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12090042CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20803 ALVES DR I CONTRACTOR: YMCA OF SILICON I PERMIT NO: 12090042 OWNER'S NAME: YMCA OF SILICON VALLEY 1 1922 THE ALAMEDA FL3 I DATE ISSUED: 09/07/2012 1 OWNER'S PHONE: 4083516400 SAN JOSE, CA 95126 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL License Class Lic. H Contractor Date 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 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 whichthis 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 1 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 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, 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 6he 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 all non -point so gulations per the Cupertino Municipal Code, Section 9.18. q Signature Date (" �i✓ YMCA PHASE II- CONSTRUCT ADDITIONAL PARKING AREA, COURTYARD RENOVATION TO REMOVE NON - ACCESSIBLE AMPITHEATER Sq. Ft Floor Area: I Valuation: $65000 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 by: s ��}� ���TC 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. I 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 Are Air Quality Management District I will maintain compliance with the Cupe n Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections ; 5, V33, and 25534. Owner or authorized agent: �� Date: / ~ 71' *D41"A SSA I P o,^ %o�i f� t Y A4 C J-- 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 Professional CITY OF CUPERTINO VM_7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20803 Alves Dr. DATE: 09/06/2012 REVIEWED BY: Sean IM APN: BP#: 'VALUATION: 1$65,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: PENTAMATION 1GENCOM PERMIT TYPE: WORK I Phase II: Construct additional parking area; Courtyard renovation to remove non -accessible SCOPE ampitheater. Mcch. Plan (:'heck Pl,unh. Plus Check F_lec. Plan Check FT FlLfeclr. Permil Pee: Plumb. Permit Tee: lilec. Permit Fee. Other Afec h. Insp. Other Plumb Insp.Li Ocher Elec. Insp. Lj Week Insp, Fee: Plumb. Insp. Fee: Elec. Insp. Fee. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These tees are based on the nreliminary information available and are only an estimate- Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 72-7 hours Plan Check, Hourly $266.00 ISTPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee-0 Reg. © OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conswuction Tax: Adininistrative Fee: 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee. $0.00 = hours Inspections $399.00 ISTINSP Inspection, Hourly 0 Travel Documentation Fees: Strong; Motion Fee: IBSEISMICO $13.65 Select an Administrative Item 1 __ Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $16.65 $665.00 TDTAL F�:E: $681.65 Revised: 07/01 /2012