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12060078CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20576 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 12060078 CONSTRUCTION, INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED: 03/05/2013 OWNER'S PHONE: 4084460700 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �31�t ADDRESS CHANGED TO 20574 HOMESTEAD (FORMERLY License Class_ Lie. # 20576) CONSTRUCT NEW PARKING LOT, LANDSCAPE, �V� �S�zj� 4 Contractor— >>. Date UNDERGROUND UTILITIES, 22 PARKING LIGHTS, 6 TRASH I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 7/24/2014- REVISION #4- MISC. PARKING LOT REVISIONS, NEW Code and that my license is in full force and effect. COMPACTOR ENCLOSURE ADDED FOR MAJOR 2- ISSD 8/22/2014 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 Sq. Ft Floor Area: Valuation: $5000000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by tion 3700 of the Labor Code, for the performance of the work for which this APN Number: 32610060.20576 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 1g DAY F 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 DAYS F OM T CALLED IN SP CTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ally, the applicant understands and will comply granting of thi • ermAeafions Issued by: Date: v with all n - of it soper the Cupertino Municipal Code, Section 9.18 RE -ROOFS: Signature Date 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) 1, 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 wit the Cupertino unicipal Code, Chapter 9.12 and 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 the Health & Safety Code, Se ns 55 _, 3, and 25534. Owner or authorized agent: 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 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, 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 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 CUPE, RTINO FM -7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20576 homestead rd FEE DATE: 07/24/2014 REVIEWED BY: Mendez APN: BP#: 'VALUATION: 1$85,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 0.0 hrs PENTAMATION PERMIT TYPE: WORK 7/24/2014- REVISION #4- MISC. PARKING LOT REVISIONS NEW COMPACTOR ENCLOSURE SCOPE ADDED FOR MAJOR 2 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the areliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E '. 7%1,13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 4 Q Work Without Permit? Q Yes ) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i Strong Motion Fee: 1BSEISMICO $23.801 # $859.00 Revisions IREVCOMNEW Commercial New Blda Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $27.80 $859.001 TOTAL FEE: 1 $886.80 Revised: 07/10/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20576 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 12060078 CONSTRUCTION, INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED: 03/05/2013 OWNER'S PHONE: 4084460700 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E]COMMERCIAL ❑ CONSTRUCT NEW PARKING LOT, LANDSCAPE, License Class Lic. # (� ��� UNDERGROUND Contractor � Date 3 UTILITIES, 22 PARKING LIGHTS, 6 TRASH ENCLOSURES I hereby affirm that I am licen's d under the provisions of Chapter 9 9/3/13 - REVISION # 3 - REVISE PARKING LOT WITH (N) (commencing with Section 7000) of Division 3 of the Business & Professions LO G DOCK & (N) TRASH ENCLOSURE- ISSD 3/5/2014 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two decla . I have and will maintain a certificate of consent to self -insure for Compensation, as provided for by Section 3700 of the Labor Co or! Sq. Ft Floor Area: Valuation: $5000000 performance of the work for which this permit is issued. Q 0 ave and will maintain Worker's Compensation Insurance, as proZided for by or 3700 of the Labor Code, for the performance of the work for which this APN Number: 32610060.20576 Occupancy Type: perm 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 WIT HI180 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 IgO DA S FO I.A I`CALLED INSPC ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 2 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -poi so e u tions per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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-1311ILDER DECLARATION Signature of Applicant: Date: [ 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(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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, StVtJonj 25505, 25P33, and 25534. '—" Owner or authorized ag t 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 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 1 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 FM__1 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept_for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf 711/12) 20576 HOMESTEAD RD DATE: 09/03/2013 REVIEWED BY: MELISSA326 10 1WADDRESS: APN: 32610 060 BP#: *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: bl"!% ". . PENTAMATION 1GENCOM PERMIT TYPE: 14 WORK REVISION # 3 - REVISE PARKING LOT WITH N LOADING DOCK & N TRASH ENCLOSURE SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept_for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf 711/12) frc.rt_ Pi QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? © Yes Q No $0.00 2 hours Plan Check, Hourly $278.00 /STPLNCK Ll Suppl. PC Fee: C) Reg. Q OT 0.0 bl"!% ". . NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept_for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? © Yes Q No $0.00 2 hours Plan Check, Hourly $278.00 /STPLNCK Suppl. PC Fee: C) Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ® Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT O Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 07 r40:: 4' 1"Cu. 4 E) Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 'ri f" t3netu�;I�a,��h���i� `t't-;- Strong Motion Fee: $0.00 0.0 hrs $0.00 Inspections Inspection, Hourly Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $278.00 TOTAL FEE. $278.00 Revised: 07101/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20576 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 12060078 CONSTRUCTION, INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED: 03/05/2013 OWNER'S PHONE: 4084460700 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL 11 License Class Lie. # p�%� CONSTRUCT NEW PARKING LOT, LANDSCAPE, UNDERGROUND Contrac Date O UTILITIES, 22 PARKING LIGHTS, 6 TRASH ENCLOSURES I hereby affirm that I am licens under the pro ' wns of apter 9 5/29/2013- REVISION #2- REVISE UNDERGROUND (commencing with Section 7007, of Division 3 of the Busi ss & Professions UTILITIES - ISSUED 7/10/2013 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 Sq. Ft Floor Area: Valuation: $5000000 performance of the work for which this permit is issued. 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 permit is issued. APN Number: 32610060.20576 Occupancy Type: 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. l agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS O ERMIT 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 DAYSyA0TVn CALLED INSPECTION. indemnify and keep harmless the Ci of Cupertino against liabilities, judgments, costs, and expenses which m cc r against said City in consequence of the p 1 granting of this permit. ition the applicant understands and will comply Iss Date: th all non -point sour re ions er the Cupertino Munici Co Section 8. .- RE -ROOFS: Signa e 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. 11OWNER-BUILDERDECLARATION 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 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 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 /Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuper, ' nicipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Sections , an�25534. 3700 of the Labor Code, for the performance of the work for which this �Section Owner or authorize ent: Dat/-�J 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 1 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 FEW FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School I)ivtrirt otr_ L Thovo foov aro ha.vod an tho nroliminary information availahle and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 711;112) 20576 homestead rd DATE: 05/29/2013 REVIEWED BY: MENDEZ 1WADDRESS: APN: BP#. *VALUATION: 1$60,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: Suppl. PC Fee: (F) Reg. Q OT PENTAMATION PERMIT TYPE: WORK REVISION #2- REVISE UNDERGROUND UTII-ITIES SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School I)ivtrirt otr_ L Thovo foov aro ha.vod an tho nroliminary information availahle and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 711;112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C`or7c�;rutir;r� lu.�.° rIL/i 1iilF.i'l!'Gd7PiC 1 C'{': Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) Strong Motion Fee: 1BSEISMICo $12.60 F 1 # $799.00 Revisions 1REVCOMNEW Commercial New Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $15.60 $799.00 TOTAL FEE $814.60 Revised: 04/29/2013 CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 20576 HOMESTEAD RD DATE: 03/1212013 REVIEWED BY: MELISSA MISC ITEMS APN: 32610 060 BP#: 'VALUATION: 1$90,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 0.0 PENTAMATION 1GENCOM PERMIT TYPE: WORK REVISION # 1 - RELOCATION OF UTILITY SERVICES FOR SITE. SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School ll:ctrint om 1 Thoco fa aro haeod nn tho nrolim;"any iafnrmatinn availahlo and aro n"k nn octimnto_ Cnntart tho Dont fnr addn'l info_ FEE ITEMS (Fee Resolution 11-053 E j: 7/I/12� FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 hours $0.00 Plan Check, Hourly Suppl. PC Fee: Q Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -(E) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 OtiSlCi-(('L1011 Tcl.`;: r1C�111U1t51/'[llll'� /''[: G Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure , Iroi c I�car r.n;t� °zrr;irrr cr�.1: Strong Motion Fee: IBSEISAffCO $18.90 F-1-1 # Revisions $799.00 IREVCO�MTI7 Tenant Improvement Bld;? Stds Commission Fee: IBCBSC $4.00 SuBTOT'ALS: ' $22.90 $799.00 TOTAL FEE: $821.90 Revised: 01/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20576 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 12060078 CONSTRUCTION, INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED: 03/05/2013 OWNER'S PHONE: 4084460700 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 ❑ LICENSED CONTRACTOR'S DECCLLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL License Class 4�5 Lic. # CONSTRUCT NEW PARKING LOT, LANDSCAPE, UNDERGROUND Contracto 6/ Date � UTILITIES, 22 PARKING LIGHTS, 6 TRASH ENCLOSURES I hereby affirm that I am licensed u rder the prov' tuns o 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 Sq. Ft Floor Area: Valuation: $5000000 performance of the work for which this permit is issued. 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: 32610060.20576 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 to building construction, and hereby authorize representatives of this city to enter WITH 80 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DA ROM LAST CALLED IN SP CT ON. 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 by: Date: with all non -point so re lations per the Cupertino Municipal Code, Section 9. 8. Signature RE -ROOFS: 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(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 comp Vance with the Cu no Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safe Code, Sectio , 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized age Da 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 FM -W FEE ESTIMATOR - BUILDING DIVISION NOTE. This estimate does not inchcde fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Devt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7%1/11) ADDRESS: 20576 homestead rd. DATE: 06/1312012 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$5,000,000 ,' PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building USE: 1 hrs PENTAMATION 1GENCOM PERMIT TYPE: WORK construct new parking lot landscape, underground utilities 22 parking lights, 6 trash enclosures. SCOPE F 22 Electrical $308.00 1BREMPOLE Fixtures, Platform NOTE. This estimate does not inchcde fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Devt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7%1/11) FEE Plumb. Plan Check 0.0 1 hrs $0.00 Plumb. Permit Fee: IPPERMIT Other Plumb Insp.0.0 hrs $44.00 Elec. Plan Check 0.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elea Insp. 0.0 hrs $44.00 NOTE. This estimate does not inchcde fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Devt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7%1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 4 hours Plan Check, Hourly $520.00 ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F 22 Electrical $308.00 1BREMPOLE Fixtures, Platform Permit Fee: Hourly Only? (E) Yes 0 No $0.00 Suppl. Insp. Fee.0 Reg. OT 0.0 hrs $0.00 ©# Shed 1 $2,346.00 ]SHED PME Unit Fee: $0.00 PME Permit Fee: $88.00 = # Plumbing $44.00 IPCSEWER Sewer, Sanitary Administrative Fee: IADMIN $41.00 E) Work Without Permit? Yes 0 No $0.00 Advanced Planning Fee. $0.00 4 hours Inspections $520.00 ISTINSP Inspection, Hourly E) Travel Documentation Fee: ITRAVDOC $44.00 Stronp, Motion Fee: IBSEISMICO $1,050.00 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $200.001 SUBTOTALS: $1,423.001$3,738.00 TOTAL FEE: 1 $5,161.00 Revised: 06/05/2012