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13030134 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO:13030134 INC OWNER'S NAME: SVF CUPERTINO CITY CENTER CORP 690 GIBRALTAR DR DATE ISSUED:05/06/2013 OWNER'S PHONE: MILPITAS,CA 95035 PHONE NO:(408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION F, r— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# -3 Fqhlal MECH r RESIDENTIAL F COMMERCIAL Contractor Date er I hereby affirm that I am licensed under the provision of C'Kapter 9 JOB DESCRIPTION:T.I.MODIFICATIONS TO(E)SALAD&JUICE BAR ON I ST(commencing with Section 7000)of Division 3 of the Business&Professions FLRTO INCLUDE MECHANICAL,PLUMBING&ELECTRICAL FOR(N)EQUIPMENT 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. 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 Sq.Ft Floor Area: Valuation:$350000 permit is issued. APPLICANT CERTIFICATION APN Number:36901019.00 Occupancy Type: 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 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. 1 1* - — -I- — I I? I Issued Date, -5�- Signatures- Date S ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for One Of All roofs shall be inspected prior to any roofing material being installed.If roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property.,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,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: I 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 performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. certificate of exemption,I Compensation laws of California. If,after making this certif 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. Date: APPLICANI CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C,) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9J8. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20300 STEVENS CREEK BLVD DATE: 03/25/2013 REVIEWED BY: MELISSA APN: 369 01 019 BP#: " ` ( EVALUATION: *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK T.I. MODIFICATIONS TOE JUICE BARON 1ST FLR TO INCLUDE MECHANICAL PLUMBING & SCOPE ELETRICAL FOR(N) EQUIPMENT OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-6,119-B,IV,V-B 500 $1,959.80 IBTIPLNCK $674.14 IBTIINSP TOTALS: 500 $1,959.80 $674.14 CH;IIE Y= Ties N PLC B�IiIUI Y ,Y s -1 Nd ELE , R0 Xkc h' Plan€°heck llhe arh.I'laxn Ctneck Elec,,Plan{:.`heck W':h. F'€.>-raiii Tee €'drim&/'c:a>ait Fte: Elec. P ernzat Fee: Hech.InspCldlr,r plumb I?np. Li Either Elec,Insp. B ch.Insp,Fee: Plumb, tans/,Fee: Elec,Insp..�ce: NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District .. These fees are based on the relimina information available and are onl an estimate. Contact the Dgpt. or addn'l in o. FEE ITEMS(Fee Resolution 11-053 Eff 7/1112) FEE QTY/FEE MISC ITEMS Pian Check Fee: $1,959.80 Select a Misc Bldg/Structure Suppl. PC Fee: Reg. OT O.Q hrs $0.00 or Element of a Building PME Plan Check: $0.04 Permit Fee: $674.14 Suppl. Insp.Feer Reg. 0 OT F-01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t;onstruction 7axr Administrative Ilee: 0 Work Without Permit? 0 Yes (j) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Z7v��rrantr: if>rr:lres. Building or Structure 0 StrongMotion Fee: IBSEISMICO $73.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $14.00 77; 77 uBTOTAL : ; $2,721.44 $0.00 To E : $2,721.44 Revised: 01/01/2013