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13060046I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10050 N WOLFE RD I CONTRACTOR: TF MCGUCKIN INC I PERMIT NO: 13060046� I OWNER'S NAME: I&G DIRECT REAL ESTATE 27 LP 1777 FOLSOM CIR I DATE ISSUED: 06/06/2013 I OWNER'S PHONE: IV LICENSED CONTRACTOR'S DECLARATION License Class Lic. # (6 ,. ` i t _ Contractor �, Date 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. Signatur ate lam` ❑ 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. MILPITAS, CA 95035 PHONE NO: (408)263-5614 JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL LJ CRM SUGAR CUPERTINO- SWi 276-290- NEW 4-0" WIDE CASED WALL OPENING CONNECTING TWO ADJACENT SUITES, ADD NEW ILLUMINATED TACTILE EXIT SIGNS Sq. Ft Floor Area: I Valuation: $2500 APN Number: 31620086.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS LAST CALLED INSPE TION. Issued 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 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, SecOons 25505, 25533, and 2553 . Owner or authorized agent: _ ��'� I ` ate.� ti CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (See. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10500 N Wolfe rd DATE: 06/06/2013 REVIEWED BY: Mendez APN: BP#: �0& �(� *VALUATION: $2,500 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENMIT TY ON 1 GENCOM USE: Commercial Building PERMIT TYPE: i WORK CRM SUGAR CUPERTINO- SW1 276-290 SCOPE l,fech. Plop Check jl,fe�ch. Permit Fee outer Alec•h. hasp. Alech. My. Fee: herlr plamb. Pemlit Fee: 77Cnsp. Phtmh. hzsp. Pc(?: .-> _ of__J•.. Elec. Phrz Chat% lslec. Permit Fee: Other Dec. My. Elec hisp, Fee: L'.'-- o,..,44--, Q—,.r 1)icfrirf .Crlmn/ NOTE: This estimate does not incivae fees aue ru uuTer -utw >,>.r>r»» v— _ .......... by - - -• - - -inFn- District, etc . Thesefees are basea on wepreirminary FEE ITEMS (Fee Resohition 11-053 Eff 7111122 rn urnumuu .�>.>•.�•�'••••• FEE ••• QTY/FEE �••• - - MISC ITEMS Plan Check Fee: Hourly Only? o Yes (j) No $0.00 ' J hours Plan Check, Hourly $133.00 ISTPLNCK A Suppl. PC Fee: Q 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 ConsIniction Tox: Aclinittiswalive Fec: G Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Flee: $0.00 Select a Non -Residential G Building or Structure Tr(wel Doctonc'nlotion F'eeS': Strong Motion Fee: IBSEISWCO $0.53 hrs Inspections F$532.00ISTINSP 7 Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: ' $1.53 $665.00 TOTAL FEE: $666.53 1\GVIou . VTILV/LV . V