12110024CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10020 N DE ANZA BLVD CONTRACTOR: WESTWOOD COMPANY- PERMIT NO: 12110024
CUPERTINO LLC
OWNER'S NAME: WESTWOOD COMPANY-CUPERTINO LLC 1855 PARK AVE DATE ISSUED: 11/28/2012
OWNER'S PHONE: 4089844800 SAN JOSE, CA 95126 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic. #
MECH RESIDENTIAL r COMMERCIAL r
Contractor Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: OLD REPUBLIC - FIRST FLOOR - INTERIOR
(commencing with Section 7000) of Division 3 of the Business & Professions IMPROVEMENT
Code and that my license is In full force and effect. CONSISTING OF UPGRADES TO EXISTING BATHROOMS TO
CODE AND UPGRADES TO EXISTING PARKING STALLS TO
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 constriction, 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
9.19.
Signature Date
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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,
wil I 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, 1 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 a against said City in consequence of the
granting of this permit. A itionally, the applicant understands and will comply
with all non -point source r ation per the Cupertino Municipal Code, Section
9.18. /
Signatu Dat/ e
Sq. Ft Floor Area: Valuation: $38000
APN Number: 31626094.10020 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 berg 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 1 use equipment or devices which emit hazardous air
contaminants as a Bay Area Air Quality Management District I will
maintain comp ance with the upertino Municipal Code, Chapter 9.12 and the
Health & Safetyode, Sectio s 25505, 25533, and 25534.
O or a o ge DateF //—
•% !/
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO
FM —
I FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10020 N. De Anza Blvd.
DATE: 11/05/2012
REVIEWED BY: RDW
APN:
BP#: lalftoq"VALUATION:
1$38,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
An interior improvement on the first floor consisting of upgrades to existing bathrooms to code and
SCOPE
upgrades to existing parking stalls to code. p
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
250
$1,950.00
1BTIPLNCK
$547.00
IBTIINSP
TOTALS:
250
$1,950.00
$547.00
MECH, HOURLY 0 1'es 0 No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY O i'es Q No
Xfecli. Plan Check
Phinib. Plan CheckF-F
Flee. Plan Check
'Lfech. Permil Fee.
Plnrnh. F'errnr/ F" e:
Ftec. Permit !
Oth; r Ah,ch. lrts/,
Orlrcr Plumb /?Tsp.
Oilx�r Elec. lrsp.Lj
A'A"' h Imp. Fir,"
Plawl)_ In y. (`e"
f ter. Imp. Fce.
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 nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,950.00
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:
$547.00
Suppl. Insp. Fee-0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conslr action Tax:
rldlninlstrative Fee:
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
Trovel Docurnentulion Fees.
Strong Motion Fee: IBSEISMICO
$7.98
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$2,506.98
$0.00
TOTAL FEE*
1 $2,506.98
Revised: 10/01/2012