12080077 CITY OF CUPERTIPO B ILDING PERMIT
BUILDING ADDRESS: 10420 BUBB RD ONTRACTOR:XL,CONSTRUCTION 'P.ERMIT NO: 12080077
OWNER'S NAME: HOME'.OF.CHRISTCH�:CUP.E&TING LL X851 BUCKEYE'CT DATE° ISSUED: 11'/02/2012
OVVN R'S PHONE: 4089968208 MILPITAS;CA;95035 PHONE NO:(408)240-6000
LICENSED CONTRACTOR'S.DE LARATION JOR'DESCRIPTION: RESIDENTIAL COMMERCIALS
License Class Lic.#; ct,6 0 APPLE-COMMERCIAL TENANT IMPROVEMENT"30550
ContractorDate. v 1` NEW I_NTERIOR PARTITIONS',DOORSJINISHES,
- -
I hereby'affirm;that I am licensed under,the provisions of-,hapter9 CEILINGS,:LIGHTING;MEP'S.NEW ROOFTOP
(commencing with Section 7000)of Division 3 of thePBusiness.&Professions EQUIPMEN_ T&
Code;and that!my license is m full;force,and effect.
11 hereby'aftirm,u'nder'penalty ofperjury one of the following two d&larationsc 1/8%2013-REVti/-ADA,REVISIONS.TO EXISTING'.DRAWINGS-TO
I'have?and will maintain acertificaWof consent to self-`insurefor Workbr,s PROVIDE ADDITIONAL DETAILS
Compensation;,as provided for by Sectidh,3700 of theoLabor•Cod'cJ6rthe
performance:ofthe work°forwhich this.permit is issued, Sq.Ft.Floor Area: Valuation:33530000
I have�an'd`Will maintain Worker's,Compensation Insufancc,as,providcdlforby
Se'chon.3700 of the Labor Code,for the performance of the work,for which this
APN'Number;,35720038,00 Occupancy Type;
permit,is issued:.
APPLICANT CERTIFICATION
I cemfyfthat I;haveread,this�application and�state that�the�abovexinformation is PERMIT EXPIRES IF WORK.IS NOT STARTED
correct,I agree;to comply with all city and county ordinances and statelaws relating
t9� ding construction�and'hereby authonze representatives of this city fo enter
WITHIN
buil1'80 DAYS OF PERMIT ISSUANCE OR. ,
uponthe_abovementioned,property for inspection purposes J
(W )r"agree to'save 1!80..DAYS FM
RO _:LAST CALLED INSPECTION.
indemnify and keep liarinless the-,City of Cupertino against liabilitiesJudgments,
'costs,and expenses whic may`accrue?againstsaid Gty inconsequence of,the
granting-bf this permit.'Add' •onally, a applicant understandstand will comply. Issued,by: - - Dater
With all non-point;so a r' lations crth'Cupertino Mun_icipal,Code;Section
1 RE=ROOFS•
Signature.` Date installed without firs[ob
All roofs shall-.be inspected;prior to any roofing-material being>installed.afa,roof is
_ t6ming.an.i`nspection,I agree to remove all new materials for,
inspection.
❑ WNER-BlIILDER.DECLARATION:
Signature of.Appl_icant;_ Date:
I Hereby affirm-that I.amex_empt from the C_ ontractor's'L'ic_ense Law for one of
the following two reasons; ALL ROOF COVERINGS TO,BE CLASS"'A"OR;BETTER
I as owner of he,-ft rty;or my employeeswith wagestas theii solcTcompensation,
will do the work,and the structure isnot intended or offered for salet(Sec:7044,
Business,&Professions Code)
I,astowner bf the,property,am exclusively contracting with licensed contractorsto' HAZARDOUS'MATERIAL'S DISCLOSURE
constructthe project,,(Sec.7044;:Bus ness&`Professions Code) Cahfor ea Health&Safety Coer;aS requirements ons under'Cha pter& 5 of.the
S 155051,i5533-and 25534. -I will
I hereby,„affirm under penalty of�'perluryone;of the:followmg three: maintain coin phance.wiih the Cupertino MunicipalCode,Chapter%12 and the
declarations: Health&Safety Code,Section 25532(a).should,I store or handle hazardous::
I have�anii wilL.maintain�a Certifcateof.Consentto;selfinsure for'Worker'.s material: Additionallyshould.I use eq 'pment or evices°which.emit�hazardous
Compensation;-as,provided for by_Section 3700 of the Labor Code,,,for`tl a air contaminants,as defined by.the;Ba`, 7 ea Air uali Management DistrictT
performance'of,the.work,for whichAis.permit is issued, will rnaintain�co"pllancewith-the,C p tins ici 1 Code,,Chapter`91.2_aod:
r;by the Health.&Safety;Code,;Sectio 05,355 ;;a 25534..
,Sermons 700u o the LaboWCode'for thepperfotrmance of the ork-forawhich-this r i!%
Ownermorauthorize`doagent2 .Date:
Lcertify.fhatJOhe performance of,thelwork'for.which this;permitl'is issued;l shall7
-not employany,_person inaiiy manner.,so+as to,beconie�subject.to,�the Woiker's
.Compensation lawstof California: If;aftermnking this,,,certificate of exemption,1 CONSTRUCTION LENDING°AGENCY
becomesubjecta.to the Worker'sCompensation provisions;ofthe Labor Code,I;must I hereby affirm thatthere is.a construction lending agency4or the performance of
`,forthwith comply-with proyisions:or this permit shall be.deem_ ed.re_voked. work's for which this permittis issued:(Sec.3097,Civ.C)
Lender's Name,
,APPLICANT CERTIFICATION Lender's Address
I certify that.l.havelread this,applicatiohkan'd�state�that the above information-iso
,corzect:,[agree.to comply,With all city and.county ordinances,an&state laws9rel,ating
,to building construction,and.here-by'authorizexrepresentatives ofthis city;toee`r
upon theabove_mentioned property for inspection purposes (We),agrec.to save
indemnify and keep harmless the CityofiCupertmo against]iabi litics,j Lidgments ARCHITECT'S DECLARATION
-costs;and expenses whichemay accrue against said Ci, conseguence',of the 1.understand mvvlans shall be used as public,recoids;
�grantmg'ofthisvoerinit.Addhidhn lly,.theapnds plicant understaand will comply
wrth,all non7poim"source regulations.perihe Cupertino,Municipal_Codc,'Section Licensed Piofessional
:Signature Date
:CITY OF CLiPERTINO
FEE EST_ IMATOR=BUILDING DIVISION
ADDRESS: 10420;BUBB RD DATE: 0110812013 REVIEWED BYi: mendez
APNx - 04- 1:2080077 'VALUATION: $100,000.
*PERMITTYPE:. Building'Pe.rmit PLANCHECKTYPE: Tenantlmprovement'
USE:
_ PENTAMATION
Commercial Building 1GENCOM '
_ PERMIT TYPE: a
WORK- ;REVISION; -'ADA REVISIONS TO EXISTING D-RAWNINGTO PROVIDE ADDI`fIONAL DETAILS.
SCOPE'
INN X_
G1eclr:f'Tri C'ht:ck I'Iturw.Plum!'hccif Flet.-Plan("h�rck
L1ech; Perwil,Fee,. PIllrriG. f'ehorzir7 <<i: I li:c.Pc:rmir.l`ee;
f/rmlIns . rff,Nfech. Msp. ,oiir re(
,Weh: htip: Fe,: , fnp..Pc>e: Dec.Lnsp,:fILniec`p:.
NOTE.-,This estimate does not:include fees due p other Departments.(Le-Planning,Public Works,Fire,Sanitary"Sewer District,,School.
District we). :These`ees arekbased on the; relimina in ormation available and,ar?onl .an estimate. Contact the De t'oraddn'l in o.
FEE:IT.EMS'(Fee Resolution.ll.-053 Eff 7AP-12) FEE, QTY&Et MISC ITEMS
P1amCheck Feer Hourly Only? 0 Yes Q No $0.0,0 4; hours Plan Check,Hourly
Suppl. PC Fee: �. Reg: Q.OT 0,0 hrs $0.00 $532.00 isTPLNCK
PME Plan Check-: $0:010
-Permit Fee:,. $0.00
Suppl. Insp.Fee-E) Reg. 0,0 his, $0.00.
PME Unif Fee: $0:00,
PME Permit Fee: $0,:
T-T
Cons°hxiction Ta:�
Adminisirwive-1 e:-
Work Without'Perinit7No,
Q Yes :� $0:0.0
Advanced'Plan nin <Fee:'. Select'a Non=Residential O
TrcwefDoc:rur}e�itu/v�if�ites:. Building or Structure`
Sfrong Motion Feer 1'BSEISMIC0 $21::00 Select an Administratiye.ltem
816'Sids Commission Fee:. IBCBSC $4.:_00'
SiTBT®TALS $25.00 :$.5320,0 �� TOTALFEE:'" $557.00
Revised: 10101/2012
CITY OF CUPERTINO BUILDIN.GPERMIT
BUILDING;,ADDRESS:i 10_420 BUBB`kD CONTRACTOR:'XL CONSTRUCTION . P.ERMIT:NO%12080077
OWNER'S`NAME: HOME OF CHRIST CH CUP,P,ERTINO LLC, 851 BUCK-EYE-,CT DATE ISSUED:,11%02/201.2
.OWNEWSTHONE: 4089968208 M1LPITAS;'CA,,9503.5 PHONENO:(408)240 6000
LICENSED CONTRACTOR'S DECLARATIONt
License Class Lic..#.. vl� -L[f✓j UILDINGPERMIT NF - BLDG LECT
B I O:' -1 E PLUMB
�._ . l
ti r MECH RESIDENTIAL COMMERCIAL
:Contractor X'.L �ylf�Zrj Date
`I:herebyaaflir"m"that I am Jiceosed urider'the provisions of Chapter;9 JOB DESCRIPTION:APPLE-COMMERCIAL TENANT IMPROVEMENT 30550
'(commencing wrth,Sectnon 7000)of.Division 3of the Business B_&-Professions SQFT,
'Code4nd,thM4ny license,is imfull.fore6andieffect: NEW INTERIOR�,PARTITIONS,;DOORS,FINISHES,
CEILINGS.LIGHTING,MEP'S,NEVI ROOFTOP EQUIPMENT&
1 hereby°affirm underap-enalty of perjury one;of the;following two:declarations:,
d`rh"ave and will maintain a certificate of consent to-self-insure for•Worker?s.
Compensaiion;,as provided for.by Section 3700 of,the-LaborCode,:forthc
performance of the,work forwhich this permit is,issued: "
I:.have and-will maintain Worker'§Compeusatiori Insuranee,:as;pr`od ded;_for by
Section 37,00 of the Labor Code,for the performance-of the work 1br which:this
permit-is issued:,. 'Sq.Ft;Floor Area: Valoatiori:,$3430000
APPLICANT CERTIFICATION
I'certify-that Irhave.iead,this;application and,state thatthe:abo.,vc�information is APN NumbervS5720038.00 OccupancyType:
correct 1 agree to comply with all c tysapd countyordinances and state laws relating
to bmldmg construction and'heiebyauthonze representatives_of this city'to enter
upon"the"above-mentioned propertyfor;inspectwn'pbrposes: (We)agree to save
indemnify'and keep,harmless the CityofCupertino against liabnhtnes;tjudgments, pERMIT'EXPIRES IE WORK IS.NOT STARTED
costs,and ex enses which may`accruela anst said City mconse uencofdhe;
grantingof this permit..Additionall ;the ap icant,understands�and will comply WITHIN 180,DAYS OF PERMIT ISSUANCE OR
with,all non-pointy -r e regulation Zper'the -upertmo Municipal Code,Section 180,DA ,S FRO AST CALLED INSPECTION:
91'8.,
APV-17
II - `�7 / / L—
Signature Date I'4 Issued by: ( " L �/ Dater
❑ OWNER-BUILDER DECLARATION
1 hereby'affirm that I;am exempt=from the,Contractor's,Lice nse Law for,one�of RE-ROOFS:,
'the following two reasons: All roofsshalhbe;inspected.pnorto°any roofing"material being installed.If Sroof is
,.as owner of ihc'roperty',or myemployees.wnth`wages as'their=sole,compensation, installed withoutfirst'obtaining an inspection,I agree to remove'all"new materials for
will,do the work,:and the structure is-not.iniended,or offered focsale°.(Sec'7044, 'inspecti'on.
Business kProfessions Code)
1,'as owner.'of the'property,;am exclusively�contracting with licensed,contractors to Signature.of Applicants Date:
constructfthetprojecu(Sec.7044„Business&Professions,Code).
1 hee6b'affietn�uoder penal of er u =one of"the;followin three ALL,RQOF`COVERINGS TO BE�CLASS"A''OR BETTER
_y-- P b' P -j r9 •.-g
d'ecl®rations1
[fiave'and will maintain`a Certificate of Consent to self-iiisure.forW,orker's
' HAZARDOUS M'ATERIALS'DISCLOSURE'
Pompesationfan provided for by Section-3700 of the Labor Code;for the
n encei o'"the woikforwhich"'this permit is issued. I have:read the,hazardous'materials:requir.ementsrgnder.Cliapter6.95'=of the
I;have:and will maintain Worker's�CompensatPonlnsurance;as°,provided'forby Cahfornia'Health&t�Safet :Code.Sections�25505,25533;rand 25534 I"will maintain
Section 3700.of the Labor Code,for,the performance of:the7work forwhich.this. compliance withahe Cupertino Municipal Code,Chapter 9.12 and the Healtb&
Safety Code,Section 25532(a)-shouid I store or,handle';hazardops material..
..:- q,P
e Y Add►tnonally,sfioul'd`F.use e m mentor devices;which. air
Peertif!that issued. Add*"-
work for which'this permit is issued,I shall. contaminants as def ned'by the::Bay.Area,Air=Quality ManagementwDistricf.I:will
P y YP j. e P P .4
Com ensation laws of,Calnfomian Ifraftersmak ng th ss ert>ffcate�of exem Ai I Health'n S nety Code' etions 5505 25533nand 2 534 Chapter.9.12:and the I
p 11
become,subi'ect to the:Worker s Compen"satnoniprovnsnons ofthe -:aborCode,.1 must
uthorized gent:
forthwith comply with such'prov.isions or this permit,shall be cemed_revoked., Owner r
- Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING',A`GENCY
I:certify',that I have read this.application dnd.state that the,above`information is
correct.l agree;to„complywith;alI city and county ordinances and state laws relating "'[h66y,affifm that thdr6'is a construction lending4kchidy forthe perforinance;of work's'
to;building,construction,and.hereby authorize representatives of this city to enter for wIn'ch'I s',permrt`is issued(Sec:3097,Civ,C)
upon the�aboye,mentioned.property,for;inspection.purposes:•-(We)agree to save Lender'$Name, h
indemnify and keep liarmless'th City of.Cupertino,against liabilities judgments, '
costs,*d',expenses-whnch may accrue against"said+Cnty nn=consequence`of the Lender's`Ad'dress
gran Wig of,ihispermit.,Addition aIIy,,the ap p I icanf'und ers tan d s and.wi11,comply
with:all'non-point source iegulations"per the Cupertino,Municipal Code,Section ARCHITECT'S DECLARATION
9:18'.
I understand mypl"an"s,shall bemsedas.publ_ic records:
Signature ,Date
Licensed Professional '
CITY OF CUPERTINO
f
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10420 Bubb Road, DATE: 0:8707/20.12 REVIEWED BY:. Sean
APN: 357-20=038 BP#: ''VALUATION: $3;430,000
IFERMIT'TY,PE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
Commercial Building P.ERMITTYPE: 1BTI
WORK 'Tenant Im rovement; 30550 sq-'ft,).
SCOPE
TYPE.OF FLR;AR'EA
OCCUPANCY'TYPE-, CONSTR. s.f. 'PC FEES PC FEE ID BP FEES BP FEE ID
B (Tenant Improvements) A 11-B,111;&IV;V-B 301550. $3',232:36 IBTIPLNCK $11,478.06, IBTIINSP
TOTALS: 30;550 $3;232 36 .,' $11,4.78.06
� a 2v •-
1VIECH,H®URLY Yes; � No PLUMB,HOUR3LY Q Yes Nod ELEt,H®URLY b es Q No
�� �a� r
L9 zr/a. Mori Check I%ir 7rf% :'lc:r 'l c c'k r. .: i'lan b he-k
,4-h P o Oi Fee ltr.zh.-I.,rir,r r�izcr i�fcr. F'trrr�ti "c
(J.irrer;lat�i�l:.rnsp., O'r',c,r I'.'te�rf(;.i�,r;:>, O.rru '/•!er_Insp.
Alc��ii.lrrs;�.f'cte: PrFarirli Irra`p. l��'i':� r'e°c.lrs, riar
NOTE:'This estimate.does°not include fees du e,to,oiherDeparimenis(i.e.Planning,Mlic Works,Fire,Sanitary Sewer District,School
District;etc.). These. ees,,are based•on�the relimina, information available and are:onl an estimate. ContacCthe Dept -or addn''1 info,
FEE,ITEMS (Fee Resolution 11-053,L f.-7/I/1I,) FEE` QTY/FEE- MISC ITEMS
Plan.Check Fee.: $3;232:36 Select.a MiscBldg/Structure
Suppl. PC Fee: Q.Reg. .0 OT 0'.-p hrs $0.06- or Element of a_Building
PME PaanCheck: $.0:00
Permit>Fee: $111,478-06
Sup.pl: I P'. Fee,''.Q Reg•. Q QT' 0 0 hrs $0.00
PME Uhh Fee: $0.00
PME Permit Fee $0.00.
C'Imstt rrrati�n.I ay.
�1c��niriistrcaFitie.l�c'>r-.` - Q
Work Without Permit? Q Yes• ;Q,No $0..00 Q
Advanced Planiiin Fee: $0.00 Selecta Non-Residential Q
7icaicl Doc;tlrrun!uti»
Pees: Building or Structure Q
i
Strong Motion Fee: A?SEISMICO $720.30 Select an Adrninisirativedtem
Rldg.Stds Commission.Fee IBCBSC $138.00
�Q -
���' SUBT®TA�IJs 15,568:72 $0.00 eTOTiFEE $15,568.72
Revised: 07/01/201.2