11120098-VOIDEDCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22382 HOMESTEAD RD
CONTRACTOR: KITAMI
PERMIT NO: 11120098
OWNER'S NAME: THOMAS E HARRINGTON TRUST
929 WASHINGTON ST
DATE ISSUED: 03/02/2012
OWNER'S PHONE:
SAN CARLOS, CA 94070
PHONE NO: (650) 591-7651
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic. # �
COMM TI, LOBSTER SHACK, 2347 SF, NEW KITCHEN
Contractor l—K42 TA"( (VIL
Date �%� 2 ZO(
WITH
•
NEW KITCHEN EQUIP, NEW BAR, RELOCATION OF
I hereby affirm that I am licensed under the provisions of Chapter 9
ENTRY
(commencing with Section 7000) of Division 3 of the Business & Professions
DOORS, NEW LIGHTING, NEW ELECTRICAL OUTLETS,
Code and that my license is in full force and effect.
NEW
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
Sq. Ft Floor Area:
Valuation: $150000
performance of the work for which this permit is issued.
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: 32601018.22382
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that [ 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 FROM 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 s ce regulations per the Cupertino Municipal Code, Section
9.18.
?, 2 r
RE-ROOFS:
Signatur Date ✓ ;?4017--
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, [ agree to remove al I new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby alum 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
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)
I, 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. I 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 tie work for which this permit is issued.
will maintain coin pliance 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 2550 , 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner Z ,
permit is issued.
or authorized agent: — Dater
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, 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 constriction, 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
bL1q
CITY OF CUPERTINO
IM -1 FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 22382 Homestead Rd
FLR AREA
s.f.
DATE: 12/16/2011
REVIEWED BY: jsg
BP FEES
APN: p�� Q� D/
BP#:
"VALUATION: 1$150,000
*PERMIT TYPE: Building Permit
$2,285.65
L CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
]ATHNSP
PENTAMATION 1A TI
PERMIT TYPE:
WORK
PME Plan Check:
A
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
P
FEE ID
BP FEES
BP FEE ID
A (Tenant Improvements)
II-B,111-B,IV,V-B
2,347
$2,285.65
ATIPLNCK
$1,256.30
]ATHNSP
hrs
$0.00
PME Plan Check:
A
$0.00
Permit Fee:
$1,256.30
Suppl. Insp. Fee -0 Reg.
0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
2,347
$2,285.65
$0.00
$1,256.30
MECH, HOURLY O Yes 0 No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY 0 Yes 0 No
MISC ITEMS
Plan Check Fee:
$2,285.65
Li0
- ..
Suppl. PC Fee: 0 Reg. O OT
0.0
hrs
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Tee Resolution 11-053 E . 7/1,/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,285.65
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. O OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,256.30
Suppl. Insp. Fee -0 Reg.
0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
( `r,7t � tt7x f7(ru Tint:
iclritfvra'tr".r'i+ e dear:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Plannini, Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
i
I'rc.ra cf /.7;�t.tr3 ?c^rt1 fLturi 1'" :-
Strong Motion Fee:
IBSEISMICO
$31.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$6.00
SUBTOTALS:
$3,579.45
$0.00
TOTAL FEE:
1 $3,579.45
T1L____
Revised: 1210412- Cry �"��