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12020106CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10351 BUBB RD CONTRACTOR: XL CONSTRUCTION PERMIT NO: 12020106 OWNER'S NAME: SI 39 LLC 851 BUCKEYE CT DATE ISSUED: 02/23/2012 OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 j611, LICENSED CONTRACTOR'S DECLARATION ✓License Class Lie. # Contractor 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. 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 �,JFja Compensation, as provided for by Section 3700 of the Labor Code, for the L 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 1 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 indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs, and expense hich may accr against said City in consequence of the granting of this p it dditional ,the app cant understands and will comply with all non-ul Wino Municipal Code, Section 9.18, Signature Date 1Z ❑ 'OWNER -BUILDER DECLARATION 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 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. Date BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB F >` MECH RESIDENTIAL COMMERCIAL' JOB DESCRIPTION: APPLE - COMMERCIAL TENANT IMPRO VEMENT(950SQFT) NON-STRUCTURAL INCLUDE MECHANICALIELECTRIC & NO PLUMBING.NEW V.P. OFFICE AND FOUR(4)ADDITIONAL Sq. Ft Floor Area: Valuation: $180000 APN Number: 35720009.10351 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 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. l will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should l store or handle hazardous material. Additionally, should l use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District l will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & a ty Code, tions 505, 25533, and 25534. Ow uthorized ent: f / Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work'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 _ply BUILDING ADDRESS: 10351 BUBB RD CONTRACTOR: XL CONSTRUCTION PERMIT NO: 12020106 OWNER'S NAME: SI 39 LLC 851 BUCKEYE CT DATE ISSUED: 02/23/2012 OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION License Class �r Lic. # i `t _74 V L/ Contractor )Q Ca ak h��.___ Date +i I, -?— I 1 hereby affirm that I am licensed under the provision 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. 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 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 1 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 ❑ OWNER-BUI ER DE ARATION I hereby affirm that I am exem 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 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). 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 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-pouit source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: BLDG T_ ELECT F_ PLUMB T_ MECH r RESIDENTIAL r COMMERCIAL I— JOB DESCRIPTION: APPLE - COMMERCIAL TENANT I MP RO V EMENT(950SQFT) NON-STRUCTURAL INCLUDE MECHANICAL/ELECTRIC & NO PLUMBING.NEW V.P. OFFICE AND FOUR(4)ADD[T[ONAL 3/14/2012 -REV# I- STRUCTURAL REVISION TO ADD HEADER TO OFFICE ENCLOSURE - REV# I ISS'D 3/14/2012 Sq. Ft Floor Area: Valuation: $180000 APN Number: 35720009.10351 1 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: 3 1 L 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 au horized agent: 3 ate: %Z C ! TR CTION LENDING AGENCY I hereby affirm thatre is a struction lending agency for the performance of murk's for which this permi ' (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: TYPE OF CONSTR. / DATE: VyREVIEWED BY: 0 . -I 16KADDRESS: APN: BP#: % -VALUATION: Iso *PERMIT TYPE: Building Permit $0.00 PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: hrs $0.00 PENTAMATION 1 B TI PERMIT TYPE: WORK STRUCTURAL REVISON TO ADD HEADER TO OFFICE ENCLOSURE SCOPE 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 0 $0.00 Suppl. PC Fee: Q Reg. C) OT $0.00 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 SuppL Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 0 $0.00 $0.00 MECH, HOURLY © Yes G No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY ® Yes Q No NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the prelininary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes E) No $0.00 72 7 hours Plan Check, Hourly $260.00 ISTPLNCK Suppl. PC Fee: Q Reg. C) OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 SuppL Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 7 0 G Work Without Permit? Q Yes No $0.00 Advanced PlanningFee: $0.00 Select a Non -Residential Building or Structure G 0 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.001 $260.00 TOTAL FEE: 1 $260.00 Revised: 1/19/2012 WON CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10351 bubb rd. DATE: 02/23/2012 REVIEWED BY: bobs. PC FEE ID APN: 3 S� BP#: IaDav/ 'VALUATION: 1$180,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION 1 B TI PERMIT TYPE: WORK U. comm. offices ace non structural include M E no Ps. New V.P. office 4 additional offices SCOPE reconfigure 2 Offices into conference room. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 0 $0.00 $0.00 $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes G No $0.00 Suppl. Insp. Feel@ Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 0 $0.00 $0.00 NIECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY 0 Yes Q No Li NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nrelininary information available and are only an estimate Contact the Dent for addn 7 info. FEE ITEMS jfee Resolution II -053L' . 711/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes ® No $0.00 F-17 hours Plan Check, Hourly $130.00 ISTPLNCK Suppl. PC Fee: (j) Reg. ® OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes G No $0.00 Suppl. Insp. Feel@ Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 G Work Without Permit? ® Yes (E) No $0.00 Advanced Plannine Fee: $0.00 ® hours Inspections $1,040.00 ISTINSP Inspection, Hourly G C) Strong Motion Fee;: IBSEISMICO $37.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $8.00 SUBTOTALS: $45.801$1,170.001 TOTAL FEE: 1 $1,215.80 Revised: 1/19/2012