11040109I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10650 S DE ANZA BLVD CONTRACTOR: DUPLAN PERMIT NO: 11040109
CONSTRUCTION INC.
OWNER'S NAME: BYER PROPERTIES 390 INDUSTRIAL ST DATE ISSUED: 09/07/2011
OWNER'S PHONE: 6504005173 CAMPBELL, CA 95008 PHONE NO: (408)866-6682
b, LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALS
License Class�C"-3� /�, L�-� Licc. # 1
Contractor Date xv %-
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 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 apainstpid City in consequence of the
granting of this permitAddi�ionally, 1fe applicant understands and will comply
with all non -point source ulatiops pe ie Cupertino Municipal Code, Section
9.18.
Signatures
❑ 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
SMOKE EATERS - NEW UNENCLOSED PATIO AT
EXISTING
RESTAURANT, ADD NEW GAS LINE FOR FUTURE SPACE
HEATERS
Sq. Ft Floor Area:
Valuation: $34700
APN Number: 36937027.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHI ,fIQ=DAYS OF PERMIT ISSUANCE OR
180 DAY ,' OM 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
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 Aix Air Qu))nijity,A4anagementDistrict I
will maintain compliance with the Cup lino Mu rtci I Code, Chapter 9.12 and
the Health & Safety Code, Sections 2 05,255 d 25534.
Owner or authorized agent:. Datey6
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must I I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
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.
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Date
CITY OF CUPERTINO
FFF FSTIMATOR — BUILDING DIVISION
ADDRESS: 10650 s de anza blvd
DATE: 04/18/2011
REVIEWED BY: bobs.
APN: 369-37-027
BP#:
"VALUATION:
$34,700
rPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARYPENTAMATION
USE: Commercial Building
1 GENCOM
PERMIT TYPE:
WORK
new unenclosed patio at existing
restaurant add new gas line for futures ace heaters.
SCOPE
:�tt'zI �°i r:,t7 t,ti .::7i
<„tIt � r fis£'7:
_.f.._. :'<•"/Pt f..t':;j
�siP.ED
it ,rif t. frt FJ.°.
Arn'rU- 'r,.nrn £n— ern h—ad me ilia nrvlrsninnry infernya inn nvailahle and are only an estimate. Contact the Dept for addn'l into.
FEE ITEMS (I ee Resohttion 09-051 f ff. 7/I11O
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No
$0.00
I I hours
$378.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
his
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:G Reg. 0 OT
0.0
his
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee: 0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes G No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure 0
Strong Motion Fee: 1BSEISMMo
$7.29
4.0 hrs
$504.00
Inspections
IINSPMIS Standard Inspections
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$9.29
$882.00
TOTAL FEE:
$891.29
Revised: 01/15/2011