11120072CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 MARIANI AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 11120072
OWNER'S NAME: MISSION WEST PROPERTIES
851 BUCKEYE CT
DATE ISSUED: 01/11/2012
OWNER'S PHONE: 4087250700
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
❑ LICENSED CONTRACTOR'S DECLARATION
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PLUMB
p.,
License Class Lic. 8I 6y � b
BUILDING PERMIT INFO: BLDG ELECT
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Contractor 5 T r(n L T Ovi Date [.
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: APPLE -- COMM T.I (2713SQFT) NON-STRUCTURAL
(commencing with Section 7000) of Division 3 of the Business & Professions
INCLUDE MECHANICAL/ELECTRICAL; NO PLUMBING OR
Code and that my license is in full force and effect.
EXTERIOR WORK
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
Sq. Ft Floor Area:
Valuation: $500000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31622018.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date 1 �Z
Issued by: ,`// Date:
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
permit is issued.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Ow or thprued agent:
r^ �— / Dater
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of %%ork's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature fate
LiePncM PmfPcainnol
CITY OF CUPERTINO BUILDING PERMI _
BUILDING ADDRESS: 20400 MARIANI AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: It 120072
OWNER'S NAME: MISSION WEST PROPERTIES
851 BUCKEYE CT
DATE ISSUED: 01/11/2012
OWNER'S PHONE: 4087250700
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
❑ LICENSED CONTRACTOR'S DECLARATION
r
BUILDING PERMIT INFO:
License Class Lie. # q:Za V
BLDG ELECT PLUMB
F_
F F
�/ /
J
MECH RESIDENTIAL COMMERCIAL
Contractor /(L C o, ,sir. , &,bate
[ hereby affirm that I am licensed under the provisions if Chapter 9
JOB DESCRIPTION: APPLE -- COMM T.I (2713SQFT) NON-STRUCTURAL
(commencing with Section 7000) of Division 3 of the Business & Professions
INCLUDE MECRAANICAL/ELECTRICAL; NO PLUMBING OR
Code and that my license is in full force and effect.
EXTERIOR WORK
I hereby affirm under Penalty of perjury one of the following two declarations:
2/15/2012-REV# I - REVISE OFFICE ROOM TO LAB-REV#1 ISS'D 2/15/2012
1 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 pemtit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $560000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31622018.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that l 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnity and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
K2 I S
Issued by: Date: '-
Signature Date l 12
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
[ 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
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
1 certify that in the perfonnance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Own o ut agent
/ j'j—
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
1 certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of wrk's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
5�_Mffi
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
iaADDRESS:
20400 mariani ave.
DATE: 02/15/2012
REVIEWED BY: bobs.
APN:3/' a Q D
BP#:
"VALUATION:
1$60,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
revise office room to lab.
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Aictrirt- otc )_ Tho_ce foo_c aro hacod an tho nroliwinary infnrmadnn availahlo and aro nnly an ovdmmo_ Cnniart tho Aont far addn'I infn-
FEE ITEMS (Fee Resolution 11-053 E . 711/111
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly
Only? Q Yes ® No
$0.00
1 hours Plan Check, Hourly
$130.00 ISTPLNCK
Suppl. PC Fee: Q Reg. 0 OT
0 0
his
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg.
j OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
G
Work Without Permit? Q Yes No
$0.00
Advanced Plannine Fee:
$0.00
Select a Non -Residential
Building or Structure
G
Strong, Motion Fee:
IBSEISMICO
$12.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$15.60
$130.00 TOTAL FEE:
$145.60
Revised: 1 /19/2012
CITY OF CUPERTINO
FM-7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20400 mariani ave.
DATE: 12/12/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
1$500,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1BTI
PERMIT TYPE:
WORK
t.i. comm. offices ace non structural include M E no plumbinq or exterior work.
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
2,713
$2,141.34
IBTIPLNCK
$2,235.86
IBTIINSP
TOTALS:
2,713
$2,141.34
$2,235.86
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY 0 Yes Q No
, , 'e, d'r•'rrir : f' ..
'£ f',; L':
X,°c� F'c?t`i�its :e L':
„
f).•`i7r+f .. (r1��7,
i9,',:h 1n7p (Yr„
Eie, . law. ; er.
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 preliminary information available and are only an estimate- Contact the Dept for addn'l info.
FEE ITEMS (I,ee Resolution 11-053 GfJ:' 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,141.34
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:
$2,235.86
Suppl. Insp. Fee-0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(:`r,r2str't:c:iic;rr ?�rx:
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
7 u: rr111rrr;;,,<:n! rrtr�,t I eErs
Strong- Motion Fee: IBSEISMICO
$105.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$20.00
SUBTOTALS:
$4,502.20
$0.00
TOTAL FEE:
1 $4,502.20
Revised: 12/04/2011