08030165CITY OF CUPERTINO BUILDING Pl Rf OMT -j -,,'?-c -
217
BUILDING ADDRESS: 10056 ORANGE AVE BLDG A CONTRACTOR: MIRAGE CONSTRUCTION PERMIT NO: 08030165
OWNER'S NAME: MARCI PROPERTIES LLC 400 REED ST DATE ISSUED: 09/05/2008
OWNER'S PHONE: 4087778720 SANTA CLARA, CA 95050 PHONE NO: (408) 496-0143
❑ LICENSED CONTRACTOR'S DECLAeeT1O1y. r—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.N
MECH RESIDENTIAL COMMERCIAL
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 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.
Date
OWNER -BUILDER DECLARATION
P
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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)
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 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,1 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.
Signature v, Date
JOB DESCRIPTION: GEN'L COMMERCIAL BUILDING 1,991.25 SQ FT. BLDG A
3/13/2012 - REVN1 COMMERCIAL BUILDING REVISION,
3/13/2012 - REV#I COMMERCIAL BUILDING REVISION, ADD INTERIOR STAIRS
FROM 1ST LEVEL TO BASEMENT -3/29/2012 REV#I ISS'D
Sq. Ft Floor Area: Valuation: $258863
APN Number: 35717058.C56A Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by ate: J—zfL
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.
Ow u �rigent:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of cork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
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CY OF CUPERTINO
BUILDING DIVISION PERNHT
Bu]T5Vff ORANGE AVE BLDG A TBD — TO BE DETERMINED 08030.165
OWNER'S NAME: PERMIT ISSUE DATE
MARCI PROPERTIES LLC 09/05/2008
PHONE: SANrrARY NO. CONTROL NO.
ARCHITECT/ENGINEER BUILDING PERMIT INFO
BLDG BLECr PLUMB MECH
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
Ucense Class Lie. r
Date Contractor
ARCHr('EG'TS DECLARATION
I understand my plans shall be used u public records
Uccnred Prufessional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractmra License Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alta, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's Ucense Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
❑ 1. as owner of the property. or my employees with wages as defr sole compensation,
will do the work. and the structure Is not intended or offered for sale (Sec 7044, Business
and Professions Code The Contractors License Liw does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for We. If,
however, the building or improvement is sold within one year of completion, rhe owner -
builder will have the burden of proving that he did nes build or improve for purpose of
P; -L As owner of the property, am exclusively convecting with licensed contractors to
construct the project (Sec, 7044, Business and Professions Code:) The Contracmes U.
cense _Law docs not apply to an owner of property who builds or improves thereon, and .
who contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law.
❑ 1 am exem t under Sec , B h P C for this on
Owner Dale y
W R 'S COMPENSATION DECLARATION
1 hereby afn[m under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Cz%iG®te of Consent to self -insure for Workers Compen-
sation, as provided for by Section 37DO of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insiura cr, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued,
My Workers Comprnaadon Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EKEMPIION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any n in any maoncq Ito hcoOm bjeet m the Workers' Compensation
Laws of mf ia. Dale -f`7 5— / D
Appllcanr a,,
NOT7CE��: If, to making this Certificate of Exemption, you shouldlf, for making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deernmed revoked.
CONSTRUCTION LENDING AGENCY
1 hemby air= that there is a constructinn lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C-)
Lenders Name
Lenders Address
1 certify that I have read this appliwion and surae 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.
(Wer) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, cosy and expenses which may in any way scene against said City
in consequence of the granting of this permit.
AP ICANT UNDERSTANDS AND WILL COMPLY WITH NON -POINT
REGULOONS.
a274 eKd92
S
gnature of Applianugm anow to
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safmy
Code, Sc:cdon 25532(s)? �(
[3 Yes No
Will the applicant or future building occupant use equipment or devices which
emit haiJrdous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Calif rr-
nia Hcalth do Safcty Coder, Sccdons 25505, 25533 a.d 25534.1 undersand tbu if the building
docs not eurendy ha.e a tenant, that it is my responsibility to notify the occupant or the
requ'ens hich MUStX met prior io issuance or a Ccnificate of Occupancy.
or authorbcd
Job Description
GEN'L COMMERCIAL BUILDING 1,991.25 SQ FT. BLDG A
Sq. Ft. Floor Area
35717058.)jumber
$258863 Valuation
Required Inspections
Issued by:
_run
AW
Re -roofs
Type of Roof
Date
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'' or better
CITY OF CUPERTINO
0-M-77- FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the prelininary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (1 -'Le Resolution 11-053 E . 7.111)
ADDRESS: 10056 orange ave.
DATE: 03/13/2012 REVIEWED BY: bobs.
MISC ITEMS
-APN:---
Bp # : jso
`PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
comm. bldq revision= Add interior stairs from 1st level to basement.
SCOPE
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the prelininary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (1 -'Le Resolution 11-053 E . 7.111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes ® No
$0.00
72-7 hours
$260.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. FeelD Reg. Q OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Work Without Permit? C) Yes (F) No
$0.00
Advanced Plannine Fee:
$0.00
Select a Non -Residential G
Building or Structure
Strom Motion Fee:
$0.00
0.5 hrs
$41.00
Admin./Clerical Fee
IADMIN
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$301.00
TOTAL FEE:
$301.00
Revised: 1/19/2012