12070079CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10020 N DE ANZA BLVD
CONTRACTOR: DEB CONSTRUCTION,
PERMIT NO: 12070079
INC
OWNER'S NAME: WESTWOOD COMPANY-CUPERTINO LLC
5635 W LAS POSITAS BLVD STE 405
DATE ISSUED: 09/13/2012
OWNER'S PHONE: 9167899944
PLEASANTON, CA 94588
PHONE NO: (925)734-0611
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class Lic. N Ze7
COMERICA BANK- COMM T.I TO INCLUDE RELOCATION
Contractor /3
OF
Date
LIGHT FIXTURES, NEW GYP, BOARD NEW COUNTER
1 hereby affirm that I am licensed under the provisions of Chapter 9
FINISHES
(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
Sq. Ft Floor Area:
Valuation: $25000
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for tie performance of the work for which this
APN Number: 31626094.10020
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITBON 180 DAYS 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 FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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Issued by: /1/ �i� Date: �' /� 'l�-
granting of this permit. Additionally, the applicant understands and will comply
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with all non-pong source regulations per the Cupertino Municipal Code, Section
9.18. �f
l��/#'l
RE -ROOFS:
Signature Date ( /
All roofs shall be inspected prior to any roofing material berg installed. If a roof is
installed withoit first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
1 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
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should 1 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 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio s 2 05, 25531, and 25534.
ol
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person inany manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
W—M7
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
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ADDRESS: 10020 n de anza blvd.
QTY/FEE
DATE: 07/11/2012
REVIEWED BY: bobs.
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APN:
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'VALUATION: 1$25,000
*PERMIT TYPE: Building Permit
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PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
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PENTAMATION 1GENCOM
PERMIT TYPE:
WORK mit.i. exisitin comm. bank includes relocation of light fixtures new . board new counters
SCOPE finishes.
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QTY/FEE
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NOTE: This estimate does not inchide fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are hased on the Dreliminary information available and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? (F) Yes 0 No
$0.00
F-47 hours
$532.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee -0 Reg. 0 OT
1-0-.0-1
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
® hours
$532.00
Inspections
ISTINSP Inspection, Hourly
0
i
Strong Motion Fee: IBSEISMICO
$5.25
Select an Administrative
Item
Bldg Stds Commission Fee: IBCBSC
$1.00
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6.25
1 064.00
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$1,070.25
Revised: 07/01/2012