11120074CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10212 N DE ANZA BLVD
CONTRACTOR: HALLMARK
PERMIT NO: It 120074
CONSTRUCTION INC
OWNER'S NAME: 10212 N DE ANZA LLC
3360 DE LA CRUZ BLVD
DATE ISSUED: 03/12/20I2
OWNER'S PHONE: 4086552326
SANTA CLARA, CA 95054
PHONE NO: (408)727-4422
❑ LICENSED CONTRACTOR'S DECLARATION
I.,.
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S 3 3 b %
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class3— Lic. #
MECH RESIDENTIAL' COMMERCIAL
1111 3 --/2 _/Z
Contractor �7R1 ��^''�-�'� Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: E'TRADE- COMM. T.I (4868SQFT) STRUCTURAL
(commencing with Section 7000) of Division 3 of the Business & Professions
INCLUDES
M/EfP S
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
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
Sq. Ft Floor Area:
Valuation: $525000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 31626088.00
Occupancy Type:
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,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signat Date ` 2 �2
Issued by: Date:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall he inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall he deemed revoked.
ner authorized nt: /2..�
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
f1hereby
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
affirm that there is a construction lending agency for the performance of Aork's
to building constnrction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of Unis permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall he used as public records.
Signature Date
Licensed Professional
FM
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10212 n. de anza blvd.
DATE: 12/12/2011
REVIEWED BY: bobs.
APN: A 6 Q S'K
I BP#: 111aX2V
"VALUATION: 1$525,000
xPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE•
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
t.i. comm. offices ace structural includes M E Ps.
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
4,868
$2,230.70
IBTIPLNCK
$3,803.06
IBTIINSP
TOTALS:
4,868
$2,230.70
$3,803.06
MECH, HOURLY 0 Yes (E) No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY 0 Yes Q No
d lljoLj
NOTE: This estimate does not include fees due to other Departments (i.c Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the Dreliminary information available and are only an estimate- Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 L' . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,230.70
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:
$3,803.06
Suppl. Insp. Fee,0 Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction i CiA:
I dministrotirkr f_1 ez:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Strong; Motion Fee:
IBSEISMICO
$110.25
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$21.00
SUBTOTALS:
$6,165.01
$0.00
TOTAL FEE:
$6,165.01
Revised: 12/0412011