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10100209 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20833 STEVENS CREEK BLVD STE 104 CONTRACTOR:A-TEAM PERMIT NO: 10100209 CONSTRUCTION INC OWNER'S NAME: STEVENS CREEK OFFICE CENTER AS 3044 SCOTT BLVD DATE ISSUED: 1 1/18/2010 OWNER'S PHONE: 4082537071 SANTA CLARA,CA 95054 PHONE NO:(408)482-2565 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class $ Lic.4 sb� i r r r MECH RESIDENTIAL COMMERCIAL Contractor A—T eav,\ C_0 QCCOybate 11-(o—1'O JOB DESCRIPTION:MINOR INTERIOR WALL MODIFICATIONS,REALIGNMENT OF I hereby affirm that I am licensed under the provisions of Chapter 9 EXISTING DOORWAY,INSTALLATION OF ONE INTERIOR (commencing with Section 7000)of Division 3 of the Business&Professions DOOR,NO RE-ROOF,NO STRUCTURAL. 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:$11000 I have and wil I 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:32632053.104 Occupancy Type: permit is issued. Y, APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES W WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WI'I1EIIN 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: o with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 11 —1 3—10 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. ❑ DECLARATION I hereby affirm that I 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) 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. [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 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 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 wil I maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, Date: I I 18-1 0 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,1 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: DATE: REVIEWED BY: APN: BP#: "VALUATION: *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building TOTZ1� PENTAMATION 1GENCOM USE: FLOOR 4R/ 1. PERMIT TYPE: WORK SCOPE Xtech. Plan Check Phimh. Nun Check Elec.Plan Check 0.0 hrs $0.00 Ff"/I fermi!Fec. phimb. Permit Fcc. Elec. Permit Fee: IEPERMIT Oilrcr MCC/7. G,YI, 0.-/;: P,r;..;;; l,,,y, Other Elea Insp. Ej�rs $42.00 11laCh, /nip.Fcc' Pixrrib. ln.l. h: :. Clc°c.l +r;. I'r'�' NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addh7 info. FEE ITEMS(Fee Resolution 09-051 E . 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 41 l.f. Interior Partitions Suppl. PC Fee: 0 Reg. 0 OT 0.0 firs $0.00 $538.00 IPARTICOMM PME Plan Check: $0.00 0 # Window/Sliding Glass Door Permit Fee: $0.00 $380.00 1WINREP Replacement Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00 Electrical PME Unit Fee: $0.00 $42.00 IBREMRECEP Recep/Switch/Outlets PME Permit Fee: $42.00 Conso-iielion Tax Acoustical Fee: © Yes E) No $0.00 Work Without Permit? Q Yes G No $0.00 0 Planning Fee: $0.00 Select a Non-Residential Q Travel Documentation Fee: ITRAVDOC $42.00 Building or Structure 0 i Strong Motion Fee: IBSEISMICO Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $960.00 TOTAL FEE: $1,047. 97, .3 Revised: 10/17/2010