13050128 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19925 STEVENS CREEK BLVD CONTRACTOR:DEVCON PERMIT NO:13050128 .
CONSTRUCTION INC
OWNER'S NAME: STEVENS CREEK INVRS LLC 690 GIBRALTAR DR DATE ISSUED:05/16/2013
OWNER'S PHONE: 4084990223 MILPITAS,CA 95035 PHONE NO:(408)942-8200
e' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCI4,L0
don
License Class Lic.# �1pAPPLE-IST FLOOR-COMM.T.I TO INCLUDE REMODEL
��, OF BREAKROOM
Contractor Date REVISION#1-REDUCE SCOPE OF WORK;CHANGE
I hereby affirm that I am licensed under the provisions of Chapter 9 MILLWORK,VENDING MACHINE LOCATION,ISLAND&
(commencing with Section 7000)of Division 3 of the Business&Professions DOWNLIGHTS ABOVE ISLAND-ISSUED 7/22/2013
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:$150000
Ue 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:31621089.00 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 DAYS OF T 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 FR LLED 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 �—(ZZ
granting of this permit. Additionally,the applicant understands and will comply I ate:
with all non- oint ource regulations per theC, rtino Municipal Code,Section
9.18.
RE-ROOFS:
Signa 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(See.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 the Health&Safety Code,Se ' n 5505,25533,a 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized ag nt: Date:
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
REM
ISION
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISIONFM
s
ADDRESS: 19925 STEVENS CREEK BLVD DATE: 07/10/2013 REVIEWED BY: MELISSA
APN: 316 21 089 BP#: VALUATION: $0
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PENTAMATION
PRIMARY SFD or Duplex 1GENRES
USE: PERMIT TYPE: e
WORK REVISION# 1 - REDUCE SCOPE OF WORK- CHANGE MILLWORK VENDING MACHINE
SCOPE LOCATION, ISLAND & DOWNLIGHTS ABOVE ISLAND
LTec77.Plan Check 1'Irftrrb. plan Check Elec.Plan Check
l tech.Permit Fee: Plumb.Permit Fee: Flec. perrniz Fee:
Ozl%ter•Alech.Insp. Other Plumb Insp. Other Elec.Insp.
"Meeh.Lnsp.Fae: plumb. Imp.Fee: Glee.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS(Fee Resolution 11-053 Eff. 711/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j)No $0.00 C� hours Plan Check,Hourly
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $278.00 ISTPLIVCK
�:]....
PNM Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee-.(E) Reg. Q OT k.0 hrs $0.00
PNM Unit Fee: $0.00
PME Permit Fee: $0.00
t,2lnis r i e- ee:
Work Without Permit? 0 Yes E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential '•`
Building or Structure 0
-F=
Travel DouzCI7'7c 17 117f?11 eLS:
Strong-Motion Fee: $0.00 Select an Administrative Item
Bld¢Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $278.00 TOTAL FEE: 1 $278.00
Revised: 07/01/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19925 STEVENS CREEK BLVD CONTRACTOR:DEVCON PERMIT NO:13050128
CONSTRUCTION INC
OWNER'S NAME: STEVENS CREEK INVRS LLC 690 GIBRALTAR DR DATE ISSUED:05/16/2013
OWNER'S PHONE: 4084990223 MILPITAS,CA 95035 PHONE NO:(408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Class Lic.# APPLE-1ST FLOOR-COMM.T.I TO INCLUDE REMODEL
OF
Contractoryice Date
�// 2 BREAKROOM
I hereby affirm that I am licensed under the provisions of 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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$150000
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:31621089.00 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 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 DA 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: Dater '
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. _
RE-ROOFS:
Signatur Date `S �6/f 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 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,Sec
,pp"25505,2553 34.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agen 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 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
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19925 STEVENS CREEK BLVD DATE: 05/16/2013 REVIEWED BY: MENDEZ
APN: BP#: 130, /a VALUATION: $150,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B T®
WORK I APPLE- COMM. T.I TO INCLUDE REMODEL OF BREAKROOM
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.L
B (Tenant Improvements) II-B,111-B,IV,V-B 661 $1,969.60 IBTIPLNCK $801.28 1BTII1VSP
TOTALS: 661 $1,969.60 $801.28
MECH,HOURLY 0 Yes G No PLUMB,HOURLY 0 Yes E) No ELEC,HOURLY 0 Yes No
L1Cc]r. ,z3tan Check Plrr,°trb. Plan C heck Fe%.Plon Check
1411—h. Permit I'ec Plumb.Permit Fee: Etc:_•. PermiX Fee:
GiheF ii'lec'h.Insp. Otl;e'r phinzb hesp. E1__L_ Oiher Elec.Insp.
lUlech.Itgsp. Fee: PlzuiA hup.Tee: Elec.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(La Plannina Public Works,Fire,Sanitary Sewer District,School
District,eta). These ees are based on the relimina information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,969.60 Select a Misc Bldg/Structure
Suppl.PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $801.28
Suppl. Insp.Fee:) Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
",.
0rZSti-ZICiZ0:2 C71:
0
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel OCL"me"vati n Fees:
Building or Structure 0
i
Strong Motion.Fee: IBSEISMICO $31.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $6.00
SUBTOTALS: $2,808.38 $0.00 TOTAL FEE: 1 $2,808.38
Revised: 04/29/2013