11080226CITY OF CUPERTINO BUILDING
BUILDING ADDRESS: 10051 S DE ANZA BLVD
CONTRACTOR: RAM BUILDING CO
PERMIT NO: 11080226
OWNER'S NAME: MARDESICH CO CROSSROADS LLC
1097 RIDGELEY DR
DATE ISSUED: 11/16/2011
OWNER'S PHONE: 4082553042
CAMPBELL, CA 95008
PHONE NO: (408)879-9756
LICENSED CONTRACTOR'S DECLARATION
7 F+
BUILDING PERMIT INFO: BLDG ELECT PLUMB'
License Class b Lic. #
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Contractor �'N` Q%JLIX)1 ram% >O Date ti Z`� �
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: TECHNOLOGY CREDIT UNION - COMM T.I (3084SQFT)
(commencing with Section 7000) of Division 3 of the Business & Professions
EXPAND BRANCH TO EXISTING TENANT T-BARPARTITIONS,
Code and that my license is in full force and effect.
ONLY ELECTRICAL NON-STRUCTURAL
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
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
indemnity ep harmless the City of Cupertino against liabilities, judgments,
costs,(expen s whndd.fto.alru
against said City in consequence of the
grantfthis rmit.the applicant understands and will comply
with an -poi t sourerr the Cupertino Municipal Code, Section
9.18.
l l/17/2011-REV#I- REVISE EXTERIOR ACCESSIBILITY PATH OF TRAVEL- 1/24/2012
REV# I ISS'D
Sq. Ft Floor Area: I Valuation: $74000
APN Number: 35908018.10051 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature ate I Issued by: _ Date: 2 C7 /
❑ OWNER -BUILDER DEC�ATION
I hereby affirm that I 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)
I, 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. l 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.
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
cnnta
ants as define the Bay Area Air Quality Management District I will
complian with t e Cupertino Municipal Code, Chapter 9.12 and the
Safety Cde, Sec olds 25505, 25533, and 25534.
I hereby affirm that there is a construction lending agency for the performance of mork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
Date
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10051 s.de anza blvd.
DATE: 11/17/2011
REVIEWED BY: bobs.
APN:
BP#: 11080226
"VALUATION:
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
PERMIT TYPE:
wORK
revise exterior accessibility path of travel
SCOPE
`IPC:1t. P:!7"r�%?G
F font
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Li
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.1'1r�utl;. it"::ii. 1 "1"',
It? P, r'm
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 nreUidnary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 ff. 711111,)
FEE
QTY/FEE
MISC VTEOS
Plan Check Fee:
$0.00
Select a Misc B1 tructure
rArement of a Building
Suppl. PC Fee: 0 Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
!: t;ttut"'1':{}-cr'I4t• J: e.'i?:
0
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0-.00
Select a Non -Residential
Building or Structure
0
0
"T av ,/ Fees:
Strong Motion Fee:
$0.00
#
$0.00
Revision (, r%)
1REVCOMTI Tenant Improvemen `�
✓✓
Bldi; Stds Commission Fee:
$0.00
SUBTOTALS:
$0.001
$0.00
TOTAL FEE:
I 0.00
0
Revised: 10/01 /2011
FM_7
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10051 s. de anza blvd.
DATE: 08/31/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
1$74,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
U. commercial expand branch to exisiting tenants ace non structural t-bar. partitions, only electrical.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
3,084
$2,171.30
IBTIPLNCK
$2,457.74
IBTIINSP
TOTALS:
3,084
$2,171.30
$2,457.74
MECH, HOURLY 0 Yes Q No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY 0 Yes Q No
7;
Li
lir.'ch Iasi. l'[; CC
..,. .grn t'e'c
NOTE: These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Ef. 711'11
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,171.30
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,457.74
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(I,(;rIvtfwCfiom7 Tar
Acoustical Fee:
0 Yes (E) No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee
$0.00
Select a Non -Residential
Building or Structure
Q
0
i
(rati GI lirrrr,n<rrttc�tir:-�c.I'= f ,s:
Strong Motion Fee:
IBSEISMICO
$15.54
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$3.00
SUBTOTALS:
$4,647.58
$0.00
TOTAL FEE:
1 $4,647.58
Revised: 07/04/2011