11060188 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20245 STEVENS CREEK BLVD CONTRACTOR:TERSINI CONSTRUCTION PERMIT NO: 11060188
INC
OWNER'S NAME: KENNETH&MARK TERSINI 21710 STEVENS CREEK BLVD DATE ISSUED:08/15/2011
:ER'S PHONE: 4082572100 CUPERTINO,CA 95014 PHONE NO:(408)257-2100
IJ LICENSED CONTRACTOR'S DECLARATION ] j
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class__ Lic.# 51 ZL..y E&
r MECH F RESIDENTIAL F COMMERCIAL rY
Contractor �e�t N CpNy11WCS V Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COMMERCIAL.BUILDING-REPLACEMENT OF EXISTING
(commencing with Section 7000)of Division 3 of the Business&Professions WOOD
Code and that my license is in full force and effect. FASCIA REPLACED WITH ALUMINUM CANOPY AT MAIN
ENTRY.SITE WORK=RESTRIPING FOR ACCESSIBLE PARKING
1 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�Q.
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 die work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$65000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:31625043.00 Occupancy Type.
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 1.80 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature—R, A Date `b 4 Issued b "
��— �•.— _ y: � Date:
OWNER-BUILDER DECLARATION
I uereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant:_ Date:
construct the project(Sec.7044,Business&Professions Code).
hereby affirm tinder penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the
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
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,1 must
forthwith comply with such provisions or this permit shall be deemed revoked. er or ze gent:
_ -_ Date: `b �
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of 6wrk's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
in,1—inify and keep harmless the City of Cupertino against liabilities,judgments,
tnd expenses which may accrue against said City in consequence of the Lender's Address
.,ng of this permit.Additionally.the applicant understands and will comply
all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
5. zs.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20245 STEVENS CREEK BLVD CONTRACTOR: TERSINI CONSTRUCTION PERMIT NO: 11060188
INC
OWNER'S NAME:
CUPERTINO, CA 95014 PHONE NO: (408)257-2100
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic. # 61
Contractora%s%r4 °I CK%&V% Date '91 k6l It , —
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.
MECH I_ RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: COMMERCIAL BUILDING - REPLACEMENT OF EXISTING
WOOD
FASCIA REPLACED WITH ALUMINUM CANOPY AT MAIN
ENTRY. SITE WORK=RESTRIPING FOR ACCESSIBLE PARKING
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. Sq. Ft Floor Area:
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
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 Date 1
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I 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
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.
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
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.
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
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.
APN Number: 31625043.00
Valuation: $65000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:
RE -ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or Handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
: �
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Nwrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
Date
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
5-M-7 FEE ESTIMATOR - BUILDING DIVISION
19ADDRESS: 20245 stvns drk blvd
DATE: 06/22/2011
REVIEWED BY: bobs.
a _y4
APN
BP#:
"VALUATION:
1$65,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
I PERMIT TYPE:
WORK
re lacement of exisitn wood fasica replaced with aluminum canopyat main entry
SCOPE
Site work = restriping for accessible parking and signage.
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 09-051 Ejf. 71I1102
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes
E) No
$0.00
0 hours
$126.00
Plan Check, Hourly
IsTPLNCx
Suppl. PC Fee: G Reg. 0 OT
1 0.0
brs,
$0.00
PME Plan Check:
$0.00
300 s.f. Restucco
$443.00 1STUCOAPP
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. O OT
F0701
hrs
$0.00
0 # Awning / Canopy (Support'd by Bldg)
$317.00 1AWNATTBLD Canopy
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_`cara t Utz_°�it�r Tax
Acoustical Fee: 0 Yes (D No
$0.00
0
E)
Work Without Permit? 0 Yes G No
$0.00
Plalming Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Strong Motion Fee: IBSEISMICO
$13.65
= hrs
$126.00
Inspections
11NSPMIS Standard Inspections
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$16.65
$1,012.00J
TOTAL FEE:
1 $1, 028.65
Revised: 04/29/2011