11050195CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 N DE ANZA BLVD
CONTRACTOR: DEVCON
PERMIT NO: 11050195
CONSTRUCTION INC
OWNER'S NAME: BERG FAMILY PARTS LP
690 GIBRALTAR DR
DATE ISSUED: 11/30/201 1
,MINER'S PHONE: 4089961010
MILPITAS, CA 95035
PHONE NO: (408)942-8200
�{J LICENSED CONTRACTOR'S DECLARATION
i� I— �
v
BUILDING PERMIT INFO; BLDG ELECT PLUMB
License Class Lic. 4 -
f— F I
91---V- �
MECH RESIDENTIAL COi\ID4ERCIAL
Contractor o/Date
JOB DESCRIPTION: APPLE - COMM'L T.I(600SQFT) RUN CONDUIT FROM 20400
I herebyaffirm that I am licensed under the provisions of Chapter 9
p p
MARIAM TO 10500 N DE ANZA BLVD & INSTALL UPS
(commencing with Section 7000) of Division 3 of the Business & Professions
EQUIPMENT & RACKS IN EXISTING 1 DF ROOM.ELECTRIC
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
Sq. Ft Floor Area:
Valuation: $500000
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
APN Number: 31622017.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT S IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 11 Q f AYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS` OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
in
k
costs, and expenses which may accrue against said City consequence of the
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Issued by: f' Date r
granting of this permit. Additionally, the a licant understands and will comply
with all non -
/ (
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.
ElOWNER-BUILDER D LAI2ATI0
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS NIATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the folloving three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store om• handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino
:
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
CONSTRUCTION LENDING CY
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
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
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FFF ESTIMATOR - BUILDING DIVISION
igADDRESS: 10500 De Anza Blvd
DATE: 05/23/2011
REVIEWED BY: L.S.
-NI
APN: 316-22-017
BP#:
"VALUATION: 1500000.00
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
PENTAMATION 1 B TI
PERMIT TYPE:
CEO
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE H)
B (Tenant Improvements)
I-A,I-B
600
2805
IBTIPLNCK
1053.28
IBTIINSP
TOTALS:
600
2805
1053.28
MECH, HOURLY 0 Yes G No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY Yes " No
il t _��" �f�F:?,:
Elec. Plan Check 0 hrs p
Elec. Permit Fee: IEPERMIT
ir.3°iris
z°I�+:,r; i�,:;;. 0
Other Elec. Insp. 0 hrs 42
A/nTT.`. Thnoa £n— — h—ad nn Me nrn]inylnaru infnr"in inn ayailahle and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resohition 09-051 Eff. 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
2805
ff
126
Electrical
IBREMMISC Special Circuits
Suppl. PC Fee: G Reg. 0 OT
0
hrs
0
PME Plan Check:
0
Permit Fee:
1053.28
Suppl. Insp. Fee:G Reg. 0 OT
F071
his
0
PME Unit Fee:
0
PME Permit Fee:
42
Acoustical Fee:
0 Yes (D No
0
0
G
Work Without Permit? 0 Yes (2) No
0
Plafmin Fee:
0
Select a Non -Residential
Building or Structure
0
0
i
Travel Documentation Fee: 1TRAVDOC
42
Strong Motion Fee:
1BSEISMICO
105
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
20
SUBTOTALS: `
067.279994
126
TOTAL FEE:
4193.28
Revised: 04/29/2011
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10500 N DE ANZA BLVD
DATE: 06/01/2011
REVIEWED BY: SUEW.BS
APN: 316-22-017
BP#: 11050195
*VALUATION: 1$500,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
_7PRIMARY
USE: Commercial Building
PENTAMATION 1 B TI
PERMIT TYPE: i
WORK
RECREATED FROM 5/23/11 FILE MISPLACED. RUN CONDUIT FROM 20400 MARIAM TO 10500 N
SCOPE
DE ANZA, INSTALL UPS EQUIP & RACKS. ELECTRICAL HOOKUP UPS/EQUIP ANCHORAGE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
I-A,I-B
600
$2,805.00
IBTIPLNCK
$1,053.28
IBTIINSP
TOTALS:
600
$2,805.00
$1,053.28
MECH, HOURLY O Yes G) No
PLUMB, HOURLY Q Yes (j) No
ELEC, HOURLY (D Yes Q No
!7omb P l,w <'h'"'
Elec. Plan Check 0.01 hrs $0.00
Elee. Permit Fee: IEPERMIT
�
Other Elea Insp. 0.0 hrs $42.00
L
JVn1rJV Tl, ilia availahle and are nn1v an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Elf. 7/1/10)
FEE
QT-1
MISC ITEMS
Plan Check Fee:
$2,805.00
# Electrical
$126.00 BREMMISC Special Circuits J
I
Suppl. PC Fee: 0 Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,053.28
Suppl. Insp. Fee:O Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
i t?itSii'((i'(lr))1 i{t1"
Acoustical Fee: 0 Yes (F) No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee;
$0.00
Select a Non -Residential 0
Building or Structure
Travel Documentation Fee: 1TRAVDOC
$42.00
Strong Motion Fee: IBSEISMICO
$105.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$20.00
SUBTOTALS:
$4,067.28
$126.00
TOTAL FEE:
F$4,193.28
Revised: 04/29/2011