13030036I CITY OF CUPERTINO BUILDING PERMIT I
IBUILDING ADDRESS: I0125 BANDLEY DR I INC CONTRACTOR: SMI CONSTRUCTION I PERMIT NO: 13030036 I
I OWNER'S NAME:
SAN LEANDRO, CA 94577 PHONE NO: (510)351-3288
❑ LICENSED CONTRACTOR'S DECLARATION
License. Class Lic. It 16
Contractor A I. Date %
1 hereby affirm that I am licensed under the provisi s o hapter 9
(commencing with Section 7000) of Division 3 of t Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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
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 pr rty for inspection purposes. (We) agree to save
indemnify and keep harmle the City of Cupertino against liabilities, judgments,
costs, and expenses whi may accrue against said City in consequence of the
granting of this permit Additionally, thelicant understands and will comply
with. all non -point s atio s re Cupertino sipal Bode; "Section
9.18.
❑ I . OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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,
will 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).
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.
l.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.
1 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 haveread 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.
JOB DESCRIPTION: RESIDENTIAL a COMMERCIAL
MINOR T.I. REPLACE TWO COMPARMENT SINK WITH.
THREE
COMPARMENT SINK. REMODEL WALL PARTITIONS &
WALL
PANELS
Sq. Ft Floor Area: I Valuatlon: $8000
APN Number: 32634047.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
2W1fTBU1N,,S180 DAYISSUANCE OR
LA LLED INSPECTION.
Is ate: It
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
1 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) shoulP store or handle hazardous
material. Additionally, should I use equip t or devices which emit hazardous
air contaminants as defined by the Bay A Air Quality Management District I
will maintain compliance with the Cup u icipal Code, Chapt@r 9.12 and
the Health & Safety Code, Sections 2 2553 5534.
Owner or authorized agent: Date
I hereby affirm that there is a 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
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
CITY OF CUPERTINO
F-M-7- FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10125 BANDLEY DR
DATE: 03/07/2013
REVIEWED BY: MELISSA
APN: 326 34 047
BP#:
`VALUATION: $8,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
MINOR T.I. REPLACE TWO COMPARMENT SINK WITH THREE COMPARMENT SINK. REMODEL
SCOPE
WALL PARTITIONS & WALL PANELS
Xfech. Plan Check
Phunh. Plan Cheelr
Elec. Plan Check
,Lfech. Permi[ Fee:
Plumb. Po -mil Pee:
Elec. Permit Pee.
Other Afech. Insp. '
0/her Plumb Insp,Li
Ocher Elec. Insp. EIF
Akch. Insp. Fee:
Plunrh. Lisp, Fee:
Elec. InsP. Fee:
NOTE. This estimate does not include fees due to other Departments (i. a Planning, Public Works, Fire, Sanitary Sewer District, School
Distrfe etc.). Thesefees are based on the prelinddn information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
F__17 hours
$133.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
10701
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? O Yes 0 No
$0.00
Suppl. Insp. Fee-0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
i
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICO
$1.68
2.0 hrs
$266.00
Inspections
ISTINSP _�] Inspection, Hourly
Bldg, Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS-
o
$2.68
$399.00
TOTAL FEE:
$401.68
0 Revised: 01 /01 /2013