10090070CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20916 HOMESTEAD RD STE F CONTRACTOR: SMI CONSTRUCTION PERMIT NO: 10090070
INC
OWNER'S NAME: O
o
License Class Lic. #--<..........".-£-'-''-Q/..-.»<---.,..---r--t3
Contractor hLk1:Z: Date._J.+-+--.!l>-/-...L-_O_'_
I hereby affirm that I am licensed under the provisio
(commencing with SectioD 7000) of Division 3 of the
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 hereb r uthorize representatives of this city to enter
upon the above mentioned prope for inspection purposes. (We) agree to save
indemnify and keep harmless e City of Cupertino against liabilities, judgments,
costs, and expenses which y accrue against said City in consequence of the
granting of this permit. A itiona e applicant understands and will comply
with all non-p
-",_.-----
.
installed without first obtaining an inspection, I agree to remove all new mat
o
I hereby affirm !thatl 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 Iicensed 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, 1
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 r have read this application and state that the above information is
correct. 1 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.
SAN LEANDRO, CA 94577
JOB DESCRIPTION: RESIDENTIAL D
QUICKLY CAFE -COMM'L TI, REMODEL EXISTIN
KITCHEN, NEW TYPE I HOOD, COOKING EQUIPMJj:NT,
REMODEL ADA RESTROOM, 1200 SQFT WORK AR A
Sq. Ft Floor Area: Valuation: $40000
APN Number: 32609052.F Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STAR'IlED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTI N.
JSSU~ ~te:.....:.0----'-/_~-+-_~_·_
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a
oof is
rials for
inspection.
Signature of Applicant: Date: ;-_
ALL ROOF COVERINGS TO BE CLASS "A" OR BETrE
1--------------------------,...---1
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 «f the
California Health & Safety Code, Sections 25505, 25533, and 25534. I \\/ill
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 nd the
Health & Safety Code, Section 25532(a) shoul!}1 store or handle hazard us
material. Additionally, should I use equip 't or evices which emit hdzardous
air contaminants as defined by the Bay a Air uality Management Oistrict I
Owner or authorized agent: +-.I'I'---.L----r-..",..""---
, 2
aintain compliance with the Cu' icipal Code, Chapter 9.12 and
the Health & Safety Code, Sections
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the perform an e of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name t
Lender's Address, +-_
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional _
Signature Date
II
CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
ADDRESS: I DATE: REVIEWED BY:.
*VALUATION: 1$1,200APN: I BP#:
*PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Tenant Improvement
PRIMARY
PENTAMATION I TUT:II.Commercial Building USE: HOOR·IReA PERMIT TYPE:
WORK
SCOPE
1
1 ~ TI ...
TYPE OF FLRAREA I
OCCUPANCY TYPE: CONSTR. (s.C.) PC FEES PC FEE ID BP FEES BP FE~ID
!
B (Tenant Improvements) II-B,III-B,IV,V-B 1,200 $1,897.94 lBTIPLNCK $1,064.59 lBTIIN.~p
TOTALS: 1,200 $1,897.94 $1,064.59
MECH, HOURLY o Yes o No PLUMB, HOURLY o Yes (9 No ELEC, HOURLY o Yes 0 No
'~"-LIt. 1'10/1 ( 'il,,('" I I [,lwlI!>. Plw/ ("IIL'('A I 1: lei '. "'<In ('II .., k I I
I \11' :h. I>alllit Te,,' I !'Ium/> !'el'mil F,·c. l'1'.'c. PermiT I'"n
Ol!II:I'\ff!ch. 1m!, U I (hl/('I" Pluml' hill' U I (MIL'/' Elci 1111/" U I
M"ch Imp !',,,. PhI/lib. ['1''1'. F"o:. El,,, Imp. !' "1'
NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 'I in' o.
FEE ITEMS a'ee Resolution 09-051 Err 7/fIIO) FEE QTYfFEE MISCITEMS
Plan Check Fee: $1,897.94 Select a Misc Bldg/Structure
Suppl. PC Fee: o Reg. o OT 1 0 .0 I hrs $0.00 I or Element of a Buildin~
PME Plan Check: $0.00
Permit Fee: $1,064.59 I
Suppl. Insp. Fee:€> Reg. o OT I 0.0 I hrs $0.00
PME Unit Fee: $0.00 I
PME Permit Fee: $0.00
Cnnstr1/cfirl/l TdX I I I
Acoustical Fee: o Yes 0No $0.00 0
Work Without Permit? o Yes 0No $0.00 I 0
Planning Fee: PLLONGRNGC $0.00 Select a Non-Residential 0
Travel Documentation Fees.' I
Building or Structure 0 ...
Strong Motion Fee: I BSEISMICO $0.50 ielect an Adm;n;stmtive Iter
Bldg Stds Commission Fee: I BCBSC $1.00
SUBTOTALS: $2,964.03 $0.00 TOTAL FEE: -I $2,964.03
Revised: 9/01/2 10