12060077 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20620 HOMESTEAD RD CONTRACTOR:SOUTH BAY PERMIT NO: 12060077
CONSTRUCTION,INC
OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED:03/01/2013
OWNER'S PHONE: 4084460700 CAMPBELL,CA 95008 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATIOONN JOB DESCRIPTION: RESIDENTIAL Ll COMMERCIAL
License Class Lic.# ��f— DEMO OF EXISTING RITE AID AND PW MARKET 10773
' SQFT
Contracto Dat /'
I hereby affirm that I am licensed der the provi ' ns of Chapter 9
(commencing with Section 7000) Division 3 of the Business&Professions
Code and that my license is in fu 1 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 Arca: Valuation:$500000
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:32610060.20620 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 RMIT 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 18 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
granting of this permit. Addition3"e applicant understands and will comply lss by: Date: 7 1
with all non-point source regu 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-BUILDER DECLARATION
I hereby affirm that 1 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
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(See.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). 1 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
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
performance of the work for which this permit is issued. will maintain compliance with the Cuperti unicipal Code,Chapter 9. 2d
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co ,Sections 255 ,2 nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: ate:
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,] 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.
Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20620 homestead rd. DATE: 06/13/2012 REVIEWED BY: bobs,
APN: BP#: A0Cv00 `VALUATION: 1$500,000
*PERMIT TYPE: Demolition Permit PL,4N CHECK TYPE:
PRIMARY Commercial Building PENTAMATION 1COMMLDEM
USE: PERMIT TYPE:
woRK demo of exisiting rite aid and pw market 107732 s.f.
SCOPE
FEE ID FLR AREA
s.f.
1 DEMOCOM 10,773
Mech. Plan Check Phmrb. Plan Check Elec.. Plan Chexk
ibtech.Permit fee: 7P/11-117permit Fee: Flee, Permit Fre'
01110r,19c•rh. ln.rp. Oiher Plumh Insp. Lj Other Elec. Insp.
klech. hujs , fee: Plumb, Insp. Fee: Flex. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7fl /1/Il) FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
Suppl. PC Fee
Phanb.lklech./Llec
Permit Fee: $1,303.00
Suppl. Insp. Fee-.0 Reg. Q OT 0.0 his $0.00
Plumb.Afech./Flec
Plurnh.Mech./Elec Permit Fee:
Construction Tax:
Administrative.Fee:
Work Without Permit?
,ldvaneed Plcrrnling Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICO $105.00 Select an Administrative Item
Bldp- Stds Commission Fee:_ 1BCBSC $20.00
SUBTOTALS: $1,428.00 $0.001 TOTAL FEE: 1 $1,428.00
Revised: 06/05/2012