13040050 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 MARIANI AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 13040050
OWNER'S NAME: MISSION WEST PROPERTIES 851 BUCKEYE CT DATE ISSUED:04/04/2013
OWNER'S PHONE: 4088628234 MILPITAS,CA 95035 PHONE NO:(408)240-61900
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# 0 T.I. FOR INTERIOR MECHANICAL& ELECTRICAL,NO
`l �j� STRUCTURAL CHANGES
Contractor Yt, ��i51 -tX%uDate '"J- 5/15/2013-REV# 1 TO CHANGE LOCATION OF EXITING
I hereby affirm that 1 am licensed under the provisions of Chapter 9 DOOR& MECHANICAL UNIT ISSUED OVER-THE-
(commencing with Section 7000)of Division 3 of the Business&Professions COUNTER
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 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:$200000
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 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 FJOWTAST 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 thes /j I
granting of this permit. Additionally,the applicant understands and will comply Issue y: Date: / f
with all non-point source regulations 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,1 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
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 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 1 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,Sections 25 05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this e
Owner or authorized agent: 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,l 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 1 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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20400 MARIANI AVE DATE: 05/15/2013 REVIEWED BY: MELISSA.
APN: 316 22 018 BP#: X30 ) 'VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK REV# 1 - CHANGE LOCATION OF EXITING DOOR & MECHANICAL UNIT
SCOPE
,blech. Plan Check Plumb. Plan Check Dec. Plan Check
A1tech. Penni!Fee: Plumh. Peimit Fee Dec,Permit Fee:
Other hfech. Ins/), Other Plumb Insp, 011rer Elce, Jnsp,
Alech, Imp. Fee: Plumb. hasp.Fee: Elec, Insp. Fare:
NOTE: This estimate does not include fees due to other Departments(ie.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'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? O Yes (F) No $0.00 r-17 hours Plan Check,Hourly
Suppl. PC Fee: (F) Reg. OT0.0 hrs $0.00 $133.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consor action.Ten-:
Adminlstralive Fee �
Work Without Permit? O Yes E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fees: Building or Structure
i
Strone Motion Fee: $0.00 Select an Administrative Item
Bldy-Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $133.00 TOTAL FEE: $133.00
Revised: 04/29/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 MARIANI AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 13040050
OWNER'S NAME: MISSION WEST PROPERTIES 851 BUCKEYE CT DATE ISSUED:04/042013
OWNER'S PHONE: 4088628234 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class C Lic.# � T. 1. FOR INTERIOR MECHANICAL&ELECTRICAL, NO
STRUCTURAL CHANGES
Contractor '�,L
hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business tic 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:
1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Codc,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$200000
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.1 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 F ST 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 r<
granting of is pe ' Additionally,the applicant understands and will comply b Rate:
with all non oint urea r talions per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatur Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,l agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
1 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(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Scc.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
1 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 1 store or handle hazardous
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,shonld I use eq�ipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as de"ned (he Ba�Area it Quality Management District
y
performance of the work for which this permit is issued. will maintain compliance wit the Cuaertino unicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ions 25 0512 53,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
ZLq —
permit is issued. Owner or authorized agent: Date:
I certify that in the performance of the work for which this permit is issued,l 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,1 CONSTRUC N 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 slate 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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20400 MARIANI AVE DATE: 04/04/2013 REVIEWED BY: MELISSA .
APN: 316 22 018 BP#: 30 *VALUATION: $200,000
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1B TI
USE: PERMIT TYPE:
WORK ��. OR INTERIOR MECHANICAL & ELECTRICAL NO STRUCTURAL CHANGES
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
8 (Tenant Improvements) II-8,111-B,IV,V-B 2,200 $2,103.15 IBTIPLNCK $1,832.76 IBTIINSP
TOTALS: 2,200 1 $2,103.15 $1,832.76
MECH,HOURLY O Yes O No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No
rblech. Plan Check Phwrb. Plan Check Elea. Plan Check
rbfech. Perini!Fee: Plrfmb. Permit Fee: 6lec. Permit Fee:
Otlw;-Heck Insp, Qrher Plumb Insp. Ll I Other Elee.Insp.
AIleeh,Insp. Fec: Phnnh his/i. Fee: F.lec, Imp. Frye;
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff: 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,103.15 Select a Misc Bldg/Structure
Suppl. PC Fee: E) Reg. () OT 0.0 1 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,832.76
Suppl. Insp. Fee.S Reg. 0 OTFO.OTrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Con.strtiction Tats:
Administrative Fee: 0
Work Without Permit? O Yes (F) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Travel Documentation Fees: Building or Structure O
i
Strong Motion Fee: IBSEISMICO $42.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $8.00
SUBTOTALS: $3,985.91 $0.00 TOTAL FEE-T $3,985.91
Revised: 04101/2013