15020093 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20600 HOMESTEAD RD CONTRACTOR:SOUTH BAY PERMIT NO: 15020093
CONSTRUCTION,INC
OWNER'S NAME: SOBRATO INTERESTS l ETAL 1711 DELL AVE DATE ISSUED:02/17/2015
OWNER'S PHONE: 4084460700 CAMPBELL,CA 95008 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
STEIN MART-INSTALLATION OF STORE FIXTURES IN
License ClassLic.# �f[ LA RECEIVING AREA
Contractor ')--h 1
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. Sq.Ft Floor Area: Valuation:$18000
1 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:32610066.20600 OccupancyType:
permit is issued.
APPLICANT CERTIFICATION
I certify that l have read this application and state that the above information is PERMIT EORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state laws relating WITH-INr
�IIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enterPE
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYST CALLED INSPECTION.
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 Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisMINA
Owner or authorized agen ate:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
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,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20600 Homestead rd DATE: 02/17/2015 REVIEWED BY: Mendez
APN: BP#: VALUATION: 1$18,000
TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK Stein Mart- installation of store fixtures in receiving area
SCOPE
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the preliminar information available and are only an estimate. Contact the Deptfor addnl info.
FEE ITEMS L,(Lee Resolution 11-053 fff. ZIZLj3 FEE QTY/FEE A/HSC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 hours Plan Check, Hourly
Suppl. PC Fee: (D Reg. 0 OT 1 0.0 hrs $0.00 $286.001]STPLNCK I
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes (j) No $0.00
Suppl. Insp. Fee:(j) Reg. 0 OT 10.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
sr I n "),A
F
0
H
Work Without Permit? 0 Yes No $0.00 G
Advanced PlanninjZ Fee: $0.00 Select a Non-Residential G
Building or Structure 0
A
Strong Motion Fee: IBSEISMICO $5.04 3.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $429-00ISTINSP Inspection, Hourly
SUBTOTALS: $6.04. $715700 TOTAL FEE: $721.041
Revised: 01/06/2015