11070002 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10562 S DE ANZA BLVD CONTRACTOR: PERMIT NO: 11070002
OWNER'S NAME: BYER PROPERTIES 4o t y�,&& ATE ISSUED:07/29/2011
IER'S PHONE: 4156262937 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
License Class-:T>- Lic.#
BUILDING PERMIT INFO: BLDG r ELECT PLUMB
��p 3�
MECH r- RESIDENTIAL COMMERCIAL
Contractor -C 6'. k ItDate 7 " 2--A -2d!
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FIDELITY NATIONAL TITLE-T.l(3100SQFT}INTERIOR
(commencing with Section 7000)of Division 3 of the Business&Professions MINOR PLUMBING,NON-STRUCTURAL METAL STUD WALLS,
Code and that my license is in full force and effect. T-BAR,FIRE SPRINKLERS,CARPETING NON-STRUCTURAL
1 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:$120000
permit is issued.
APPLICANT CERTIFICATION APN Number:36938037.10562 Occupancy Type:
1 certify that 1 have read this application and state that the above information is
correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signaurf e` Date - Z - �c r Issued by: Date:
L OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
All roofs shall be inspected prior to any roofing material berg installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,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:
I,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
1 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&SafetyCode,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
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will
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.
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 Owner or aut orized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. -dr-- Date: - Z`�-ZG� Y
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of mmork'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
cc -mnd expenses which may accrue against said City in consequence of the
g o of this permit.Additionally,the applicant understands and will comply
mtiitn all non-point source regulations per the Cupertino Municipal Code.Section ARCHITECT'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
(LffTY OF (CU]FIEILBUN®
FEE IESTM1ATOR—HUIDLMN G DffVffSffON
ADDRESS: 10562 s.de anza blvd. DATE: 0412612012 REVIEWED BY: bobs.
APN: BP#: DDD *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK revise floor layout, occupancy calcs exterior access. upgrades.
SCOPE
FlFech, pe)'C)'!i%I'aL': rDf ono. Tee:
O;ii:'1'LJ .r fall Fiji I'-NP. LJ r.�%r:P3'1:;%?:'...h
El
C;e"'. hisj 1-
(:NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . Thesefees are based on the relimina information available and are onlan estimate Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 1.1-053 Hit: 7-1111) FEE QTY/FEE I' ISC ITEMS
Plan Check Fee: Hourly Only? (E)Yes () No $0.00 2 hours Plan Check,Hourly
Suppl. PC Fee: (D Reg. OT Q.Q hrs $0.00 $260.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. OT Q Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? C) Yes No $0.00
Advanced.Planning Fee: $0.00 Select a Non-Residential G
";ar-;E :Fzt.zrara��rtrztrf�;"� �elBuilding or Structure
d
Strom Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SU BTOTA]LS:' $0.00 $260.00 TOTAL>F>E>E $260.00
Revised: 04/01/2012
RMOON
CITY OF CUPERTINO BUILDING PERMIT P)ATE
BUILDING ADDRESS: 10562 S DE ANZA BLVD CONTRACTOR:P&T GENERAL PERMIT NO: 11070002
CONSTRUCTION CO INC
OWNER'S NAME: BYER PROPERTIES LP PO BOX 4786 DATE ISSUED:07/29/2011
OWNER'S PHONE: 4156262937 SAN JOSE,CA 95150 PHONE NO:(408)224-4655
❑ LICENSED CONTRACTOR'S BUILDING
f—
��� � ILDING PERMITINF®: BLDG ELECT PLUMB
License Class Lic.# 0
r ry MIECII RESIDENTIAL COMMERCIAL
Contractor Y .C Date
herebyaffirm that I am licensed under the provisions of Chapter 9 JOBB DIESCRI?TION:FIDELITY NATIONAL TITLE-T.I(3I00SQF-I)-INTERIOR
ap p MINOR PLUMBING,NON-STRUCTURAL METAL STUD WALLS,
(commencing with Section 7000)of Division 3 of the Business&Professions T-BAR,FIRE SPRINKLERS,CARPETING NON-STRUCTURAL 4/26/2012-REV#I -REVISE FLOOR LAYOUT,
Code and that my license is in full force and effect. OCCUPANCY CALCS,EXTERIOR ACCESS UPGRADES-5/09/2012 REV#I ISS'D
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
permit is issued. Sq.Ft Floor Area: Valuation:$120000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:36938037.10562 Occupancy Type:
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 S']['AR'][']ED
costs,and expenses which may accrue against said City in consequence of the WITHIN ��® ���� OF PERMIT �������� ®�
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][,AST CALLED INSPECTION.
9.18.
Signature Date I Zy C� Issued by: , ���� ��Z Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
Signature of Applicant: Date:
I,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 thisSafety 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
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,1 must Owner thorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT 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%ork'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
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CETY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10562 S DE ANZA BLVD CONTRACTOR: PERMIT NO: 11070002
OWNER'S NAME: BYER PROPERTIES g L49,t_Cr/ ATE ISSUED:07/29/2011
OWNER'S PHONE: 4156262937 PHONE NO:
❑ LICENSED CONTRACTO/R'S,D)ECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB F
License Class " Lic.# &' 3"i'1/ 3 r "
t MECH RESIDENTIAL COMMERCIAL
Contractor 4—T 41,11, .� fL A't� -00/f- Date � `�r1 � �f
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FIDELITY NATIONAL TITLE-T.1(3100SQFT}INTERIOR
(commencing with Section 7000)of Division 3 of the Business&Professions MINOR PLUMBING,NON-STRUCTURAL METAL STUD WALLS,
Code and that my license is in full force and effect. T-BAR,FIRE SPRINKLERS,CARPETING NON-STRUCTURAL
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:$120000
permit is issued.
APPLICANT CERTIFICATION APN Number:36938037.10562 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
E➢D
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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 180 DAYS FROM LAST CALLED ffNSP ECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Sign ur�f e[ � Date���t 1 Issued by: [ C�i�T'� Date ��
❑ 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 a 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: HAZARDOUS MATERIALS DISCLOSURE
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 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. I 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 1 store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. 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.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,1 must Owner or aut orized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. e� Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of wrk'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 ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
FEE IES71MA70R—BUR LDING DRV]ISRON
ADDRESS: 10562 s.de anaa blvd. DATE: 07/01/2011 REVIEWED BY: bobs.
APN: 16P#: VALQJATI®1V: 1$120,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 B TI
USE- PERMIT'TYPE:
WORK �t.i. comm banks ace incudes minor plumbing,mechanical electrical t-bar. non load bearing walls.
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC]FEE IID BP]FEES BP FEE IID
CONSTR. s.f.
B (Tenant Improvements) II-B,III-B,IV,V-B 3,100 $2,107.20 1BTIPLNCK $2,385.56 1BTIINSP
TOTALS: 3,100 $2,107.20 $2,385.56
MECH,HOURLY () Yes E),No PLUMB,HOURLY ()_Yes Q No lE]L]EiC,1EI®tJRLY Q Yes 0 No
Hf.."J,?. lliao("'F2d. li(b:Jl(.�✓(iC1"
j5J'±;7i1 tern., 1`�f.'e c. tTr;nw,;r 1''ec."
NOTE. These ees are based on the prelindnary information available and are on!E an estimate. Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 09-051 h'ff 71'1110J FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,107.20 Select a Misc Bldg/Structure
Suppl. PC Fee: E) Reg. 0 OT 1 0.0 1 hrs $0.00
or Element of a Building
PME Plan Check: $0.00
Permit Fee: $2,385.56
Suppl.Insp.Fee10 Reg. 0 OT ELI hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(,ouS!v tct,I,w? Tall
Acoustical Fee: 0 Yes 0 No $0.00 Q
Work Without Permit? Q Yes (D No $0.00
i'lannin $0.00 Select a Non-Residential Q
1"r°car¢f.l:)tu;trrnF>ntt?tic3rt 1'e�>s Building or Structure 0
e
Strong Motion Fee: IBSEISMICO $25.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $5.00
SUBTOTALS: $4,522.96 $0.00 ,. tOTAIL IFIE]E $4,522.96
Revised: 04/29/2011