13060159 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22354 HOMESTEAD RD CONTRACTOR:TRAN JUNIOR GENERAL PERMIT NO:13060159
CONSTRUCTION
OWNER'S NAME: THOMAS HARRINGTON 728 DAKOTA DR DATE ISSUED:07/09/2013
OWNER'S PHONE: 6509416900 SAN JOSE,CA 95111 PHONE NO:(408)829-1777
❑ LICENSED CONTRACTOR'S DECLARATION JOB,,DESCRIPT14OW: RESIDENTIAL 11 COMMERCIAL®4--1) A c&4kf_
License ClassLie. 420 —t—_-- 04 ,� TENANT IMPROMMINT TO CHANGE USE(M TO B)
�)_ — INSTALL
Contractor-ZM,41 A IC C CrA C CM ate 07 0, NON-LOAD BEARING WALLS TO CREATE FACIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 ROOMS AND
(commencing with Section 7000)of Division 3 of the Business&Professions FOOT MESSAGE AREAS.
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:$35000
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:32601018.22354 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 FRO ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Is
Is
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9,18.
RE-ROOFS:
Signature Date 0
_2 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. 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 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,Sections 25505,25533,and 25534. _
Section 3700 of the Labor Code,for the performance of the work for which this Owner or an orized agent: Date:S7—0!1-- (+
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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: 22354 HOMESTEAD RD DATE: 06/1912013 REVIEWED BY: MELISSA
APN: 326 01 018 BP#: 5 `"VALUATION: 1$35,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B TA
WORK CHANGE USE M TOB INSTALL NON-LOAD BEARING WALLS TO CREATE FACIAL ROOMS &
SCOPE FOOT MESSAGE AREAS. MECHANICAL, ELECTRICAL& PLUMBING REVISIONS
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. 01).
B (Tenant Improvements) 11-B,111-B,IV,V-B 1,063 $1,989.20 IBTIPLNCK $1,055.56 IBTIINSP
TOTALS: 1,063 $1,989.20 . $1,055.56 .
To MU i'a*un-
L1 cli. Plarz(,heck I'himb. Plan("heck Elec:,Illus(,heck
J1<tecl,. perfn;l Fee: p?l Mh'k'er tni!Fee: I lea. Permit Tec::
F
lfiec�ki.7rsl. E3
Other t'lumb Insl�. Other Flec.Ins; .
In.s/a.Fee: Plumb, /r,:>).Fee' Elec' hasp,lei>e:
NOTE.This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the relimina information available and are onl an estimate- Contact the De t or addn'1.info.
FEE ITEMS (Fee Resolution 11-053 Eff7/I/Q FEE QTYIFEE MISC ITEMS
Plan Check Fee: $1,989.20 Select a Mise Bldg/Structure
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,055.56
Suppl. Insp.Feer Reg. 0 OT 6.Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
o nslrwdion Tax:
Administrative wee:
Work Without Permit? 0 Yes (j) No $0.00
Advanced Planning,Fee: $0,00 Select a Non-Residential .
Travel Documentation /F'�>c s: Building or Structure
Strong Motion.Fee: 1BSEISMIC® $7.35 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $2.00
13TUTL $3,054.11 $0.00 fiU ` L $3,054.11
Revised: 04/29/2013