12020068I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 18920 FORGE DR CONTRACTOR: DEVCON PERMIT NO: 12020068
CONSTRUCTION INC
I OWNER'S NAME: FORGE DRIVE INVESTORS, LLC 1690 GIBRALTAR DR I DATE ISSUED: 06/26/2012 1
OWNER'S PHONE: 4152845700 I MILPITAS, CA 95035 1 PHONE NO: (408)942-8200 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class� Lic. # 3 l 1 l 1Q3
Contractor LJssLod (o 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:
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 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 pe dditionally, the -applicant un r ds and will comply
with all non- sou nicipal Code, Section
9. 18..
Signature Date v
❑ . 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 3100 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: RESIDENTIAL
COMMERCIAL
APPLE -COMMERCIAL TENANT
IMPRO VEM ENT(2700SQFT)-LAB
SPACE,INCLUDE STRUCTURAL, ADD EXTERIOR
SCREENED
EQUIPMENT YARD TO SUPPORT AIR COMPRESSOR
Sq. Ft Floor Area: Valuation: $600000
APN Number: 31609030.18920 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 wit a upertino Municipal hapter 9.12 and
The Health &Safety Code ectio 2550 ,and 5534. n
Owner or authorized agen . Dater / !/
LENDING AGENCY
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature
Date
CITY OF CUPERTINO
Imo! FEE ESTIMATOR - BUILDING DIVISION
igADDRESS:
18920 forge dr.
DATE: 02/15/2012
REVIEWED BY: bobs.
APN 121 U � 6
BP#:
Da0O& O
-VALUATION:
1$600,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
t.i. comm labs ace includes structural
add exterior equipment and to support air compressor.
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
2,700
$2,128.16
IBTIPLNCK
$2,162.64
IBTIINSP
TOTALS:
2,700
$2,128.16
$2,162.64
:::...
..
.....:.......
....C'
M. .
>� H;ET
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are bated on the nrelininary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (F'ee Resolution 11-053 E . 7-1/11)
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are bated on the nrelininary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (F'ee Resolution 11-053 E . 7-1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly
Only? ® Yes (F) No
$2,128.16
2 hours Plan Check, Hourly
$260.00 ISTPLNCK
Suppl. PC Fee: (F) Reg. (D OT
0,0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Q Yes E) No
$2,162.64
$0.00
Suppl. Insp. FeelD Reg. � OT
Q,Q
hrs
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
G
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
2 hours Inspections
$260.00 ISTINSP 7 Inspection, Hourly
G
Strong Motion Fee:
IBSEISMCO
$126.00
Select an Administrative
Item
B1dFStds Commission Fee:EIBCBSC
$24.00
4x'f:;
$4,440.80
$520.00;-tp';:1>�;
$4,960.80
Revised: 1/19/2012