11060089CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18920 FORGE DR
CONTRACTOR: DEVCON CONSTRUCTION
PERMIT NO: 11060089
INC
OWNER'S NAME: FORGE DRIVE INVESTORS, LLC
690 GIBRALTAR DR
DATE ISSUED: 06/29/2011
OWNER'S PHONE: 4085551212
MILPITAS, CA 95035
PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
ELECT PLUMB
C4x
BUILDINGPERMIT INFO: BLDG
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License Class Lie.#
�77Contractor
MECH RESIDENTIAL COMMERCIAL
Date
I hereby affirm that I am licensed under the provisions of Chapter
JOB DESCRIPTION: 18920 & 18922 FORGE DR- APPLE DEMOLITION OF
(commencing with Section 7000) of Division 3 of the Business & Professions
NON-STRUCTURAL WALLS(89,670SQFT),CEILINGS,
LIGHTING & FLOORS ONLY.RESTROOM CORES REMAIN
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
Sq. Ft Floor Area:
Valuation: $150000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31609030.18920
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non-pontt surce regulations per the Cupertino Municipal Code, Section
9.18 `
Signature ' �` Date
Issued by: Date:
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued,
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Qw4ner or.authoriZert agent fy
forthwith comply with such provisions or this permit shall be deemed revoked.
r
•'
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of nnork's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (See. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
DEMOLITION
CITY OF CUPERTINO
19m] FEE ESTIMATOR - BUILDING DIVISION
FEE ID FLR AREA
IDEMOCOM 89,670
ADDRESS: 18920118922 Forge Dr.,
DATE: 06/13/2011
REVIEWED BY: larry s
APN:
BP#:
*VALUATION: 1$150,000
`PERMIT TYPE: Demolition Permit
El
PRIMARY Commercial Building
USE:
'T-1 DI
PENTAMATION 1COMMLDEM
PERMIT TYPE:
WORK
Permit Fee:
SCOPE
Suppl. Insp. Feer Reg. 0 OT
FEE ID FLR AREA
IDEMOCOM 89,670
NOTE. These fees are based on the Prelintinary information available and are onlv an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 09-051 Eff� 7/1,170
-w Ci
QTY/FEE
Ch�:
FFee: fm;
--I—
PC Fec
El
'T-1 DI
NOTE. These fees are based on the Prelintinary information available and are onlv an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 09-051 Eff� 7/1,170
FEE
QTY/FEE
MISC ITEMS
PC Fec
'T-1 DI
Permit Fee:
$7,844.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
A
Strong Motion Fee: IBSEISAffCO
$31.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$6.00
SUBTOTALS:
$7,881.50,
$0.00E-- TOTAL FEE: 1
$7,881.50
Revised: 04/29/2011