
ihher Afech.Insp, Other Plumb Insp, Otfrer Elec.InsP.
�tlech.In P.Fae: Plaunh. Pnsp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.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 Det fiv addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,056.44 Select a Misc Bldg/Structure
Suppl.PC Fee: (j) Reg. () OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $836.48
Suppl. Insp.Fee-(F) Reg. Q OT ro,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conso action Tax:
.4diniaaistrative Fee: 0
Work Without Permit? Yes (F) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
Travel Docuin..entaiio r Fees: I i
Strong Motion Fee: IBSEISMICO $16.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $2,913.72 $0.00 TOTAL FEE: T2,913.72F1
Revised: 08/01/2013