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12070101CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: DEVCON PERMIT NO: 12070101 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED: 07/26/2012 OWNER'S PHONE: 408996 10 10 M I LPITAS, CA 95035 PHONE NO: (408)942-8200 Q LICENSED CONTRACTOR'S DECLARATION r r r SLicense Class Lic. it �� �� � BUILDING PERMIT INFO: BLDG ELECT PLUMB r r MECH RESIDENTIAL COMMERCIAL Contractor a- VC (�%�, Date o7 I hereby affirm that I am licensed under the provisio of Ch pter 9 JOB DESCRIPTION: APPLE - FLOOR 2 - COMMERCIAL TENANT (commencing with Section 7000) of Division 3 of the Business & Professions IMPROVEMENT, 4320 SQFT, STRUCTURAL RELOCATE TWO CHAMBERS Code and that my license is in full force and effect. INCLUDE PARTITIONS AND NEW DOORS 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 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 permit is issued. APN Number: 31622017.00 Occupancy Type: 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 WITHIN 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 RO LAST CALLED IN PECTION. 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. Additionall , the applicant understands and will comply Issued by: Date: with all non-point sone-re upertino Municipal Code, Section 9.18. c6 I 01 RE-ROOFS- Signature Date 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. ❑ R DECLARATION Signature of Applicant: Date: I hereby affirm that 1 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). 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 following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 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 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 CUDexliko Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code ons 2�5533,534. Section 3700 of the Labor Code, for the performance of the work for which this))Gpermit JJ is issued. Owner or authorized age _Date: O` 1 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, 1 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. 1 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 CITY OF CUPERTINO F -P07 FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10500 n. de anza blvd. DATE: 07/16/2012 REVIEWED BY: bobs. PC FEE ID APN: BP#: L&IO 'VALUATION: 1$500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAMATION 1 B TI PERMIT TYPE: WORK comm. structural relocate 2 chambers include partitions, new doors. �t.i. SCOPE 'ii1 r,., 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 4,320 $2,258.04 IBTIPLNCK $3,497.22 1BTHNSP U�%;rn/; -'C frsp. k•= '. .. - 'ii1 r,., ��;�;>s fr7sya- f'.^tr: 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i, �37if_1'3Y'Plf'.PlClY7 Tax: A' .. ... rpelit(lFll.i[t-�iid4'(? 1`L'@'. 0 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: 4,320 $2,258.04 Vii`; ? .`:is : I $3,497.22 Strong Motion Fee: IBSEISMICO r>� .>i . �:: • :err: QTY/FEE MISC ITEMS Plan Check Fee: $2,258.04 ,rick.,. ph'AA 5 5. arm.. ., jNrrilii� � .,,• ('t��c't'� 1,1. r 1'[;�;Y C)•{ ;,,t J hrs 'ii, f. fel:'. 1 etr•.Dt!! �' c'. i:iirrc.: 1h%is h. C1;1.:'i.'.1°L: n..iJ:•Li U�%;rn/; -'C frsp. k•= '. .. - 'ii1 r,., ��;�;>s fr7sya- f'.^tr: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,258.04 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 J hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,497.22 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i, �37if_1'3Y'Plf'.PlClY7 Tax: A' .. ... rpelit(lFll.i[t-�iid4'(? 1`L'@'. 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure z ..!b`c 7 E��rJ L'flil7i,'ialUif!)J? 1'r.'f:'.i' Strong Motion Fee: IBSEISMICO $105.00 Select an Administrative Item Bldg; Stds Commission Fee- IBCBSC $20.00 •�%%+• �\,,...rM1�. .,... ....-.:�r: $ 880.26 f � 0.0-0: Revised: 07/01/2012 CITY OF CUPERTINO F. -M. -M FEE ESTIMATOR - BUILDING DIVISION if } f lJ- } ' �, j 5 } f• �}'�f #y 32 f % ` s C ��� � 1J r$f17� l S� ���f,� 1. ]]] S 7 `�`�([�(�� � � NOTE. 10500 N. De Anza �',� �y�,[i (� Cir Clay ; sir ' �f; I r. ��.}}.-- � ti :3; :'Ji ; �S�;,j s `,�t''s: �"t}�t,F:n���(�{ ���{;S �c4 }$fir � � ,j� S5$S5$$ul��, �F�S%?({"�r ��/� � i�f �y7�z:Sr`�$j �;�z1 DATE: 10/01/2012 REVIEWED BY: gs 4ADDRESS: APN: BP#: 'VALUATION: $0 *PERMIT TYPE: Building Permit Elec. Permit Fee: PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: Other Elco. Insp. PENTAMATION PERMIT TYPE: WORK ee: Elec'.Insp. Fee.- hrs SCOPE PME Unit Fee: if } f lJ- } ' �, j 5 } f• �}'�f #y 32 f % ` s C ��� � 1J r$f17� l S� ���f,� 1. ]]] S 7 `�`�([�(�� � � NOTE. > •� ��` j iso � £ r , s F�%�:' .;�'.�is < F'; t1(i i r r �jS�1.Ep��. #. � ��,rf'"sj�„� � � �f, �$"jS7� ����,j���� a'�;•4�7�{,�r i��i a]���3�}t°������r �j[•t ; ! ]���"�,�"�('}��� �',� �y�,[i (� Cir Clay ; sir ' �f; I r. ��.}}.-- � ti :3; :'Ji ; �S�;,j s `,�t''s: �"t}�t,F:n���(�{ ���{;S �c4 }$fir � � ,j� S5$S5$$ul��, �F�S%?({"�r ��/� � i�f �y7�z:Sr`�$j �;�z1 \i . _£.r J. \1' .7 • .S}l j .-� Y4 , z _r�i Ss I�j ,�Ci$:.s„�.3:_[; =a2_M---------- $0.00 Atech. Plan Check Plumb. Plum Check Elec. Plan Check 1Lfa1l1. PermitFee: Plumb. Permit Fee: Elec. Permit Fee: Other Afech. Insp. Other Plumb Insp.Lj Other Elco. Insp. 1ldcch. In p. Fee, Numb. hisp. Fee: ee: Elec'.Insp. Fee.- NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District.etc.). These Pees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E . 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes Q No $0.00 Select a Misc Bldg/Structure or Element of a Building Su 1. PC Fee: •: Re OT PP � g• ® 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. © OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Adininistrative Fee: Q E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning_Fee. $0.00 2 hours Plan Check, Hourly E) $266.00 ISTPLNCK 0 Travel Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldy,Stds Commission Fee: $0.00 • }!� U S S Z} >,[r i I.a �' �% ,.-, j i ; $266.00..y.:.r:g'5v $266.00$0.00 Revised: 07/01/2012