11120067CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10080 N WOLFE RD
OWNER'S NAME: CUPERTINO FINANCIAL CTR PARTS LLC
OWNER'S PHONE: 4085679900
❑ LICENSED CONTRACTOR'S DECLARATION
License Classr //++ Lic. tl 0
Contractor CW1 Date � Z S Z I
1 hereby affir at I 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 u tions per the Cupertino Municipal Code, Section
9.18.
Signature Date2-1
❑ fj"ER-BUILDER DECLARATION
1 hereby affirdrthat I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
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 10
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.
CONTRACTOR: APPLIED CONSTRUCTION PERMIT NO: 11120067
TECH
1230 OAKMEAD PKWY DATE ISSUED: 01/05/2012
SUNNYVALE, CA 94085 PHONE NO: (408)252-9990
BUILDING PERMIT INFO: BLDG r— ELECT F_ PLUMB f—
MECH r RESIDENTIAL COMMERCIAL r
JOB DESCRIPTION: STE SW3-200 - HITACHI -COMM. T.I NON-STRUCTURAL
INCLUDE MECHANICAL/ELECTRICAL;NO
PLUMBING(998SQFT)
Sq. Ft Floor Area: Valuation: $125000
APN Number: 31620086.10080 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued Date:
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. I 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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Own" nr:a ...... r ..... ..at: ...... ....... ..............
;1
.eR-.rl IIatR..::;::
CONSTRUCTION LENDING AGENCY
I herebyAffirm that there is a construction lending agency for the performance of ,�wrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Signature Date I Licensed Professional.
CITY OF CUPERTINO
ffim_� FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10080 n. wolfe rd.
DATE: 12/12/2011
REVIEWED BY: bobs.
PC FEE ID
APN:
BP#:
-VALUATION: 1$125,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
/BTIPLNCK
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
t.i. comm. offices ace non structural include M E no plumbing.
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,111-B,IV,V-B
998
$1,945.60
/BTIPLNCK
$972.24
/BTIINSP
PME Plan Check:
$0.00
Permit Fee:
$972.24
Suppl. Insp. Fee:Q Reg. 0 OT
p,p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
7DTALS' '
998
$14945.60
: r
$972: 4
:..:,..... :..... f...
'1''e:',
�,.;.;
'..`lie' • :1a`,f��j�t:1;'`;'::
.. .�
:1?s'<'a:.
•� .. T:...
4J[.2:%,. n. ti ...,I'.i. _.,
.. •. x; _,.. � .'171 (. ...x
1: St':. �:7i � ?... ....
$1,945.60
Select a Misc Bldg/Structure
or Element of a Building
_j'.
17T
ET
hrs
$0.00
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nrelininary information available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (1-ee Resolution 11-053 Efl' 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,945.60
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$972.24
Suppl. Insp. Fee:Q Reg. 0 OT
p,p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
T'V: _�q' : .,,1a:r rry ].:,a:. ?",.;r.
Stronja Motion Fee: IBSEISMICO
$26.25
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$5.00
................... .
..........._:�._...:,.,,�.
2 9.49.09
$ ,
.00 . :.:>l;`
$0 ':'�"�':'��'�,�:... ..,..,..�.:.-
$2,949.09
Revised: 12/04/2011