13050144 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10605 N WOLFE RD CONTRACTOR:ZELHAM INC PERMIT NO: 13050144
OWNER'S NAME: MARCHESE CHRIS TRUSTEE&ET AL 121 E 50TH ST DATE ISSUED:08/14/2013
OWNER'S PHONE: 2407445285 BOISE,ID 83712 PHONE NO:(208)658-1700
El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALS
License Class Lic.# w T.I.TO REMOVE(E)SPA AND CREATE(N)EXERCISE
ROOM(592 S.F.),ADD CIRCUITS AND OUTLETS FOR
Contractor"" ( Date t' EXE I EQUIPMENT
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions INST L PONY WALL IN REPLACEMENT OF PERMANENTLY
Code and that my license is in full force and effect. f D EXTERIOR DOORS-ISSD OTC 8/29/2013
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. .0Sq.Ft Floor Area: Valuation:$44000
1 have and will maintain Worker's Compensation Insurance,as provided
Section 3700 of the Labor Code,for the performance of the work for wthi, APN Number:31647019.00 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 DAY F 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:
with all no - of t so rce egulations petthe 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
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(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 wi he Cupertino Municipal Code,Chapter 9.12 a d
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S 0 25 11 ,25533,a 5534.
Section 3700 of the Labor Code,for the performance of the work for which this i
Owner or authorized agent: _ Date
permit is issued.
r ~
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.
I
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10605 N WOLFE RD CONTRACTOR:ZELHAM INC PERMIT NO: 13050144
i
OWNER'S NAME: MARCHESE CHRIS TRUSTEE&ET AL 121 E 50TH ST DATE ISSUED:08/14/2013
i
OWNER'S PHONE: 2407445285 BOISE,ID 83712 PHONE NO:(208)658-1700
El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALS
License Class Lia# T.I.TO REMOVE(E)SPA AND CREATE(N)EXERCISE
ROOM(592 S.F.)
Contractor 1=4_��1� Date
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:$44000
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:31647019.00 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 DAYS FROM 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 fV)ldi
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: a•�/•���
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date__jo All roofs shall be inspected prior to any roofing material being installed.If a roof is
71
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-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)
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(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 'ons 25505,25533,and 25 34.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: —.t� 'Pate: E
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, ARCHITECTS 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
i
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10605 North Wolfe Road DATE: 05/21/2013 REVIEWED BY: Sean
APN: BP#:
/ *VALUATION: 1$44,000
,
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1A T®
WORK Tenant Improvement to removes a and create exercise room 592 sq ft).
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (s.f.)
A(Tenant Improvements) II-B,111-B,IV,V-B 592 $2,270.41 IATIPLNCK $589.45 1ATHNSP
TOTALS: 592 1 $2,270.41 1 1 $589.45
MECH,HOURLY O Yes '_O No; PLUMB,HOURLY Q Yes 'Q No ` ELEC,HOURLY Q Yes Q No
Ade 'I,PIa1�r t:i(�O i�£raT),PI£�rt 'i?cr_�t, I lee.Purr
i't?±`ml 1I't'P: 'Ie!:.P£'rmi7 fl.,
q T /i f� / L'L':
Of w���h d)Ills`/', t_�1',tt_'1'�Ii.`f:.imp
E3
Pr`t,attt.Il,s, Fee: /roc:. T,rsp. 11kn:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Seiner District,School
District,etc.). These fees are based on the prelindnarj information available and are only an estimate. Contact the Dept./or addn'I info-
FEE
nfoFEE ITEMS (Fee Resolution 11-053 E{. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,270.41 Select a Mise Bldg/Structure
Suppl.PC Fee: (DReg. 0 OT f7O hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $589.45
Suppl. Insp.Fee:Q Reg, Q OT 0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes O No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure
Strong Motion Fee: 1BSEISWCO $9.24 Select an Administrative Item
Bld,g Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $2,871.10 $0.00 TOTAL FEE: 1 $2,871.10
Revised: 04/29/2013
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