11110150I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20803 ALVES DR CONTRACTOR: VANCE BROWN PERMIT NO: 111 10150
INC
OWNER'S NAME: YMCA OF SILICON VALLEY 3197 PARK BLVD DATE ISSUED: 12/22/201 1
OWNER'S PHONE: 4083516400. PALO ALTO, CA 94306 PHONE NO: (650) 849-9900
t� LICENSED CONTRACTOR'S DECLARATION F F_ r,
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lic. N ! Z Z—{ (— (— r
MECH RESIDENTIAL COMMERCIAL
Contractor V4NCG ?'PC" �4 ( NC_ Date / Z - ZZ - I
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: YMCA- COMM T.1(750SQFT) EXPAND EXISTING
EXERCISE
(commencing with Section 7000) of Division 3 of the Business & Professions ROOM, NO DEFERRED M,E,P'S; NO STRUCTURAL
Code and that my license is in full force and effect.
1 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
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 t'I6P_ /"1a49�-C 14M Date 12-- u-I
❑ OWNER -BUILDER DECLARATION
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,
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).
1 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.
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.
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. 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 al I non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Sq. Ft Floor Area: I Valuation: $26265
APN Number: 32632039.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued Date: 2
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 contaminants as defined by the Bay Area Air Quality Management District 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:_ F/u^ 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 Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profess
Signature
Date
FM-,7,
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20803 alves dr.
DATE: 11/28/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$26,265
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
commercial business space, expand existing exercise room no deferred M E Ps.No structural.
�t.i.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.L
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
750
$1,936.00
/BTIPLNCK
$847.60
/BTIINSP
TOTALS:
750
$1,936.00
$847.60
MECH, HOURLY ()Yes (F) No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer Distric4 School
District. etc.). These fees are based on the vrelininary information available and are only an estimate- Contact the Dept for addh7 info.
FEE ITEMS (fee Resolution 11-053 ff. 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,936.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$847.60
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Con tructjo7l
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
�
1':y J<`tlyd7C.'t7]tllt'rJJt %('i.':i:
Strom Motion Fee: IBSEISMICO
$5.52
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$2,791.12
$0.00
TOTAL FEE:
$2,791.12
Revised: 10/01 /2011