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12090045CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20425 STEVENS CREEK BLVD I CONTRACTOR: XL CONSTRUCTION I PERMIT NO: 12090045 I OWNER'S NAME: WESTWOOD COMPANY-CUPERTINO LLC 1851 BUCKEYE CT DATE ISSUED: 09/06/2012 OWNER'S PHONE: 4088624351 I MILPITAS, CA 95035 I PHONE NO: (408) 240-6000 I ❑ LICENSED CONTRACTOR'S DECLARATION License Class 174 Lic. # � + O 0 � Contractor 1(�_� v +S V v�(,�Fs'� Date Ll 116,11 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. Signature , Date ` ❑ OWNER -BUILDER DECLARATION I hereby affirm that I 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). 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. BUILDING PERMIT INFO: BLDG ' ELECT PLUMB MECH F RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: APPLE - 2ND FLOOR - COMMERCIAL TENANT IMPROVEMENT OF EXISTING SPACE CONVERT TO LAB ON 2ND FLOOR (481 SQFT) Sq. Ft Floor Area: Valuation: $120000 APN Number: 31626094.20425 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: r % � u Date: r, 1_L__ 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. Owner thagen: Date: (J jN_ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Niork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date Licensed Professional WE CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION i ADDRESS: 20425 stvns crk Blvd. DATE: 09/06/2012 REVIEWED BY: bobs. APN: BP#: / ,2,v 100` 5 'VALUATION: 1$120,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building PENTAMATION PERMIT TYPE: 1GENC0 T.1 comm exisiting space convert to lab at 2nd floor. [707 SCOPE , r r77i r�!' �'�'1 f)w r,Akch, �Jtsp (�1/tut'1`10 )11lyrs,i El A/,,ch My. I��rt( �Iittr7i; b1v1. F,�c: NOTE: This estinnate does not include fees due to otter Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School >)na AW ein 1 Th— foot aro hacod ne tho nrolin�inary infarmation available and are only an estimate. Contact the Dept for addn'l info. ..... ., .. _.. _ ... _.. .....- --------- FEE ITEMS (Fee Resolution 11-053 G : 7'I/11) ---- ------ FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? (j) Yes Q No $0.00 hours Plan Check, Hourly $266.00 ISTPLNCx Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 lE.t'717tj ?}'(!'1tt I s7. Work Without Permit? ® Yes No $0.00 Advanced Planning Fee: $0.00 0 hours Inspections $665.00 ISTINSP Inspection, Hourly ©A Strong Motion Fee: IBSEISIWCO $25.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 - SUBTOTALS; $30.20 $931.00 TOTAL FEE: $961.20 Revised: 07/01 /2012