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12070221CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22382 HOMESTEAD RD CONTRACTOR: THOMAS E PERMIT NO: 12070221 HARRINGTON TRUST OWNER'S NAME: JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic. # FITNESS STUDIO - COMMERCIAL TENANT IMPROVEMENT Contractor Date (2524 SQFT) FOR FITNESS STUDIO 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 Sq. Ft Floor Area: Valuation: $50000 performance of the work for whichthis 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 APN Number: 32601018.22382 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City m con pe y g ry � sequence of the granting of this permit. Additionally, the applicant understands and will comply Issued Y 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 berg installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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.I2 and the declarations: Health & Safety Code, Section 25532(s) 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 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 the Health & Safety Code, Sections 550 533, and 25534. ` d1� `� Owner or authorized agept: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person inany manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRU ON LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must 1 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 1 certify that 1 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, ARCHITECT'S DECLARATION 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 sourceati s per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date Z I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 22382 HOMESTEAD RD I H CONTRACTOR: TOR: TRUSTS E I PERMIT NO: 12070221 ARRIN OWNER'S NAME: LOS ALTOS, CA 94022 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie. # r- r r MECH RESIDENTIAL COMMERCIAL Contractor Date 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. 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 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. Signature ❑ OWNER -BUILDER DECLARATION I hereby affirm that I 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 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 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. JOB DESCRIPTION: FITNESS STUDIO - COMMERCIAL TENANT IMPROVEMENT (2524 SQFT) FOR FITNESS STUDIO, RE -ROOF 37 SQ 10/15/2012 REVISION # I - ADD MECHANICAL SOUND WALL ON ROOF- ISSD Sq. Ft Floor Area: Valuation: $50000 APN Number: 32601018.22382 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: Date: RE -ROOFS: 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. 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, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: CONSTRUCTION LENDING AGENCY Date: I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 22382 Homestead Road DATE: 10/15/2012 REVIEWED BY: Sean APN: BP#: *VALUATION: j$1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: PENTAMATION 1GENCOM PERMIT TYPE: WORK Revision #1: Add mechanical sound wall on roof 48 L.F. . SCOPE z,���� �.. :.i_` � �� �.� ' �_�'! �1�3��: � Yi�i��i�ti�:�`7f��r}�����S��jl���s ��; a-.��ai :SF_ - - A_ ..a-„ti. :-t.z _:.4'.. _-�.- ��•s'. � - � .����i r . S:`' a,•1: 4kiI:S�'..S__,7�,:7���5„`.a���.-..__hr Xkech. Plan Check Phunb. Plan Check Elec. Plan Check i'-Ic:ch. Permit Fee: Plumb. Permit Fee. Elec. Permit Fee: h9ech. Insp. r1e,h. Other Plurnh Insp.Li Other Elec. Insp. In.;p. Fee: Plumb. h)sp. Fee. Elec. Insp. NOTE: This estimate does not inchide fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711112,) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 F-17 hours Plan Check, Hourly $133.00 ISTPLNCK Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. © OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conso-itclion Tax: Administrative Fee: 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Plannin& Fee: $0.00 1 hours Inspections $133.00 ISTINSP Inspection, Hourly 0 ©� Travel Documentation Fees: Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC . $1.00 $1.50 266.00 sf` $jf $267.50 Revised: 10/01 /2012 CITY OF CUPERTINO I� FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 22382 Homestead Road DATE: 07/27/2012 REVIEWED BY: Sean APN: BP#: "VALUATION: 1$50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION 1A TI PERMIT TYPE: WORK Tenant Improvement 2524 sq ft for fitness studio. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) II-B,III-B,IV,V-B 2,524 $2,344.38 ]ATIPLNCK $1,365.17 ]ATIINSP TOTALS: 2,524 $ 2 344.38 ;s; ::<' ::,s: ........................ $1 365.17 ..: ;:. "%�r. J::' :: 5...: cf'-;;)js's is .�.r:. �'," `•;:i'.r: .. �:; q�+� yy��,,-'-'.-.'i1; %SC is ]•;. 7:. �f, r �_r'a,s,):A: •.i.' i'�.C•`.;'::5: < ;'1 7..l.. Sy . : y�,. z..r� r:+ �jtiis' '•SSs :, F. t' �; gs .-y ..;i?r.�: i. s-� i_::>'-.4'•. - l.3f ,�:: r; S; ,r;.� •�a . .a,£:'� Pr::'3 ;.., ,:r• . r ii..., t`S. i.'1 r. iTE. I.�f IJ•. r"r]i ,... 1+; E34 .."r,i.''l"r,.:'C. ��+'�. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E(f 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,344.38 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,365.17 Suppl. Insp. Fee-0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �r;i7.1;1'?!i'Ilr?Y7 F dx. E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure 0 I Strong Motion Fee: IBSEISMICO $10.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $2.00 $3 722.05 0.00 Revised: 07/01 /2012