12010146CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20956 HOMESTEAD RD CONTRACTOR: SMI CONSTRUCTION INC PERMIT NO: 12010146
OWNER'S NAME:
SAN LEANDRO, CA 94577 PHONE NO: (510)351-3288
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor L�pY/I Date
I hereby affirm that I am licensed under the provisiodif"
C Ater 9
(commencing with Section 7000) of Division 3 of the & 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 au rize representatives of this city to enter
upon the above mentioned property r inspection purposes. (We) agree to save
indemnity and keep harmless fliS,46ty of Cupertino against liabilities, judgments,
costs, and expenses which in
on ocrue a amst said City in consequence of the
granting of this permit. Add , t e plicant understands and will comply
with all non -point "/
ulat s per t Cupertino Municipal Code, Section
9.18.
Signature ,
n
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:
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.
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, 1 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 die Worker's Compensation provisions of the Labor Code,1 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.
BUILDING PERMIT INFO: BLDG F ELECT 4— PLUMB F
MECH RESIDENTIAL r COMMERCIAL f—
JOB DESCRIPTION: STE D - NEI TEA HOUSE - COMM.T.I (t045 SQFT)FOOD
SERVICE ESTABLISHMENT WITH TYPE I HOOD WITH
EQUIPMENT, SERVICE COUNTER, NEW PARTITION WALL;
Sq. Ft Floor Area: I Valuation: $25000
APN Number: 32609061.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: ��,�r✓ �/%TG Date: 3 ' �, '%1�1-
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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should se equipment or devices which emit hazardous air
contaminants as d ned by the Bay Area Air Quality Management District I will
maintain compli ce wi the Cupertino Municipal Code, Chapter 9.12 and the
Health &
Date: 7
CONSTRUCTION LENDING AGENCY
I hereby fft that there is a construction lending agency for the performance of )wrk's
for which 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.
Date I Licensed Professional
�W''CITY OF CUPERTINO
WFEE ESTIMATOR - BUILDING DIVISION
iaADDRESS:
20956 homestead rd #d
DATE: 01/24/2012
REVIEWED BY: bobs.
APN: U& 0,? d�p
BP#: l a
VALUATION: 1$25,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION .16 TI
PERMIT TYPE:
WORK
t.i. food service establishment with type 1 hoodw/ equipment, service counter, new partition wall non
SCOPE
strcutural.
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
1,045
$1,950.40
IBTIPLNCK
$1,034.56
IBTIINSP
TOTALS:
1,045
$1,950.40
.,.
$1,034.56
$
::;:
::: :r:. :i7.71
MECH.,.NOU'..
3�.
tom*! "r
::....................
....
.. , ... ....'>;,!
.
�.
� .
� .
Li
L_J
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc )_ These fen_c are haled an the nrelimina" infnrmatian availahle and are anly an e_dunatp COntaCt the Dent fnr nddn'1 Info
FEE ITEMS (fee Resolution 11-053 & 71,i11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,950.40
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: e Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,034.56
Suppl. Insp. Feee. Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
(D
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
Strong Motion Fee:
IBSEISMICO
$5.25
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
77
.....:.�:: �
�.�.::::.. ....................
$2,991.21
$0.00 ' ::� �. �::.�.�:.�:.'� �:� ��''�k�, � ,;:
$2,991.21
Revised: 1 /19/2012