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12020120CITY OF CUPERTINO BUILDING PERMIT"`''_- Q -Z� BUILDING ADDRESS: 20955 STEVENS CREEK BLVD CONTRACTOR: ELEVEN WESTE PERMIT NO: 12020120 BUILDERS, INC OWNER'S NAME: ESCONDIDO, CA 92029 PHONE NO: (760) 796-6346 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class_ Lic. # �z3gw7 r r r "� MECH RESIDENTIAL COMMERCIAL ContractorOcyef W �t-4rtn Date l'L 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: WHOLE FOODS - INTEIOR REMODEL IN AN EXISTING (commencing with Section 7000) of Division 3 of the Business & Professions GROCERY RETAIL STORE CONSISTING OF COMPLETE Code and that my license is in full force and effect. REMOVAL OF EXISTING "CAFE GRATITUDE" ISLAND, 6/13/12 - REV#1 - INCREASE THE HEIGHT OF THE PROPOSED STORAGE RACKS TO 84"-8/22/2012 REV# I ISS'D 1 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. Sq. Ft Floor Area: 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, t e applicant understands and will comply with all non -point regulati er pertino Municipal Code, Section 9.18. Signature Date I Z ❑ Z OWNER -BUILDER DECLARATION 1 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, 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). 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 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 Califomia. If, after making this certificate of exemption,) 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. APN Number: 32631022.00 Valuation: $80000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ' /✓ %Gl7 Date: 5- 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 1 store or handle hazardous material. Additionally, should 1 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. I hereby affirm that there is a construction lending agency for the performance of %ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20955 STEVENS CREEK BLVD CONTRACTOR: ELEVEN WESTERN PERMIT NO: 12020120 BUILDERS, INC OWNER'S NAME: ESCONDIDO, CA 92029 PHONE NO: (760) 796-6346 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Z Lie. 4 L4 J-I -I O '3 Contractor EVLti W C—�f? r to 3 Z LJ 7- t 1 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. 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. 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 1 certify that I have read this application and state that the above information is correct. 1 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 LZ Zvl L 101 1 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, 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). 1 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 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 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 rm 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. 1 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. BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r MECH r— RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: WHOLE FOODS - INTEIOR REMODEL IN AN EXISTING GROCERY RETAIL STORE CONSISTING OF COMPLETE REMOVAL OF EXISTING "CAFE GRATITUDE" ISLAND, Sq. Ft Floor Area: I Valuation: $80000 APN Number: 32631022.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b 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: Dale: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 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 1 store or handle hazardous material. Additionally, should 1 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. Date: ZG 2 cv/ L I hereby al9lmi -tketdW1_e.Sa construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Signature Dale I Licensed FM-1CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20955 Stevens Creek DATE: 06/13/2012 REVIEWED BY: Sean APN: BP#: 12020120 'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION PERMIT TYPE: WORK #1: Increase the height of the proposed storage racks to 84". [Revision SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID M (Tenant Improvements) II-B,III-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 1 $0.00 MECH, HOURLY O Yes 0 No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No 1'i'rur.'• 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 nreliminarv, information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolulion 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feed Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 O 0 Work Without Permit? Q Yes Q No $0.00 Advanced Planning Fee: $0.00 84 I.f. $327.00 Storage Racks ISRACKS-8 0-8' High 0 0 1 rove l nc;crurlcr!r!;;; %r)rl 1-r Strong Motion Fee: $0.00 Select an Administrative Item Blda Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.00 $327.00 TOTAL FEE: 1 $327.00 Revised: 06/05/2012 CITY OF CUPERTINO V_� FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20955 stvns crk blvd. DATE: REVIEWED BY: bobs. APN: BP#: `VALUATION: ism,wo *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION 1 M TI PERMIT TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID M (Tenant Improvements) II-A,III-A,V-A 1,600 $3,401.62 1MTIPLNCK $1,658.44 1MTIINSP TOTALS: 1,600 $3,401.62 $1,658.44 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes ..0 No 19ech. flan Chick 111unrh. 1116n Check Flee. Plon C ixrt/ :'Lk•c1i. 1',.r,ni, Fare: Piuwh. Perrrui A'r.: F.!e;. P(,,nih P'. Olh '; a is c11. 116P. Orn.;1 ,`'i;::nb ImpLi O/ (• .., c . 1. i'.,'). PIuoth /;LS). /'Pd: Elec. l7;.tih. 1-ee NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Dreliminary information available and are on/v an estimate. Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,401.62 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Pen -nit Fee: $1,658.44 Suppl. Insp. Fee.e Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Penn -it Fee: $0.00 L:nnsli uciinr, 1 ar: Adininistrotive Fete:: 0 Work Without Permit? ® Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 71avel 1)cu:rrni( Watiorz Pecs: Strong Motion Fee: 1BSE1SM1CO $16.80 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $4.00 SUBTOTALS: $5,080.861 $O.00F TOTAL FEE: 1 $5,080.86 Revised: 1 /19/2012