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13020017 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7335 BOLLINGER RD CONTRACTOR:WILKINSON PERMIT NO: 13020017 CONSTRUCTION&DESIGN OWNER'S NAME: SEET DING SHEE TRUSTEE&ET AL 1 I COTTONTAIL LN DATE ISSUED:04/10/2013 OWNER'S PHONE: 4083944611 VALLEY SPRINGS,CA 95252 PHONE NO:(408)594-1709 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lic.# � �. UNITS D& E*SPECIALTY FOODS* T.I.FOR NEW FOOD STORE INTO(E)2 UNITS(D& E)TOTAL OF 3223SF. NO Contractor Date STRUCTURAL CHANGES OR EXTERIOR WORK- 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions REVISION#1- CLARIFICATION ON DETAIL SHEET SDA-ISSD Code and that my license is in full force and effect. OTC 5/20/2013 1 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 die Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$45000 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 ApNumb#r:35923018.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the a v - IT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county or t WITHIN 180 OF PERMIT ISSUANCE OR to building construction,and hereby authorize represe city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS OM CALLEDINS CTION. 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 Issued by: Date: 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 being installed.If a roof is installed without first obtaining an inspection,l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,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. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti ns 2 O5,25533,and 25534. Section 3700-of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date; permit is issued. I certify that in the performance of the'rvork 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I 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 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, 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 source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7335 BOLLINGER RD CONTRACTOR:WILKINSON PERMIT NO: 13020017 CONSTRUCTION&DESIGN OWNER'S NAME: SEET DING SHEE TRUSTEE&ET AL I 1 COTTONTAIL LN DATE ISSUED:04/10/2013 OWNER'S PHONE: 4083944611 VALLEY SPRINGS,CA 95252 PHONE NO:(408)594-1709 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL IJ License Class T2 Lic,N �� 7��� UNITS D &E*SPECIALTY FOODS* T.I.FOR NEW FOOD STORE INTO(E)2 UNITS(D& E)TOTAL OF 3223SF. NO Contractor Date �jC' STRUCTURAL CHANGES OR EXTERIOR WORK hereby a trm thaf�am licensed undeF�he 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. 1 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. Sq.Ft Floor Area: Valuation:$45000 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 APN Number:35923018.00 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. l agree to comply with all city and county ordinances and state laws relating WITHIN 80 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 DA S FROM LAST CALLED INSPECTION. 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 Issued by: V44Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature 1V'�/ Date .40 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(See.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 9.12 and the declarations: Health&Safety Code,Section 25532(a)should 1 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 1' performance of the work for which this permit is issued. • will maintain compliance with the Cupertino Mlunicipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2553,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater ��G-1 pennit 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I 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 I certify that 1 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7335 BOLLINGER RD DATE: 02/0512013 REVIEWED BY: MELISSA APN: 359 23 018 BP#: 3ol *VALUATION: $45,000 *PERMIT TYPE: Building Permit PLAN CHECK YPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: IM T� WORK *SPECIALTY FOODS* NEW FOOD STORE INTOE 2 UNITS D & E TOTAL OF 3223SF. NO SCOPE STRUCTURAL CHANGES OR EXTERIOR WORK OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. M (Tenant Improvements) II-B,III-BJV,V-B 3,223 $3,047.86 IMTIPLNCK $2,598.47 IMTIINSP TOTALS: 3,223 $3,047.86 1 $2,598.47 MECH,HOURLY Q Yes (F) No PLUMB,.HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No htec.h. Plan Check Plunrh. Plan Check Elec. Plan Check I F Mech. Permit Far: Plumb. Permir ree: Dec. Pennir Fee: Orher Alech. Insp. Oder Plumh Insp. Other Elect. Insp. Ll Aleck. Insp. FL: PlunA lush. Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the preffinina information available and are only an estimate. Contact the Dept/or addn'l info, FEE ITEMS (Fee Resolution 11-053 L11.' 7/1/12) FEE QTYIFEE MISC ITEMS Plan Check Fee: . $3,047.86 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. Q OT 0,0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $2,598.47 Suppl. Insp. Feel@ Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Adin lnistroiive.Fee: Q Work Without Permit? © Yes (j) No $0.00 E) Advanced PlanninL Fee: $0.00 Select a Non-Residential Q Travel Docrunentation Fees: Building or Structure Q Strong Motion Fee: IBSEISMICO $9.45 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $5,657.78 $0.00 TOTAL FEE: $5,657.78 �n Revised: 01/01/2013 1V"