12080208CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19925 STEVENS CREEK BLVD
OWNER'S NAME: STEVENS CREEK INVRS LLC
CONTRACTOR: BARRON BUILDERS INC I PERMIT NO: 12080208
415 CLYDE AVE, STE 104 DATE ISSUED: 08/23/2012
OWNER'S PHONE: 4089961010 1 MOUNTAIN VIEW, CA 94043 1 PHONE NO: (650) 269-7061
❑ LICENSED CONTRACTOR'S DECLARATION
License Class f-I> p
Lic. 4 `' � $ G 4
Contractor t3.A O M �A LPOCS Date.
11-03((2
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:
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.
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 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 P> -23 -12
❑ 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)
1, 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.
Signature—r� Date
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: APPLE- REPLACE 13 PACKAGE UNITS, 18 SPLIT SYSTEMS,
ADD NEW HVAC SYSTEM. CONTINUATION OF EXISTING
PROJECT ON ROOF
Sq. Ft Floor Area: I Valuation: $300000
APN Number: 31621089.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D YS FROM L CALLED INSPECTION.
Issued by: / t 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.
Owner or autho ,zed agent: r Z 3 P' 2
1— Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of vwrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19925 STEVENS CREEK BLVD
CONTRACTOR: BARRON BUILDERS INC
PERMIT NO: 12080208
OWNER'S NAME: STEVENS CREEK INVRS LLC
415 CLYDE AVE STE 104
DATE ISSUED: 08/23/2012
OWNER'S PHONE: 4089961010
MOUNTAIN VIEW, CA 94043
PHONE NO: (650) 269-7061
Cl LICENSED CONTRACTOR'S DECLARATION
r._
(
�
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. # .
( r
p
Contractor;'Date
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: APPLE- REPLACE 13 PACKAGE UNITS, 18 SPLIT SYSTEMS,
(commencing with Section 7000) of Division 3 of the Business & Professions
ADD NEW HVAC SYSTEM. CONTINUATION OF EXISTING
Code and that my license is in full force and effect.
PROJECT ON ROOF
I hereby affirm under penalty of perjury one of the following two declarations:
10/9/12 REVISION #1 ADD A MAKE UP AIR UNIT AND 2 NEW 100 AMP
I have and will maintain a certificate of consent to self -insure for Worker's
ELECTRICAL PANELS -ISSUED 10/9/12
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: $300000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 31621089.00
Occupancy Type:
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,
PERMIT EXPIRES IF WORK IS NOT STARTED
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
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
_._- -,_
Signature G-
Issued by: C J�AN�/ �/ Date:
Date
6
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
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:
I have and Will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS NIATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.9.5 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 Nlunicipal 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
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
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 taws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I Must
Owner or authorid agent:„
Forthwith comply with such provisions or this permit shall be deemed revoked.
-- - Date:_LCLq1 -
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
—
M 8.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 19925 Stevens Creek
DATE: 10/09/2012
REVIEWED BY: Sean
APN:
BP#: 12080208
*VALUATION: 1$25,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
PENTAMATION
PERMIT TYPE: FURN/A
WORK
#1: Revision to existingpermit to add a make u air unit and 2 new 100 am electrical
SCOPE
�Renyeision
als.
Mech. Plan Check 0.0 hrs $0.00
Phwib. Plan Check
Elec. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: IMPERMIT
Mimi). Permit Fee:
Elec. Permit Fee: IEPERMIT
Other Mech. Insp. 0.0 hrs $45.00
(Tiler Phnnh hup,
Other Elec. Insp. 0.0 hrs $45.00
11cch. Lasp. FCC:
Phmab. hasp. Fee:
Elec. Lisp, Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Devt for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Elf. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 # Mechanical
$133.00 1BCAIRHA Air -Handling (<=1OK cfm)
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
1 200 1 amps Electrical
$45.00 1 IECT<200 Services
Permit Fee:
$0.00
Suppl. Insp. Feet) Reg. 0 OT
0 0
hrs
$0.00
F-20-6-1 amps Electrical
$45.00 IECT<200 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$90.00
C'Mull•riction Tns:
Administrative Fee: 1ADMIN
$42.00
G
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
i
Travel Documentation Fee: ITRAVDOC
$45.00
Stroniz Motion Fee: IBSEISMICO
$5.25
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS::
$183.25
$223.00
TOTAL FEE:
$406.25
Revised: 10/01 /2012
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 19925 stvns crk blvd
DATE: 08/20/2012
REVIEWED BY: bob s.
APN:
BP#:
*VALUATION: 1$300,000
-PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
Commercial Building
PENTAMATION
FURN/A A
USE:
PERMIT TYPE:
WORK
lace 13 package units 18 split s tems add new HVAC system/
�re
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Air -Handling (<=10K cfm)
1BCAIRHA
32
#
$4,256
TOTALS:
$6 00
Mech. Plan Check 0.0 1 hrs $0.00
Plnllib, Plao Clwcli
Fec. Pl(m Check
Mech. Permit Fee: IMPERMIT
F'llfinh. Permil Free.
Ekc. Pcrmil Feu:
Other Mech. Insp. 0.0 hrs $45.00
other Plitmb Irisp.
other Elce, hap. Ll
mcch. /asp, Fec:
1'111mb, lisp. kee.
Elec. hasp, Fce.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc. ). These fees are based on the nrelindnary information available and are only an estimate. Contact the Deptfor addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
phin Check Fee:
/
Stipp/. PCFcc
PME Plan Check:
$0.00
Perinil Fec:
Supp/, Fee
PME Unit Fee:
$6,118.00
PME Permit Fee:
$45.00
i.:O1t,SU'tlCl`lO7i 1 t7S:
Administrative Fee: IADMIN
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
r1c./ticeuc:r<l Plamlirw Fc s.
/
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICO
$63.001
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$12.00
SUBTOTALS:
$6, 325.00
$0.00 TOTAL FEE:
I $6� 0
Revised: 07/01 /2012