12040145CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10475 BANDLEY DR
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class IS Lic.t1 3 %
Contractor
1 hereby affirm that I am licensed under the provisions of apter 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 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. Add[ " ally, the applicant understands and will comply
with all non - Municipal Code, Section
9.18.
❑ -"OWNER-BUILDER DECLARATION
1 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).
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,1 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.
CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 12040145
INC
690 GIBRALTAR DR DATE ISSUED: 05/01/2012
MILPITAS, CA 95035
PHONE NO: (408)942-8200
BUILDING PERMIT INFO: BLDG J_ ELECT F PLUMB r-
MECH r- RESIDENTIAL r— COMMERCIAL r—
JOB DESCRIPTION: APPLE - STRUCTURAL UPGRADES TO EXISTING
ROOFTOP
COMMERCIAL BUILDING
Sq. Ft Floor Area: I Valuation: S40000
APN Number: 32633111.00 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- �Z
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 & Sakty Code, Sections 25505, 25533, and 25534.
:
Date:#�_
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Add
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Date I Licensed Professi
I CITY OF CUPERTINO BUILDING Pam'" ' 77 V, I
BUILDING ADDRESS: 10475 BANDLEY DR I CONSTRUCTION IN VrON— PERMIT NO: 12040145
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S
License Class_ l Lic. # 3 / [ , 1
Contractor ���/ CC—A� 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 whichthis 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
❑ 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.
690 GIBRALTAR DR I DATE ISSUED: 05/01/2012
MILPITAS, CA 95035 PHONE NO: (408)942-8200
JOB DESCRIPTION: RESIDENTIAL u COMMERCIALU
APPLE - STRUCTURAL UPGRADES TO EXISTING
ROOFTOP COMMERCIAL BUILDING
DEFERRED #1- ADD EXHAUST FANS AT ROOFTOP-ISSD
5/15/12
Sq. Ft Floor Area: I Valuation: $40000
APN Number: 32633111.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b 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, 255339 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 1 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, 255 , and 25534.
Owner or authorized :
CO STRUCTION 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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Signature
Date
CITY OF CUPERTINO
FM-7, FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10475 bandley dr.
DATE: 05/15/2012
REVIEWED BY: bobs.
APN:
BP#: jl
"VALUATION: 1$45,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
deferred rooftop exhaust fans.
SCOPE
Mech. Plan Check 0.0 hrs $0.00
Phw?h. New Chf--.A
E/ee. Man Chrc°k
Mech. Permit Fee: 1MPERMIT
P,., Fee.
Other Mech. Insp. 0.0 hrs $44.00
oa;ef F'!n:
U. : r i, ,__ <<, ,, .Ll
"A.
Ml,,,b; 11)„1'..,,-
Fk:rust, /-vc
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These lees are based on the nreliminary information available and are on[v an estimate. Contact the Dent for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes 0 No
$0.00
2 7 hours
$260.00
Plan Check, Hourly
1STPLNCK
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
4 #
$88.00
Mechanical
1BREMVENF Ventilation Fan
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$44.00
Construction Tax _FT
Administrative Fee: lADMIN
$41.00
0
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
S Building or Structure
E)
0
A
Travel Documentation Fee: !TR 9 VDOC
$44.00
Strong Motion Fee: IBSEISMICO
$9.45
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$140.45
$348.00
TOTAL FEE:
$488.45
Revised: 04/01 /2012
CITY OF CUPERTINO
FM-7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10475 bandley dr.
DATE: 04/26/2012
REVIEWED BY: bobs.
APN:
BP#: d d 1- 5
"VALUATION:
1$40,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / R94ir
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENR
PERMIT TYPE:
WORK
structural upgrades to existing rooftop comm. bldg.
SCOPE
.fE c;i, !'iui7 � 'i.,�c'�:
I'luirrtJ. l'ttar• �;r. ,'� �
1:/'arc../'/�t�=. C',`rnr;l
n 77',.'1'177i. )'.. _
1aJlilli,�J. 1�5'll�„ .....
+r•;, iiC't ,,... �`ce.
blet:�t.rts�;. Ir�.:
FlttnrE�.Irtit;.l'a�:
Iflc�c. In�,�= tt•r•:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes (E) No
$0.00
73 7 hours
$390.00
Plan Check, Hourly
1STPLNCK
Suppl. PC Fee: (E) Reg. () OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Q Yes E) No
Suppl. Insp. Fee-(E) Reg. Q OT 0.0 1 hrs
$0.00
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
T7-
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
7i r:, s:) Llncurir�ntrz/iCjrr 1 4:
Strong Motion Fee: 1 SEISMICR
$
2.0 hrs
$260.00
Inspections
ISTINSP 7 Inspection, Hourly
Bldg Stds Commission Fee: SC
$2.00
SUBTOTALS:
$6.00
$650.00
TOTAL FEE:
$656.00
Revised: 04/01 /2012