12120066 CITY OF CUPERTINO BUILDING PERNIIT
BUILDING ADDRESS: 20400 MARIANI AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO:12120066
OWNER'S NAME: MISSION WEST PROPERTIES 851 BUCKEYE CT DATE ISSUED:12/20/2012
OWNER'S PHONE: 4088628234 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL0
License Class i Lie.#-.-- " ' ^ C_ r -o APPLE-COMMERCIAL TENANT IMPROVEMENT
NON-STRUCTURAL INCLUDES ELECTRICAL ONLY
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 DEFERRED#1-STOREFRONT GLAZING-ISSD OTC
(commencing with Section 7000)of Division 3 of the Business&Professions 6/6/2013
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$100000
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:31622018.00 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 WIT 80 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 180 D OM LAST CALLED 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 by: Date: es/
with all non-point source regulations per the Cupertino Municipal Code,Sectio
9.18. r -;
,J C RE-ROOFS:
Signature `� 8 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)
I,as owner of the property,am exclusively contracting with licensed contractors to _,- HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). e'read the hazardous materials requirements under Chapter 6.95 of the
California Health Sc Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the fo �` maintai ance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: &Safety Cole,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for orker material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Lab ;` 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 compliancew" a Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code;,Secti ns25 O5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: r/p
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 BUILDING PERMIT
BUILDING ADDRESS: 20400 MARIANI AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO:12120066
OWNER'S NAME: MISSION WEST PROPERTIES 851 BUCKEYE CT DATE ISSUED:12/20/2012
OWNER'S PHONE: 4088628234 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class_ Li..#
;, ` `. APPLE-COMMERCIAL TENANT IMPROVEMENT
. f ` N-STR ICT RA^L INCLUDES ELECTRICAL ONLY
Contractor Date t d REVISION#1-INT.NON-STRUCTURAL T.I.W/EL
I hereby affirm that I am licensed under the provisions of Chapter 9 k
(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:$100000
I have and will maintain Worker's Compensation hisurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31622018.00 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 DY HERMIT 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 DAY O ST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses wl}icl}in , accrue against said City in consequence of the
granting of tris perm?� Additionally,the applicant understands and will comply IsstyeeYby: Date:
with al non- omt soirrce regfilations per the Cupertino Municipal Code,Section r
9.18.
I 'y 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.
❑ 6WNER-BUILDER DECLARATION
I hereby affirm that I 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
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. 1 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 equip Ont 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 4rea''Air/Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with tl�e,Cuportini)Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25S05,255 3,and 25534. �
Section 3700 of the Labor Code,for the performance of the work for which this \ / J'
Owner or authorized agent: L \ v_ 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 CONSTRUCTs(•N 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
+j
i
V
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
W;�PERMITTYPE:
DDRESS: 20400 MARIANI AV DATE: 01/24/2013 REVIEWED BY: MELISSA
PN: 316 22 018 BP#: / Q *VALUATION: $0
Building Permit PLAN CHECK TYPE: Addition
PRIMARYPENTAMATION
USE: rSFD '[3upiX, PERMIT TYPE: 1GENRE
ESc,
ORK REVISION #1 - IN NON STUCTURAL T.I. IMPROVEMENTS W/EL CHANGES
OPE
Vfech.Plan Check P(zrrrrb. Plan Check Dec.Plan Check
If"h_ ller-mi[ r
Fee: Pktzb. Permil Fee: Flee.Pernlir 1'ce:
0 0rher rklech,Insp. Other Plumb h-up. 01her Elec.Insp.
,Iyech.ln�p.Fee: Plumb. Tnslz 17"e: Elec.Inzp,Fee:
NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelimina information available and are only an estimate Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E f 7/1112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: Q Reg. Q OT0.0 hrs $0.00 $133.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. Q OT ro 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C,0E lsll i1CZt{I Tax:
Work Without Permit? 0 Yes (D No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
I'ru 'r r crfc, ees: Building or Structure 0
i
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $133.00 TOTAL FEE: ' $133.00
Revised: 10/01/2012
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 MARIANI AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO:12120066
OWNER'S NAME: MISSION WEST PROPERTIES 851 BUCKEYE CT DATE ISSUED:12/20/2012
OWNER'S PHONE: 4088628234 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class -1 Lie.# }
Contractor € MECH RESIDENTIAL COMMERCIAL
bate 1 C3
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APPLE-COMMERCIAL TENANT IMPROVEMENT
(commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL INCLUDES ELECTRICAL ONLY
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:$100000
permit is issued.
APPLICANT CERTIFICATION APN Number:31622018.00 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 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 ofthis permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal de,Section
9.18. - s
7
Signature / Issued bx «�- Dater � --;•```;•---,,f'
m - 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
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
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. 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 I 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 ofthe 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 _- c_
become subject to the Worker's Compensation provisions of the Labor Code,I must Ow r.o�authorized agent
forthwith comply with such provisions or this permit shall be deemed revoked. 1- d
1 '
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 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 ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
EMaADDRESS: 29400 mariani ave. DATE: REVIEWED BY: bob s.
PN: BP#: "VALUATION: 1$100,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B TA
WORK t.i. comm offices ace non structural includes E only.
SCOPE
OCCUPANCY TYPE: TYPE . s.f.FLR AREA
CONSTR. PC FEES PC FEE ID BP FEES BP FEE ID
B (Tenant Improvements) II-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY Yes (•) No PLUMB,HOURLY Q Yes (j) No ELEC,HOURLY: ® Yes Q No
[L1ech.Plan Check Phfmb.Plan C beck T Elect.Plan Check
Fech.Nrnfit Fee. Plumb.Pear it fee: Llec.Per-mit Pee:
Other Afech.Lisp- Other Plumb Insp. F Other Elec.Insp. Li
�11ech.Lnp.Fee: Plumb. 11rsp.Fee: Elec.Insp,Foe:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These-Ts are based on the prelimina information available and are only an estimate. Contact the De t or addn I info.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? (Yes Q No $0.00 �2 hours Plan Check,Hourly
Suppl.PC Feer Reg. ® OT 1 0.0 1 hrs $0.00 $266.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp.Fee-0 Reg. ® OT 0.01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consttzrction Tax:
€drninistrative Fee: 0
Work Without Permit? 0 Yes (j) No $0.00 G
Advanced Planning Fee. $0.00 Select a Non-Residential G
Ar~ttel�oczrf;unturier�fees: Building or Structure 0
i
Strong Motion Fee: 1BSEISMIC0 $21.00 15.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $4.00 $1,995.00 ISTINSP Inspection,Hourly
SUBTOTALS: 1 $25.001$2,261.001 TOTAL FEE: 1 $2,286.00
Revised: 10/01/2012