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10080109CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19620 STEVENS CREEK BLVD STE 280 CONTRACTOR: FRED CHAN PERMIT NO: 10080109 OWNER'S NAME: BERKELEY, CA 94709 PHONE NO: IP LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie. # MECH r RESIDENTIAL COMMERCIAL r Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: COMM'L TI NON-STRUCTURAL.(I 667St)MECHANICAL (commencing with Section 7000) of Division 3 of the Business & Professions DEFERRED. 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. 1 have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $16000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36906010.280 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. < /'l Issued by: Date: Date OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. if a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Codp) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). J "A" ALL ROOF COVERINGS TO BE CLASS OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.I2 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must Owner or authorized agent: cy forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address 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 a Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9. 18.1 'Dale understand my plans shall be used as public records. Signature���� / < Licensed Professional l CITY OF CUPERTINO BUILDIN$.MIT ' BUILDING ADDRESS: 19620 STEVENS CREEK BLVD STE 280 CONTRACTOR: FRED CHAN PERMIT NO: 10080109 OWNER'S NAME: BERKELEY, CA 94709 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie. fi MECH r RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: COMM'L TI NON-STRUCTURAL.( I667SQ)MECHANICAL (commencing with Section 7000) of Division 3 of the Business & Professions DEFERRED. Code and that my license is in full force and effect. 8/23/10 DEFERRED 41 SUBMITTAL -MECHANICAL- 9/9/10 DEFERRED 41 ISS'D 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $16000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36906010.280 Occupancy Type: APPLICANT CERTIFICATION 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Issued b��_�1--�— Date: Signature Date — ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. if a roof is the following two reasons: installed without first obtainingan inspection, I a P gree to remove all new materials for 1, as owner of the property, or m employees with wa es as their sole compensation, Yg P� inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: �D.(2_ I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. 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 forthwith comply with such provisions or this permit shall be deemed revoked.% Owner or horized agent: Dater l �2 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address 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 ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date — /0 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT REN1810N#_&:A4— BUILDING ADDRESS: 19620 STEVENS CREEK BLVD STE 280 OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & 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: 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. I 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 permit is issued. APPLICANT CERTIFICATI ON 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature D:dc OWNER -BUILDER DECLARATIO': I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 offrred for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting „ith liccimcd contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the followi m-, I hrce declarations: I have and will maintain a Certificate of Consent to self -insure 1',r Worker's Compensation, as provided for by Section 3700 ofthe I.nhor Codc, fix the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurr. ce, as provided for by Section 3700 of the Labor Code, for the performance of the work for v, hich this permit is issued. I certify that in the performance of the work for which ibis 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 c, rtihc:t!c 01'c.Nentpiion, I become subject to the Worker's Compensation pr visit); :, of the l.ahnr Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. CONTRACfOR:M'ED—CFIAN DATE ISSUED: 09/09/2010 B G 9 I PHONE NO: r r r BU 11, 1)1 N(, PF101ITINFO: BLDG ELECT PLUMB r r r MECH RESIDENTIAL COMMERCIAL .I0I31)1:SCRIPHON: COMM'LTINON-STRUCTURAL(1667SQ)MECHANICAL DlTliRRl`.D 12/16110 -KI cVISION I- NW WALL MOUNTED TRANSFORMER, SMOKE DAMPER- ISSI) ll jI I Sq, Ft I lour Area: I Valuation: $16000 I APN Ni mbrr: 36906010.280 1 Occupancy Type: I I I Fall ii11T EXPIRES IF WORK IS NOT STARTED W I T I I IN 180 DAYS OF PERMIT ISSUANCE OR IS 0 1) . k VS FROM LAST CALLED INSPECTION. Issued hN; Date: RE -ROOFS: All rut ball he inspected prior to any roofing material being installed. If a roof is nstalle. , ii' " t dist obtaining an inspection, I agree to remove all new materials for inspcci. Sigma- ,,! Applicant: Date: k t .I . ROOF COVERINGS TO BE CLASS "A" OR BETTER 11AAARDOIIS MATERIALS DISCLOSURE I ha, t r - rl `1c I ; iardous materials requirements under Chapter 6.95 of the ('a l l tt . I I+'a l t ii & Safety Code, Sections 25505, 25533, and 25534. I will I rimiw. • ­n+I,lia ncc with the Cupertino Municipal Code, Chapter9.12 and the I Irakl ,z �: !+ t- rode, Section 25532(a) should I store or handle hazardous nia i r, +;, I. .� •Ilii ii na lly, should I use equipment or devices which emit hazardous an, conr +nu+tani. ;,.s defined by the Bay Arca Air Quality Management District f will m;6w;tt11 compliance with the Cupertino Municipal Code, Chapter 9.12 and tia 1, i v Cnde, Sections 25505, 25533, and 25534. ' O,rnrr hr a++9f„•,t ii.cd � Date: 1 I� I CONSTRUCTION LENDING :AGENCY t I herd :r.: ibcre is a construction lending agency for the performance of 7 ,+larkit t; i. permit is issued (Sec. 3097, Civ C.) 1,Cn(!• 1 - V.-115 APPLICANT CERTIFICATI r)N I certify that I have read this application and state that thr abocc information is correct. I agree to comply with all city and count) ordin;inces aw,J ~talc lass relating t to building construction, and hereby authorize represent❑:ivC; uI tliis city it) enter upon the above mentioned property for inspection pui po . s. i .i,:t ,c to >,Ivc indemnify and keep harmless the City of Cupertino agmina Gail i ie.. judgments, costs, and expenses which may accrue against said Cir, i i cen.Ctlucucc ol'ihe granting of this permit. Additionally, the applicant undci ;an,!; :::.(I ” II co )ply with all non -point % ) ARCIITTEC"I"S DFCLARATION ! is.Shall he used as public records. I.ict'n. 'i i nl CITY OF CUPERTINO FM -7 FEE ESTIMATOR - BUILDING DIVISION V/♦NA PAP L OCCUPANCY TYPE: ADDRESS: �0,5 DATE: REVIEWED BY: PC FEE ID APN: BP#:p? "VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building 7'0K1L FLOOR AREA: PENTAMATION 1 DS PERMIT TYPE: WORK Elec. Insp. Fee: SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID Deferred Submittal (Not R-3) II-B,111-B,IV,V-B 3,889 58 IDEFPLNCK .$49659— IDEFINSP Elec. Insp. Fee: PME Plan Check: q$490.00 Permit Fee: Suppl. Insp. Fee10 Reg. O OT 0.0 hrs PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 3,889 $4,091.58 Conslroction KIX 1 $496.69 MECH, HOURLY O Yes O--.,-., No PLUMB, HOURLY ()yes QNo ELEC, HOURLY O Yes O No Mech. Plan Check Plumb. Plcrrr Check E:lc�:. Plan Check Ltech. Perwi[ Fee: Plumb. Permil Fee: lslec. Permit Vcc 01her tech. Insp. k,/", Plumb Insp.Li Other Elec. Insp. Li 1 Lech. Insp. l «c: Plumb. bol). Fez: Elec. Insp. Fee: NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 E . 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. © OT 0.0 hrs PME Plan Check: q$490.00 Permit Fee: Suppl. Insp. Fee10 Reg. O OT 0.0 hrs PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslroction KIX Acoustical Fee: 0 Yes (j) No $0.00 Q O Work Without Permit? O Yes O No $0.00 Plannin Fee: PLLONGRNGC $0.00 Select a Non -Residential Building or Structure E) I 'l'rcaiwl Doczunentution Fees: Strong Motion Fee: 1BSEISMICO �, �0 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $0.00 TOTAL FEE: 0,41593.4 Revised: 8/17/2010 CITY OF CUPERTINO ISI FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: DATE: REVIEWED BY: PC FEE ID APN: BP#: `VALUATION: PERMIT TYPE: Building Permit PLAN CHECK TYPE: enant Improvement PRIMARY USE: Commercial Building 7,011-11. (•7 00R.11/0--11. 1Br[[NSP APPLICATION 1 B TI TYPE: WORK $0.00 SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-8,111-B,1V,v-B 3,889 $2,132.80 1BTIPLNCK $2,966.04 1Br[[NSP l'lrrrrr;,. Ir;sh. !'c'"'. 1;,'rc. Inst,, l :0. $0.00 Sl� Permit Fee:42 Suppl. Insp. Fee{' Reg. O OT 0.0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $0.00 TOTALS: 3,889 $2,132.801 $2,966.04: Q Yes Q No 1VIEC.HJ1.'NICAL ;© Yet, Q No PLUMBING Q 'Ye's QTY/FEE MISC ITEMS tilrc ir. Pion C'h,:r!'r Phw:A Plru) C'hrr,l f:li'�'. P;;rn C/7<•cn Lh'c/) 1'rru)U Ff"'. Phpni). Pca'mr(l 'r. !i'cr. P<.nru( Ale ( h. insl'. L Urircv Phimb lr tl, Iri;!"; ,,'.:'r . in.sp. ar hmp I "c l'lrrrrr;,. Ir;sh. !'c'"'. 1;,'rc. Inst,, l :0. NOTE: These fees are based on the preliminary information available and are only air estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Res01111ion 09-051 EK. 7/1.!1( FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,132.80 0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. O OT 0.0 hrs PME Plan Check: $0.00 Sl� Permit Fee:42 Suppl. Insp. Fee{' Reg. O OT 0.0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $0.00 Cons rcr(•1ion Ta Acoustical Fee: Q Yes Q No $0.00 $0.00 1 ` Q Q Work Without Permit? Q Yes E) No Planning Fee: PLLONGRNGC $9 .25 Select a Non -Residential Building or Structure G O /rc rvc'( 1)OC'!Ul'It171(1!!O!'f 1"C('.1": Strong Motion Fee: 1BSEISMICO $ 3, 3 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC SUBTOTALS: $6,079.81 $0.00 TOTAL F.EE:' $6,079.81 Revised: 8/12/2010 CITY OF CUPERTINO FM -1 FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: FLR AREA s.f. DATE: REVIEWED BY: BP FEES APN: BP#: 'VALUATION: 1$32,000 *PERMIT TYPE: Building Permit $2,132.80 PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: - IBT11NSP 7'OT �.L FLOOR .•tREA: APPLICATION TYPE: 1B TI WORK Suppl. Insp. Feed Reg. 0 OT 0.0 SCOPE $0.00 $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 3,889 $2,132.80 IBTIPLNCK $2,966.04 - IBT11NSP ElC<, Imp. Fcc. Permit Fee: Suppl. Insp. Feed Reg. 0 OT 0.0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $0.00 Consovelion 747Y Acoustical Fee: 0 Yes Q No $0.00 $0.00 0 E) TOTALS: 3,889 $2,132.80 Select a Non -Residential Building or Structure $2,966.04 Trove.! Docitmentaiion Feces. MECHANICAL Q Yes Q No PLUMBING Q Q No ELECTRICAL Q Yes Q No 1 cch. Plon 07C(i; Phimh. Plun CheeA Llrc,_ Plan ('h,:ck F11l1. Permit Foe' Phirnb. Peimil G'ce: Afc�ETh. harp. L Odwr Plumb 1n,rp. Uri=� ; G�; c. lns/,.. Iny. 1,«e" P/1410). Iu.y. Fec. ElC<, Imp. Fcc. NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 09-051 E f 711110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,132.80 0.00 �� do /,00elect a Misc Bldg/Structure /d or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs PME Plan Check: $0.00 $2,966.04 ; Permit Fee: Suppl. Insp. Feed Reg. 0 OT 0.0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $0.00 Consovelion 747Y Acoustical Fee: 0 Yes Q No $0.00 $0.00 0 E) Work Without Permit? 0 Yes 0 No Planning Fee: PLLONGRNGC $9 5 Select a Non -Residential Building or Structure 0 i Trove.! Docitmentaiion Feces. Strong Motion Fee: IBSEISMICO $6.72 $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC SUBTOTALS: $6,079.81 $0.00 TOTAL FEE: 1 $6,079.81 Revised: 8/12/2010