11120018CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18920 FORGE DR CONTRACTOR: DEVCON PERMIT NO: 1 1 120018
CONSTRUCTION INC
OWNER'S NAME: FORGE DRIVE INVESTORS, LLC 690 GIBRALTAR DR DATE ISSUED: 01/06/2012
OWNER'S PHONE: 4152845700 MILPITAS, CA 95035 PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION I- (—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.N r
MECH RESIDENTIAL COMMERCIAL
Contractor
1 hereby affirm that 1 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.
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
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 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.
Signature Date
OWNER -BUILDER DECLARATION
9 hereby affirm that 1 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)
1, 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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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 so ce regulations per the Cuperto Municipal Code, Section
9.18.
Signature Date /�hn/
JOB DESCRIPTION: APPLE- PHASE 3 -COMM. T.1 STRUCTURAL(9300SQfi)
ADD NEW OPEN WORK SPACE, LABS, VENDOR, AND LOBBY;
INCLUDES MECHANICAL & ELECTRICAL
Sq. Ft Floor Area: Valuation: $651000
APN Number: 31609030.18920 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTTIION.
Issued yq'.— te:
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 Applicant:
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. 1 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 Area Air Quality Management District I
will maintain compliance with t pertino Municipal Code Chapter 9.12 and
the Health & Safety Code, S ion 5505, 5 and 25
Owner or authorized agent: Date/
L
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
FM
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 18922 forge dr.
DATE: 12/02/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
1$651,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 11 TI
PERMIT TYPE:
WORK
commercial structural add new open works ace labs vendor, and lobby, includes M.E.
�t.i.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE 1D
BP FEES
BP FEE 1D
B (Tenant Improvements)
II-B,III-B,IV,V-B
9,300
$2,429.02
IBTIPLNCK
$5,748.65
IBTIINSP
TOTALS:
9,300
$2,429.02
$5,74$.65
NOTE: This estimate does not Include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
WvtrieL otr_ )_ Th~ fboc are hated an the nrolindnary infnrmntinn availahlo and aro nnly an octimnto_ Cantaet tho Dont lar addn'l info"
FEE ITEMS (I,ee Resolution II-053 E'ff. 711/II)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,429.02
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$5,748.65
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Pla�lee:
$0.00
Select a Non -Residential 0
Building or Structure
Strong Motion Fee: IBSEISMICO
$136.71
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$27.00
...... ' .s`ss l
$8,341.38
$0.00 :::'414'Ay:'#
$8,341.38
Revised: 10/01/2011