12080008CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10150 N WOLFE RD
CONTRACTOR: W.L. BUTLER
PERMIT NO: 12080008
CONSTRUCTION, INC
OWNER'S NAME: J C PENNEY PROPERTIES INC
204 FRANKLIN ST
DATE ISSUED: 09/12/2012
OWNER'S PHONE: 4158505252
REDWOOD CITY, CA 94063
PHONE NO: (650) 361-1270
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class Lic. t1
JC PENNEY PHASE 1: TENANT IMPROVEMENT (4250
Contractor 4L),G �"�
r �'« Date i` a�'(a—
HE LEVI'S AND ARIZONA SHOPS. REMOVAL OF
I hereby affirm that I am licensed under the provisions of Chapter 9
FEATURE
(commencing with Section 7000) of Division 3 of the Business & Professions
WALL, REVISE FLOORING & INSTALL ACCENT
Code and that my license is in full force and effect.
LIGHTING.
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: $24000
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 the performance of the work for which this
APN Number: 31620094.00
Occupancy Type:
p y
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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
WI'T�TIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property f '. spection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless tinityof upertino against liabilities, judgments,
costs, and expenses which ma accnre ainst said City in consequence of the
����
granting of this permit. Add' on , the applicant understands and will comply
Issued b Y� /�/'�` Date
with all non -point source re u ons per tho Municipal Code, Section
9.18. 7
p�� ��
RE -ROOFS:
Signatu 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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I 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).
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 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 ality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupe o M hcipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2 ,4.'
Section 3700 of the Labor Code, for hue 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
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10150 N. Wolfe Rd
DATE: 0810212012
REVIEWED BY: Sean
C FEE ID
APN:
BP#:
"VALUATION: 1$24,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1
PENTAMATION 1 M TI
PERMIT TYPE:
wORK
JC Pennv Phase I: Tenant Improvement 4250 sq ft the Levi's and Arizona shops.
SCOPE
is/ec•. Pea?lil FCC.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREAFEES
s.f.
'S' " .. �./i� ti - ,Y :•:Yr �:
jv •-F:'�..;>.; ::r'�� S
C FEE ID
BP FEES
BP FEE ID
M (Tenant Improvements)
II-B,111-B,Iv,v-B
4,250
$3,094.06
1
IPLNCK
$3,343.37
IMTHNSP
$3,343.37
is/ec•. Pea?lil FCC.
0,0
hrs
other Phlr,�, 1r; p.other
PME Unit Fee:
$0.00
h.ler., lnsp.Ll
AA., h 1nsp. P"e.,
Plrnuh. Gl.cp. Fee:
Advnbfi7 irative Fee:
Elec. Insp.
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
TOTALS:
4,250
$3,09
ti
3.37
Select an Administrative Item
y : ..fir.
Zai
r - is . c�i7li',•�S'.' :•ls it I, Nig`" �� L - "is 4C ;rJ=�
Sr z `��s. ��'s i,
'S' " .. �./i� ti - ,Y :•:Yr �:
jv •-F:'�..;>.; ::r'�� S
Plan Check Fee:
$3,094.06
Plnmh. Plan Check
Suppl. PC Fee: Q) Reg. 0 OT
0.0
1 hrs
Dec. Plan C.'icck
A1r.'.c h1 Permil Fec.
$0.00
Plumb, Per -mil Fee.
Permit Fee:
$3,343.37
is/ec•. Pea?lil FCC.
0,0
hrs
other Phlr,�, 1r; p.other
PME Unit Fee:
$0.00
h.ler., lnsp.Ll
AA., h 1nsp. P"e.,
Plrnuh. Gl.cp. Fee:
Advnbfi7 irative Fee:
Elec. Insp.
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,094.06
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,343.37
Suppl. Insp. Fee -0 Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consivuctlon KLY.
Advnbfi7 irative Fee:
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure
i
Travel Docionentaiion Fees:
Strong Motion Fee: 1BSEISMICO
$5.04
Select an Administrative Item
Bldp, Stds Commission Fee: 1BCBSC
1 $1.00
..;,, .,,..;;;,.._. ;::r. i�'
44 .47
'_. .,.;.... , f=
6 443.47
Revised: 07/01/2012