12010138CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS. 19925 STEVENS CREEK BLVD
OWNER'S NAME: STEVENS CREEK INVRS LLC
PHONE: 4088624397
LICENSED CONTRACTOR'S DECLARATION
License Class Lic.#
r P
Contractor, -' 1 !
Date} E
I hereby affirm that I am licensed under the provisions of Chapter 9
(comrnencing 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 tine
performance of the wort, 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 CERTIFICATION
I certify that I have read this application and state that the above infounation 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. t
Signature Date
® OWNER -BUILDER DECLARATION
I hereby affirm that I ,in exempt front the Contractor's License Law for one of
the following two reasons'
1, as owner of the property, or illy 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
CONTRACTOR. DEVCON CONSTRUCTION PERAITr NO' 12010t38
INC
690 GIBRALTARDR DATE ISSUED: 02/06/20t2
RIILPTrAS, CA 95035 - - PHONI No: (408)942-8200
BUILDING ! I°
' ELECT' PLUMB
IRECH, RE IICOMMERCIAL
JOB DESCRIPTION: APPLE - IST & 2ND FLOOR(4243SQFT) - COMMERCIAL
TENANT IMPROVEMENT; I ST FLOOR REMOVE PARTITION
WALL, ADD TWO(2) NEW OFFICES, ADD NEW ELECTRICAL
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 die Labor Code, for tine
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 tine 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 matuner 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 tlue 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
iadeinni6, 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.t8.
Sq. Ft Floor Area: Valuation' $350000
APN Number: 31621089.00 1 Occupancy Type'
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 einit 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.
Owner or a th r€ d a eat:
'.°Date.
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.)
Leader's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date I Licensed
CITY OF CUPERTINO
._FE.EES..ii — Ji f6l G DILION IS
IM
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (S.f.
B (Tenant Improvements) II-A,111-A,V-A 4,243 $2,762.56 IBTIPLATCK $4,192.59 JBTUMV
ITOTALS: 1 424.3 1 v
NOTE. This esfinudedoes not include fees due to otter-vepaninews (i.e. rianning, ru—c tvurl-, I'll vollmllsey—.1
rAsitapi iho Dont far addull info.
FEE ITEMS (Fee Alesolyjoir 11-053 Eff, 71111111
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,762.56
= If. Interior Partitions
$653.00 1PARTIC0
Suppt, PC Fee: (D Reg. 0 OT1-0-01
hrs;
$0.00
PME Plan Check:
$0.00
73 Electrical
F$277.0T01BREA;1'1T7 Fixtures, Lighting
Permit Fee:
$4,192.59
Suppl. Insp, Fee.0 Reg. 0 OT
Q,Q
hrs
$0.00
6 Electrical
$44.001 IBREAR?ECEP I Rccep/Switch/Outlets
PME Unit Fee:
$0.00
PME Permit Fee:
$88.00
1 # Mechanical
$130 VAV Boxes
O
Work Without Permit? 0 Yes Q No
$0.00
AdvancedLannh2i. Die: Pl
-
$0.00
Select a Non -Residential
Building or Structure 0
Travel Documentation Fee: I TRA VD0C
$44.00
IBSEISWCO
$73.50
Select an Administrative Item
I
P tLd L, Stds Commission Fee,: IBCBSC
I-
$14.00
SUBTOTALS:
---
lt7 1746.5
$ I I - I - -
TOTAL FEE:
$8,278.65