12060145CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 19925 STEVENS CREEK BLVD
OWNER'S NAME: STEVENS CREEK INVRS LLC
OWNER'S PHONE: 6508021816
❑ LICENSED CONTRACTOR'S DECLARATION
License Class__fie—� q Lie. #
Contractor (,11)1 11P11d'9 dyy"�,. mate 7 /
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.
CONTRACTOR: JM LEHMAN
CONSTRUCTION INC
1932 EUCALYPTUS AVE
SAN CARLOS, CA 94070
PERMIT NO: 12060145
DATE ISSUED: 07/19/2012
PHONE NO: (650) 593-6211
BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r—
JOB DESCRIPTION: SUITE 100-2 NEW CONCRETE WALKWAYS, NEW
INTERIOR
DOOR OPENING, ENCLOSE EXISTING INTERIOR DOOR 201
SQ FT
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. 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 the applicant understands and will comply
with all int source regu ti s er 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
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: 31621089.00
Valuation: $15000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:. Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material berg 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 Cod tions 25505, 25533, and 25534.
vne or' t'� Date: 1/110k__
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Nwrk'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.
Licensed
CITY OF CUPERTINO
F, M_' F FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 19925 stvns drk blvd.
DATE: 06/25/2012
REVIEWED BY: bobs.
APN:
BP#: � 1� 0 a �
*VALUATION: 1$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
PENTAMATION
PERMIT TYPE: 1GENC0 i
WORK
2 new concrete walkways, new interior door opening, enclose existing interior door.
SCOPE
,l-h,ch. Non Chr !ck
Phu>>b, Plan Check
Elec. Plan Chech
Xlec:h. pe),mit Fee:
Phrirtlz Perini( Fec:
_L_
LYcc, Permit Fec:
Other iitec h, hasp.E1__L_
Other PhImb hasp. F-1
Other Gle(. Ins/),
"(!<h. Imp, Fee:
I Phimb. fasp. Fec:
1 Elec, Insp, Frye.
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 prelinunary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes 0 No
$0.00
2� hours
$260.00
Plan Check, Hourly
ISTPLNCx
A
Suppl. PC Fee: Q Reg. Q OT
0.0
hi's
$0.00
PME Plan Check:
$0.00
F-1-1 #
$260.00
New Door Opening
IDOORNONST Non -Structural
Permit Fee: Hourly Only? Q Yes 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
C `o/lshvrclion Tyra:
Afini111.4lroliv Fee:
0
G
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G)
Building or Structure
A
T'rm�el Z�octnu �nPut7brr Fires:
Strong Motion Fee: IBSEISMICO
$3.15
=hrs
$260.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$4.15
$780.00
TOTAL FEE:`
$784.15
Revised: 06/30/2012
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
kaADDRESS:
,
19925 Stevens Creek
DATE: 08/22/2012
REVIEWED BY: Sean
APN:
BP#: 12060145
*VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair .
PRIMARY
USE: Commercial Building
PENTAMATION
PERMITTYPE: ` 1GENC0
WORK
Unreasonable Hardship submittal.
SCOPE
rLlech. Plan C'hc ck
f 11(mb, Pluu c hcc A
Elec. Non Check
!,trcrh, Permil Fee:
� Ph////¢. P� �ni( ee
G/ec. Permit FeC:
ofhel' Akwh. hisp,ET-1-
0/hCr Ph//j/h h7.S'17,
Other' Elec. Insp,Lj
!Vlach, My. Fco.
Phm/h. his!/, 1, � :
Elec. Insp, Free:
NOTE: This estimate does not include fees due to other Debartments (i.e. Planning, Public Works, Pire, Sanitarysewer District, school
717�s«:nr nsn 1 Th non f no nrn hnond n.. rhv nrolisaianry in nr.nratinn availahln and ara nnh) an ow;nlate_ Contact the Dent for addn'l into.
FEE ITEMS (Fee Resohltion 11-053 Eff. 7/1/11)
% FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
/°
$0.00
Select a Misc Bldg/Structure
or Element of a Building
i
Suppl. PC Fee: Q Reg. Q OT
0.0
/�rs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q
OT
Vow]hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Co s11,110ion Tax:
77
Achl,1i11is[1wliv(, Fees:
0
0
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
77rww/ Docrn//EWolion
Strong Motion Fee:
$0.00
#
$174.00
Accessibility Hardship Exemption
IACCHRDE
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$174.00
TOTAL FEE:
$174.00
Revised: 07/01 /2012