12110163 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10181 BU13B RD CONTRACTOR:XL CONSTRUCTION PERMIT NO:12116163
OWNER'S NAME:.DEVCON/BUBB RD INVESTORS 851 BUCKEYE CT DATE ISSUED:04/10/2013
OWNER'S PHONE; 4089961010 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
License'Class Lic.4 6171RY0 10181 & I0161 BUBB-APPLE-TENANT IMPROVEMENT
(14532 SQ FT); 318 SQ FT ADDITION(FILL IN
Contractor YL L..1,4 Tri'Iii 110 JV Date i r /Ci 2.1; ALCOVES); REMOVE AND REPLACE BUILT UP ROOFING
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Seetion 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:
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:$25000000
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:35720005.10181 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 18 D YS 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 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 non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date v" All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's Lieense 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. 1 will
I hereby affirm under penalty of perjury one of the following three maintain complianee with the Cupertino Municipal Code,Chapter 9.12 and the
deeiarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
1 have and wi11 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 1
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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent c Date:
permit is issued.
1 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
mdcnimfi.and kee harmIcss,the Ci ty•of Cupertino a ainst liabilities,judgments, ARCHITECTS DECLARATION
costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public reeords.
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: 10161 Bubb rd DATE: 11/30/2012 REVIEWED BY: gs
APN: BP#: 'VALUATION: $2,400,090
PEPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1113 Ti
USE: PERMIT TYPE:
WORK Z 1
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-B,111-B,IV,V-B 14,532 $2,745.44 IBTIPLNCK $7,704.64 1BT11NSP
TOTALS: 14,532 $2,745.44 $7,704.64
MECH,HOURLY () Yes Q No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No
Mech. Plan Check Phan6. Plun Cheek Elec, Plan Check
iLt-errui!Fete: Plumb.Permit Fec Elee.Permit Fele:
01her Heck. Insp. Other Plumb Insp. Lj Other Elee.Insp. ET_L_
Ilech,Insp.Fie- Phanh_ brsp. Tee: Elec.Insp.Flee:
NOTE: This estimate does not include fees due to other Departments(Le. Planning, Public Works, Fire,Sanitary Sewer District,School
District,eta), 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 Eff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,745.44 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $7,704.64
Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Adininisirative.Fee: Q
Work Without Permit? Q Yes (F) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Trovel Documentation Fees: Building or Structure Q
i
Strong Motion Fee: IBSEISMICO $504.02 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $97.00
SUBTOTALS: 11,051.10 $0.00 TOTAL FEE: 1 $11,051.10
Revised: 10/01/2012
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10161 Bubb rd DATE: 1113012012 REVIEWED BY: gs
APN: BP#: *VALUATION: $10,000
W"PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY g Civil/Religious activities PENTAMATION
USE: Commercial Building in BQ zone. Yes �No PERMIT TYPE: 1 BOFF
� � �
WORK 318 s ft addition
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.L
B (Offices) II-13,111-13,IV,V-13 318 $5,560.00 IBOPLNCK $1,696.00 IBOINSP
TOTALS: 318 $5,560.00 $1,696.00
Much. Plan Check Phunb. Plan Check FT Elec, Plan Check
Flech. Perwil Fee: Phrmb. Permil Fee: lilies. Pernlu Fee:
Other Mech. Insp. EIF--L- Other Plumb Insp, Other Dec. Insp. Li
;t,lech. hasp. Fe Plumb. hisp. Fee: Elev. Insp. Fee:
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 prelimina information available and are onI an estimate. Contact the Dept./or addn'l info.
FEE ITEMS (Fee Resolution 11-053 LY1 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $5,560.00 Select a Misc Bldg/Structure
Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,696.00
SuppI. Insp. Fee.e Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax: 1BCONSTAXC $864.96
Adrninistrative Pee:
Work Without Permit? 0 Yes (F) No $0.00 G
Advanced Planning Fee: IPLLONGC $85.86 Select a Non-Residential 0
Travel Documentation Fees: Building or Structure O
A
Strong Motion Fee: IBSEISMICO $2.10 Select an Administrative Item
Bldjz Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $8,209.92 $0.00 TOTAL FEE: $8,209.92
Revised: 10/01/2012