10070062CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10101 N DE ANZA BLVD CONTRACTOR: OPI COMMERCIAL PERMIT NO: 10070062
BUILDERS
OWNER'S NAME: FOUR CORNER PROPERTIES
OWNER'S PHONE: 4153984196
IG_� LICENSED CONTRACTOR'S DECL/ARATION
License Class Lic. 9
Contractor / Date
I hereby affirm that 1 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 Ois
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 re ulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that 1 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.
1 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
1 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.
445 LEIGH AVE I DATE ISSUED: 08/06/2010
LOS GATOS, CA 95032 PHONE NO: (408)377-4800
JOB DESCRIPTION: RESIDENTIAL u COMMERCIALU
MODIFICATION OF HANDICAP PARKING, RE -STRIPING
TACTILE SIGNAGE
Sq. Ft Floor Area: I Valuation: $23000
APN Number: 32634071.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b Date: &—, C�
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
1 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 1 store or handle hazardous
material. Additionally, should 1 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, Section 5533, and 25534.
Owner or authorized agent: Date: �x G
CONSTRUCTION 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
Signature Date
��,,���� CITY OF CUPERTINO
ID_I FEE ESTIMATOR - BUILDING DIVISION
ADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
*VALUATION:
1$23,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
"
')Cih AfH_; :
APPLICATION
TYPE:
1 B TI
MECHANICAL Q Yes ID No
PLUMBING Q Yes Q No I
ELECTRICAL
0 Yes Q No
w
a
cc
3l
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s .ft.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
0
$0.00
$0.00
TOTALS:
1 0
$0.00
$0.00
TTI
1,1.'r l'h„i C 7rt•r .4
NOTE. These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'1 into.
FEE ITEMS (Fee Resolution 09-051 Ff. 7/1i09)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
ISUPPKFEE
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: E) Reg. 0 OT
2.0
hrs
$252.00
PME Plan Check:
$0.00
Permit Fee: ISUPINSFEE
$0.00
Suppl. Insp. Fee: Reg.
0 OT
2.0
hrs
$252.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
,mstruc:riurr Iu�
Acoustical Fee:
Q Yes (!) No
$0.00
Q
0
Work Without Permit? Q Yes Q No
$0.00
Planning_Fee:
$0.00
Select a Non -Residential
Building or Structure
0
7, r l 1 o v(;fac +;r, rr; +; 1 ;
Strong Motion Fee:
IBSEISMICO
$4.83
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$509.83
$0.00
TOTAL FEE:
$509.83
Revised: 6/30/2010
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10101 N DE ANZA BLVD
OWNER'S NAME: FOUR CORNER PROPERTIES
OWNER'S PHONE: 4153984196
❑ LICENSED CONTRACTOR'S DFCLAR/ATION
License Class Lic. N_
Contractor e�) Date
1 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 his
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,
dditionally, the applicant understands and will comply
with all non -point sou a gulations per the Cupertino Municipal Code, Section
9.18.
Signature,��Z Date^zU
❑ OWNER -BUILDER DECLARATION
1 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,
wiI I 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 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
9A 8.
CONTRACTOR: OPT COMMERCIAL PERMIT NO: 10070062
BUILDERS
445 LEIGH AVE DATE ISSUED: 08/06/2Q10
LOS GATOS, CA 95032 PHONE NO: (408)377-4800
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r r rr
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: MODIFICATION OF HANDICAP PARKING. RE -STRIPING &
TACTILE SIGNAGE
1/12/11 REVISION kl- REVISIE HANDICAP PARKING ACCESSIBILITY (PARKING
ONLY)-ISSD 3/8/11
Sq. Ft Floor Area: I Valuation: $23000
APN Number: 32634071.00 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: Date: -7,61[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, 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(s) should I store or handle hazardous
material. Additionally, should 1 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 505, 25533, and 25534.
Owner or authorized agent: Date. _%zo/
CONSTRUCTION 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 Ad
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Profess
Signature Date