11050192CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10450 BUBB RD
CONTRACTOR: DICKINSON CAMERON
PERMIT NO: 11050192
CONSTRUCTION CO
OAVNER'S NAME: BERG FAMILY PARTNERS, L.P.
6184 INNOVATION WAY
DATE ISSUED: 07/08/2011
OWNER'S PHONE: 4089741126
CARLSBAD, CA 92009
PHONE NO: (760) 438-9114
JOB DESCRIPTION: RE SIDENTIAL El COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # qojyj
L
APPLE - COMMERCIAL TENANT
'-),f
7-F-2-01(
IMPROVEMENT(3,167SQFT)
Contractor �,i Date
TO "COMMUNITY ROOM" WORK, INCLUDES
I hereby affirm that I am licensed under the provisions of Chapter 9
PARTITIONS,
(commencing with Section 7000) of Division 3 of the Business & Professions
STRUCTURAL MODIFICATIONS, CEILINGS, FINISHES,
Code and that my license is in full force and effect.
I 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: $150000
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: 35720037.10450
Occupancy Type:
permit is issued. Q71.0
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
to building construction, and hereby authorize representatives of this city to enter
WITBEi VWZA�!."F PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA'Q�7FROM LAST CALLED INSPE TAON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source reguJi ation�,pqr 1har-upertino-Municipal Code, Section
9.18.
Y. -I 20
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.
ONVNER-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)
1, 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. Iwill
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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505,25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized a Date:Z—,7-2,-,1
permit is issued.
7�
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
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 BUILDING PERMIT
BUILDING ADDRE SS: 10450 BUBB RD CONTRACTOR: DICKINSON CAMERON PERMIT NO: 11050192
1 1 CONSTRUCTION CO I I
I OWNER'S NAME: BERG FAMILY PARTNERS, L.P. 16184 INNOVATION WAY I DATE ISSUED: 07/08/2011 1
I OWNER'S PHONE: 4089741126 1 CARLSBAD, CA 92009 1 PHONE NO: (760) 438-9114 1
ri LICENSED CONTRACTOR'S DECLARATION
License Class 5 Lic. # 6� go Z
Contractor 01 , dZ I �t)4 1�0 yn eW.7'1 Date F
I hereby affirm that 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.
I hereby affirm under penalty of perjury one of tile following two declarations:
1. 1 have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of die Labor Code, for the
performance of the work for which this permit is issued.
2. 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
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 sq�Re regulatior�s _gAhe Cupertino, Municipal Code, Section 9.18,
Signature/ —Date F—P-1— //
ri C_- OAVNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. 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. 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.
2. 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
permit is issued.
3. 1 certify that in the performance of tile 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 source regulations per the Cupertino Municipal Code, Section 9,18.
Signature.
Date
JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL F1
APPLE - COMM. T.I (3,167SQFT) TO "COMMUNITY ROOM"
WORK, INCLUDES PARTITIONS, STRUCTURAL
MODIFICATIONS, CEILINGS, FINISHES, HVAC,
Sq. Ft Floor Area:
Valuation: $150000
APN Number: 35720037.10450 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:, 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. 1 will maintain
compliance with tile 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 the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505,25533, and 25534.
Date:
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professi
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10450 bubb road
I DATE: 05/23/2011
REVIEWED BY: Is
PC FEE ID
APN:
BP#: //Oso/
*VALUATION: 1$150,000
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
IBTIPLNCK
PENTAMATION I B TI,
PERMIT TYPE:
WORK
back of house- office storage breakroom, and genius room. inc lighting and t -bar ceiling
[tig
SCOPE
PME Plan Check:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
LS. f.)
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements) A
II-B,1II-B,IV,V-B
3,167
$2,110.40
IBTIPLNCK
$2,458.12
IBTIINSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,458.12
Suppl. Insp. Fee:G Reg.
0 OT
F6 56 1
hrs
$0.00
I
I
I
I
I
TOTALS:
1 3,167
1 $2,110.40
1
1 $2,458.12
—
[
MECH, HOURLY 0 Yes 0 No
I PLUMB, HOURLY� C) Yes (j) No
ELEC, HOURLY 0 Yes (j) No
MISC ITEMS
Plan Check Fee:
Tl�", rll,,�?fi�
�Sj E3
01(0 !Wp,
Suppl. PC Fee: G Reg. 0 OT
1-0.01
hrs
NOTE. These fees are based on the prellininarT information available and are on1v an estimate. Contact the Dept for addh It info.
FEE ITEMS 6Lee Resohition 09-051 L�ff 7/1//10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,110.40
Select a Mise Bldg/Structure
or Element of a Building
A
Suppl. PC Fee: G Reg. 0 OT
1-0.01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,458.12
Suppl. Insp. Fee:G Reg.
0 OT
F6 56 1
hrs
$0.00
PME Unit Fee:
$0.00
P ME Permit Fee:
$0.00
Acoustical Fee:
0 Yes 0 No
$0.00
0
E)
Work Without Permit? 0 Yes G No
$0.00
pl�q��
$0.00
Select a Non -Residential
Building or Structure
G
0
Tll,we�
Strong Motion Fee:
IBSEISAffCO
$31.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$6.00
SUBTOTALS:
$4,606.02
$0.00
TOTAL FEE:
1 $4,606.02
Revised: 04/29/2011
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
19ADDRESS:
10450 Bubb
I DATE: 07/25/2011
REVIEWED BY: jsg
S
APN:
BP#: 11050192
*VALUATION: Iso
PERMIT TYPE: Building Permit __FPLAN
CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
F�v;
PENTAMATION
PERMIT TYPE: A
WORIC
hr,
SCOPE
PME Plan Check:
NOTE. These fees are based on the prellininary information available and are only an estimate. Contact the Deptfor addn'l liffio.
ee Resohition 11-053 fff L/Lll J1
FEE ITEMS (r,
FEE
QTY/FEE
MISC ITEMS
"i 17,
OMI
$0.00
hvvp,
h�;�,./', Pee,'
F�v;
—
Suppl. PC Fee: (D Reg. 0 OTTO
NOTE. These fees are based on the prellininary information available and are only an estimate. Contact the Deptfor addn'l liffio.
ee Resohition 11-053 fff L/Lll J1
FEE ITEMS (r,
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Mise Bldg/Structure
or Element of a Building
A
—
Suppl. PC Fee: (D Reg. 0 OTTO
— _F
-
hr,
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:G) Reg. 0
OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
0 Yes 0 No
$0.00
0
E)
Work Without Permit? 0 Yes (D No
$0.00
$0.00
Select a Non -Residential
Building or Structure
E)
0
Strong Motion Fee:
$0.00
#
$783.00
Revision
1kEVC0AWEfP Commercial New
Bldg Stds Commission Fee:
$0.00
SUBTOTALS.
$0.001
$783.00
TOTAL FEE:
1 $783.00
Revised: 07/04/2011