13010059CITY OF CUPERTINO BUILDING PERMIT
ADDRESS: 20300 STEVENS CREEK BLVD
CONTRACTOR: DEVCON PERMIT NO: 13010059
BUILDING
CONSTRUCTION INC
OWNER'S NAME: SVF CUPERTINO CITY CENTER CORP .
690 GIBRAL.TAR DR DATE ISSUED: 01/09/2013
MILPITAS, CA 95035 PHONE NO: (408)942-8200
OWNER'S PHONE: 4083933928
RESIDENTIAL COMMERCIALS
JOB DESCRIPTION:
❑ LICENSED CONTRACTOR'S DECLARATION
,
2ND FLOOR EAST WING- T.I PREP 1,280 SQ FT
I °n �
Lie. # 'a
APPLE-
License Class
Contractor J, O/d Date
I hereby affirm that I am licensed under the provisio s of hap ter 9
(commencing with Section 7000) of Division 3 of the us' less & 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
valuation: $20000
Sq. Ft Floor Area:
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
APN Number: 36901019.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
is
PERMIT EXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the above information
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 80 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
1g0 DA ROM LAST CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree f save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
of the
Date:
costs, and expenses which may accrue against said City in consequence
of this Additionally, tthcMplicant understands and will comply
Issued by:
granting permit.
with all non -point source guiati4us'per the.L�upertino MuWtion
9.18.
DateAll
RE-ROOFS:
roofs shall be inspected prior to any roofing material being installed. If a roof is
for
Signature"__
installed without first obtaining an inspection, I agree to remove all new materials
inspection.
❑�' OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
HAZARDOUS MATERIALS DISCLOSURE
I, as owner of the property; am exclusively contracting with licensed contractors to
the (Sec.7044, Business &Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
25505, 25533, and 25534. 1 will
construct project
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
25532(a) should I store or handle hazardous
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section
material. Additionally, should I use equipment or devices which emit hazardous
Area Air nit I
Compensation, as provided. for by Section 3700 of the Labor Code, for the
will air n l man ain compliance wints as defined th the Bay
i hthe Cupertino Municipal Code, Chapter 9. a
performance of the work for which this permit is issued.
the Health & Safety Code, Sections 2551)55533, and 25534.
I have and will maintain Worker's Compensation Insurance, as provided for by
Date:/
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized age
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
that s is a construction lending agencyfor the performance of
Worker's Compensation of the Labor Code, I must `Vork'sfor which
become subject to the provisions
with or this permit shall be deemed revoked.
permit is issued (See. 309ere
thirm
7,
forthwith comply such provisions
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
may accrue against said City in consequence of the
I understand my plans shall be used as public records.
costs, and expenses which
granting of this permit. Additionally, the applicant understands and will comply
the Cupertino Municipal Code, Section
Licensed Professional
with all non -point source regulations per
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
QjADDRESS:,,;0z)15 ��(%� DATE: 01/09/2013 REVIEWED BY: MENDEZ
PN: BP#: �� *VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION 1TIPREP
USE: Commercial Building ___jPERMIT TYPE:
WORK'
SCOPE
ltet.h, Plan "heck I'hmrb. Nall C'hecd,
Elec. Plan Chcck
Xfech. PermitFee,
Phmrb. Per�rrit I'ce,
Stec. Permit Fee.
Other rbleeh. hash. Other Phimb h7spr
Other Dec. hzsp.
1Ilech. Msp. Fee: phimb. lirsp. Pere
Elec. hap. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Contact the Dept for addn'l info.
District, etc.). These fees are based on the preliminary
information available and are only
an estimate.
FEE ITEMS (Fee Resolution 11-053 Eff. 7111121
FEE QTY/FEE
MISC ITEMS
$0.00 ] #
Tenant Improvement Prep
Plan Check Fee:
I �
Suppl. PC Fee: � Reg. 0 OT 0.0 hrs
$0.00 $388.00 ITIPREP
i
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feet• Reg. Q OT 0 0 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construclion Tax:
Adininisirative Fee:
Work Without Permit? Q Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
G
Building or Structure
Trfflwl Docrnnentution Fees:
�
Strong Motion Fee: IBSEISMICO
$4.20
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$5.20
$388.00
TOTAL FEE:
$393.20
Revised: 10/01 /2012