13030002 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR:DEVCON PERMIT NO: 13030002
CONSTRUCTION INC
OWNER'S NAME: S150 LLC 690 GIBRALTAR DR DATE ISSUED:07/17/2013
OWNER'S PHONE: 4089745662 MILPITAS,CA 95035 PHONE NO:(408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
License Class_ Lic.# I—) f V 1 INSTALL LASER CUTTING TOOL WITH AN EXHAUST
FAN ON
Contractor 00eIGtAJ LW5I Date FA CONCRETE PAD
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7600)of Division 3 of the Business&Professions
Code and that my liccnse 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:$70000
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 APN Number:32610053.00 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 statc laws relating WITHIN 180 DAYS OF PE ANCE 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 DAYS FROM 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 comply Issued Date:
with all non-point source lations per the Cupertino Municipal Code,Section
9.18.
/AL4E-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material bcing 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 1 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(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed eontractors 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(a)should 1 store or handle hazardous
1 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 25 ,25533,a 5534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
permit is issued.
1 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 CONS UCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 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
1 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: 20650 VALLEY GREEN DR DATE: 0310112013 REVIEWED BY: MELISSA
AN: 326 10 053 BP#: 3 D �-- `VALUATION: 1$70,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1CMAP7
USE: PERMIT TYPE: A
WORK INSTALL LASER CUTTING TOOL WITH AN EXHAUST FAN ON E CONCRETE PAD
SCOPE
Mech.Plan Check 0.0 hrs $0.00 Phonb.. Plun C"heck F_lec. Plan(;heck
Mech.Permit Fee: IMPERMIT Plumb. Permit Fee. hlec. Permir Fee:
Other Mech.Insp. 0.0 hrs $45.00 (thee Plumb Insp. E7
Other Elcc.Insp. Ll
;lle.ch.Insp. Fee: Plumb. hraEr. Fee: Elco,Inas. Fee:
NOTE. This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS Fee Resolution 11-053 EfL' 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Mechanical
hrs $266.00 $100.00 1BREMYEN5 Ventilation System
Suppl. PC Fee: E) Reg. () OTT2.0
PME Plan Check: ISUPPKFEE $0.00
Permit Fee: $0.00
Suppl. Insp. Fee.e Reg. Q OT 1 2.0 1 hrs $266.00
PME Unit Fee: ISUPINSFEE $0.00
PME Permit.Fee: $45.00
Consir action Tctx:.
Administrative Fee: IADMIN $42.00
Work Without Permit? Yes Q No $0.00
Advanced Plannin&Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITPA VDOC $45.00 Building or Structure
i
Strong Motion'Fee: IBSEISMICO $14.70 Select an Administrative Item'
Blda Stds Commission Fee: IBCBSC $3.00
SUBTOTALS: $681.70 $100.00 TOTAL FEET-
Revised:
EE:Revised: 01101/2013