12090112CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 12090112
INC
OWNER'S NAME: SI 50 LLC 690 GIBRALTAR DR DATE ISSUED: 10/18/2012
OWNER'S PHONE: 4084460700 MILPITAS, CA 95035 PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor Date R ! Gr v
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. Addi ' nally, the applicant understands and will comply
with all non -point souulations ylpertino Municipal Code, Section
9.18. /',J rce
❑ .15M&ER-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)
1, 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 'r ELECT r- PLUMB r
MECH r RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: EXTERIOR ACCESSIBILITY IMPROVEMENTS
Sq. Ft Floor Area: I Valuation: $50000
APN Number: 32610053.00 1 Occupancy Type:
Iss
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D YS FROM LAST CAI, , h INSPECTION.
ued by: 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
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.
On n ro thoriz d a
C` Date: G7
CONSTRUCTION LENDING AGENCY
I It Zaffinnat there is a construction lending agency for the performance of �iork'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.
Signature Date
Licensed Professional
,���,����� CITY OF CUPERTINO
I��/�il FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
,
20650 vallery green dr.
DATE: 09/12/2012
REVIEWED BY: bob s.
APN:
BP#:
*VALUATION: 1$50,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
PENTAMATION
PERMIT TYPE: 1GENCO i
WORK
comm. exterior access. im ovements.
SCOPE
Xleeh. Plata Check
Phrnrb. Pluu Check
Dec. Plan Check
1i,l/t. Permit Fee:
Phonb. Permit Pee:
hlec. Permit tee:
Other Alec'h. hup.
Other Phmzb Insp,
Other Etec. Insp.
;ilech. Insp. Fee:
Phnuh. h;sp. Fee.:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
htriei eta )- Thoco foot aro hacod on the nrnliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? (D Yes () No
$0.00
0 hours
$399.00
Plan Check, Hourly
1STPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 1n•s
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? (j) Yes Q No
$0.00
Suppl. Insp. Fee-(F) Reg. () OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction 7as:
Achninistralive Fee:
0
G
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
or Structure
i
Tr<n�e.l Docnutentutiort Fees:Building
Strong Motion Fee: IBSEISMICO
$10.50
F-276-1 hrs
$266.00
Inspections
1STINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
1 $12.501
$665.00
TOTAL FEE: `,
$677.50
Revised: 07/01 /2012