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12090111CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: DEVCON PERMIT NO: 12090111 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED: 09/12/2012 OWNER'S PHONE: 4088629799 MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL EI License Class Lic. # 9N7 /iy 3 APPLE- ELECTRICAL UPGRADES ADD LIGHT FIXTURES, Contractor �(/_(M Date � OUTLETS AND SWITCHES I hereby affirm that I am licensed under the provisions of C pter 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: 1 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: $20000 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 1 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 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 granting of this permit. Additionally, the applicant understands and will comply Issued b Date: with all non -point source regula ' s per the Cupertino Municipal Code, Section 9.18. �?/All RE -ROOFS: Signatu Date 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. ❑ OW�LDER LARATIONSignature of Applicant: Date: 1 hereby m e 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. I 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 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 I performance of the work for whichthis permit is issued. cipal Code, Chapter 9.12 and will maintain comconstruction I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Saf3, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this %p( l Id permit is issued. Owner or authorDate: 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, 1 LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm th 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 rMME... CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10500 n. de anza blvd. 2nd floor DATE: 09/12/2012 REVIEWED BY: bobs. UNITS BP FEES BP#: *VALUATION: 1$20,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: # PENTAMATION 10EAP11 PERMIT TYPE: WORK electrical upgrades= add lights fixtures outlets switches. SCOPE ,blech. Insp.E17L--- Ll,,h. APPLIANCE / EQUIP TYPE FEE ID �MINIM QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 5 # $67 Recep/Switch/Outlets 1BREMRECEP ,blech. Insp.E17L--- Ll,,h. 12 # $45 Insp. Fee PME Unit Fee: Plumb. hop. Fee: Elea Insp. Fee: IELECINSP $133.00 $178.00 Conswuction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? © Yes Q No $0.00 TOTALS: l $112.00 Strong Motion Fee: IBSEISMICO NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These Pees are based on the nrehminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711111) ® �MINIM MISC ITEMS P/un Chock Fee: S7tpp1. PC Fc e l.fech. Plan Check Plumb. Plun Check Elec. Plan Check 0.0 hrs $0.00 Lfech. Permi[ Fee: Plumb. Permit Fee: EIeC. Permit Fee: IEPERMT ,blech. Insp.E17L--- Ll,,h. Ot1rE r Plumb Insp,Li Other EIeC. Insp. 1.0 hrs $45.00 Insp. Fee PME Unit Fee: Plumb. hop. Fee: Elea Insp. Fee: IELECINSP $133.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These Pees are based on the nrehminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711111) FEE QTY/FEE MISC ITEMS P/un Chock Fee: S7tpp1. PC Fc e PME Plan Check: $0.00 Permit Fee: Supp1. lnsp Fee PME Unit Fee: $112.00 PME Permit Fee: $178.00 Conswuction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? © Yes Q No $0.00 Advunced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICO $4.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 .. + .1. 382.20 0.00 c Revised: 07/01/2012