10120054I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20956 HOMESTEAD RD STE AI CONTRACTOR: SMI CONSTRUCTION INC I PERMIT NO: 10120054
OWNER'S NAME:
1 SAN LEANDRO, CA 94577 I PHONE NO: (510)351-3288 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # ` / (s (l
Contractor _i% Date 2 Z
I hereby affirm that I am licensed under the provisions o Ch ter 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:
1 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 or inspection purposes. (We) agree to save
indemnify and keep harmless the pertino against liabilities, judgments,
costs, and expenses which may a against said City in consequence of the
granting of this permit. Addi ally, toe applicant understands and will comply
with all non -point source r la ions per the Cupertino Municipal Code, Section
9.18. ,
19
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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 CER 1FICATION
I certify that I 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.
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: SHANGHAI GARDEN RESTAURANT - COMM'L TI (2100SQ)
REMODEL EXISITNG RESTAURANT,REPLACE EXISTING
KITCHEN EQUIPMENT& NEW ADA RESTROOM;NO RE -ROOF &
Sq. Ft Floor Area: 1 Valuation: $95000
APN Number: 32609061.A1 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued y: Da
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 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, shout se equipment or devices which emit hazardous air
contaminants as fine a Bay Area Air Quality Management District I will
maintain coro a with the Cupertino Municipal Code, Chapter 9.12 and the
Health & lSa<Code, Sections 25505, 25533, and 25534.
Owner uthorized
Date: L //
CONSTRUCTION EN IN GEN Y
I here affirm that there is a construction lending agency for the performance of work's
for wh ch this permit is issued (Sec, 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Signature Date,
Licensed Professional
CITY OF CUPERTINO
FM__1 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20956 homestead rd. #A,,'(
DATE: 12/09/2010
REVIEWED BY: bobs.
APN:
BP#:
'VALUATION: 1$95,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
j,
fIr:)(3,2 sJ.,1 ,A:
PENTAMATION 1 BTI
PERMIT TYPE:
WORK
commercial restaurant non structural include M E P.
�t.i.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
2,100
$1,988.80
IBTIPLNCK
$1,672.54
IBTIINSP
TOTALS:
2,100
$1,988.80
=s53 °y'` '% a '{ •`''
$1,672.54.
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NOTE. These fees are based on the prelinunary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (F(-e Resolution 09-051 Eff. 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,988.80
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,672.54
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Con... ,, r i,wrion Tux
Acoustical Fee: 0 Yes 0 No
$0.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Planninn� PLLONGRNGC
$0.00
Select a Non -Residential 0
Building or Structure
i
Travel Do:cpy,r, 11,,11.on
Strong Motion Fee: IBSEISMICO
$19.95
Select an Administrative Item
�<� C.- ids =':.•,�;;?;., �a � = *r::X:r• `�
$ r ." ,.: :.,, z Q3 685.29
0.00 � .r, -�:'• :.-:���%•s- , '�• ,
r :.•:. / W
S�f'�ir%. �.•.t:r ''� 2•;�s;c;.s�� r , �•r�
Bldg Stds Commission Fee: IBCBSC
.l ,• �f ��� :11111, �r :
,;:R11rV .S � }c •,UJ �:.
r ,,•..,rUr. � ���
;�„I .Sdr ,, � �. �<• :I '.e�C�rli:Jri7����.�t���:i�fi. � sv�tjfSf,�i:'r.4�.:':s:S
$4.00
$3,685.29
Revised: 12/07/2010