12060047CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 VALLEY GREEN DR
CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 12060046
INC
OWNER'S NAME: SI 50 LLC
6" GIBRALTAR DR DATE ISSUED: 08/16/2012
OWNER'S PHONE:
MILPITAS, CA 95035 PHONE NO: (408)942-8200
171 LICENSED CONTRACTOR'S DECLARATION
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BUILDING
License Class. Lic, # _—C �V A__�3
PERMIT INFO: BLDG' ELECT PLUMB
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MECH RESIDENTIAL COMMERCIAL
Contractor r_6a) 6r��, Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: APPLE- PHASE 13- COMM T.1 8,864 SQ FT- TO INCLUDE
(commencing with Section 7000) of Division 3 of the Business & Professions
NEW CONS, SLABS, NON LOARD VEARING PARTITIONS,
Code and that my license is in fall force and effect,
CEILING AND ASSOCIATED FINISHES OFFICE/LAB SPACE
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: $900000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 32610053.00
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
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. Ad i ionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point sours egulations per the Cupertino Municipal Code, Section
9.18.
Issued b
Signature Date
13 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
1, 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:
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. 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.
permit is issued.
Additionally, should I 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
Owner
forthwith comply with such provisions or this permit shall be deemed revoked.
w Date:
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 work'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 Date
Licensed Professional
"M lin I F I
ADDRESS: 20650 Valley Green Dr
DATE: 06/0812012
REVIEWED BY: Sean
BP#:
UATION:
1$85,000
*PERMIT TYPE: Building Permit
PLANCHECKTYPE: Tenant Improvement
PRIMARY
SE: Commercial Building
PENTAMATION
PERMIT TYPE: 1 B T1
jenant Improvement (1274 sq ft) - Phase 14.
OCCUPANCY TYPE:
TYit PE O�
CONSTR,�
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�I��N�����
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B (Tenant Improvements)
TOTALS:
MECH, HOURLY 0 Yes Q) No
PLUMB, HOURLY 0 Yes 0 No
FLEC, HOURLY 0 Yes 0 No
Mech. Plan ("heck
Phwib, Plan Ctieclf
1"lec-plan ch,"ck
F7Fee:
Permil
Vec. P,?.rqzif
Odwr Plutnblrisp_
(bher Ellec, insp,
A,k!,�,h. fnlv, Fe
pl'unib, h}sv� Fee:
Elec-, Insp, Fee�,-
NOTE. This estimate does not include fees due to other Departments (ie 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 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,960.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (E) Reg. 0 OT:=hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,159.20
Suppl. Insp. Fee.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(7onsir,zic,tion 74n:
LJ
e4dininistrative Fee:
0
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced PlanqjRg_Ege1
$0.00
Select a Non -Residential
Building or Structure
E)
0
T%,Ivel Doc ume'-1,61alion
Strong Motion Fee: IBSEISAlffCO
$17.85
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.001
SURTOTALSR
$3,141.051
$0.001,
T I OTAL
$3,141.05
WZZMT$+/. E