12050006CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20863 STEVENS CREEK BLVD CONTRACTOR: JM LEHMAN PERMIT NO: 12050006
CONSTRUCTION INC
OWNER'S NAME: STEVENS CREEK OFFICE CENTER ASSOC 1932 EUCALYPTUS AVE DATE ISSUED: 05/01/?012
OWNER'S PHONE: 6508021800 SAN CARLOS, CA 94070 PHONE NO: (650) 593-6211
LICENSED CONTRACTOR'S DECLARATION � r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Classy C —' /Llic. # �P A7'�� 6
Contractor C/ IV II i''M'" [0✓IS� ! PY, Date J`
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.
MECH F RESIDENTIAL T_ COMMERCIAL F
JOB DESCRIPTION: STE 480 - JVA PROPERTIES - COMMERCIAL TENANT
IMPROVEMENT OFFICE SPACE NON STRUCTURAL, MODIFY
EXISTING T-BAR CEILING MECHANICAL AND ELECTRIC
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 Sq. Ft Floor Area:
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 n �-int source regula ' s er the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
I 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, 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 source regulations per the Cupertino Municipal Code, Section
9.18.
Valuation: $235000
APN Number: 32632053.20863 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bv- 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. 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 Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Date: /
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of wrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Ad
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION_
ADDRESS. 20863 stvns crk blvd. #480
DATE: 05/01/2012
REVIEWED BY: bobs.
APN:
BP#:
'VALUATION: 1$235,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
t.i. comm. offices ace non structural modify exisitn T-Bar ceiling mech and elect.
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
$0.00
$0.00
TOTALS:
0
$0.00
$0.00
I
MECH, HOURLY Q Yes Q No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
'. ; 1a01 C.'herk
Nwnh. Pluo OwA
fain , Plan {:heck
Lt'ch. f "'rnaid J cc:
Pfumh, l'OrM PA.'.
[s!t<c Perrnir Fce.
C�rl�r.r .l frr$. I,n,p
Oriw r Ucv . Insp. Li
llech. Inaq�. Fee.
Pluuil3. h�s�z dot
Elec , Insp.
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). Thesefees are based on the prefintina information available and are only an estimate. Contact the Deptfor addn7 info.
FEE ITEMS (Fee Resolution 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes Q No
$0.00
F__2_7 hours
$260.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Q Yes E) No
$0.00
$0.00
Suppl. Insp. Fee-0 Reg. Q OT
0.0
hrs
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C onslr7R'rlon Tax:
Adnrrirril.rrarive Fec:
Q
Work Without Permit? Q Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
Q
i
T,-cn cl Docwnentarion !Fees:
Strong Motion Fee: IBSEISMMCO
$49.35
F-8.07 hrs
$11040.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$10.00
SUBTOTALS:
$59.35
$1,300.00
TOTAL FEE
$1,359.35
Revised: 04/01 /2012