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11030035 i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO:11030035 INC OWNER'S NAME: LANE PARTNERS 690 GIBRALTAR DR DATE ISSUED:04/28/2011 OWNER'S PHONE: 6503830100 MILPITAS,CA 95035 PHONE NO:(408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# lJ �� MECH RESIDENTIAL COMMERCIAL Contractor��'VO�'n G >W5�, Date I hereby affirm that I am licensed under the provisions of Chapter 9 NEWJOB DESCRIPTION:LOBBY,IST,2ND&3RD FLOOR: T.I CONSISTING OF (commencing with Section 7000)of Division 3 of the Business&Professions FINISHES, HES,PARALSO IN I U MILLWORK BLDGPOWESHAFTS AND Code and that my license is in full force and effect. FINISHES,ALSO TO INCLUDE TWO NEW BLDG SHAFTS 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 Sq.Ft Floor Area: Valuation:$7000000 perm 3s ed APPLICANT CERTIFICATION APN Number:36901019.00 Occupancy Type: ertirthathave 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Add�itionally,the appli understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point so re regulations per e Cupe no Municipal Code,Section / 9.18. �� rr Issued by: `�. f-�' "_...__. Date: Signatur ��.""��- Date-��1� ®� ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cjupe . o Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety,Code,Sectio s 25505, 5533,and 25534. 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 Ow r or authorized agen forthwith comply with such provisions or this permit shall be deemed revoked. 7 ate: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Nwrk's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT ' BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 11030035 INC OWNER'S NAME: LANE PARTNERS 690 GIBRALTAR DR DATE ISSUED:04/28/2011 OWNER'S PHONE: 6503830100 MILPITAS,CA 95035 PHONE NO:(408)942-8200 i ❑ LICENSED CONTRACTOR'S DECLARATION I r r� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class !�s� Lic.# ' q G� �/ � , / � MECH ry RESH)ENTIAL r COMMERCIAL r Contractor��!/'�SYI Date f I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:LOBBY,1ST,2ND&3RD FLOOR: T.I CONSISTING OF (commencing with Section 7000)of Division 3 of the Business&Professions NEW PARTITIONS,CEILING,MILLWORK POWER/SIGNAL AND Code and that my license is in full force and effect. FINISHES,ALSO TO INCLUDE TWO NEW BLDG SHAFTS REVISION#1-(2)ROOF PENETRATIONS FOR HVAC-6/28/11 REV#1 ISS'D 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 Sq.Ft Floor Area: Valuation:$7000000 permit is issued. APPLICANT CERTIFICATION APN Number:36901019.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. -._a_� r ,s7 L j� l Date Issued by: _ Date: J l_ t / U) I Signature - ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I n o become subject to the Worker's Compensation provisions of the Labor Code,I must O author elm ent: C forthwith comply with such provisions or this permit shall be deemed revoked. Dater CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of nwrk's correct.I agree to comply with all city and county ordinances and state laws relating for which this,penmit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 ARCHITECTS DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20300 stvns crk blvd 1st-4th flor DATE: 03/08/2011 REVIEWED BY: bobs APN:'_� BP#: 1(1 _m1 r "VALUATION: j$7,000,000 PERMIT TYPE: Building Permit PLAN CHECKTYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building 1 B TI PERMIT TYPE: WORK T.I commercial offices ace structural includes M E Ps. New shaft from ground floor through 4th floor. SCOPE Replace exisitng front doors. OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-A,111-A,V-A 115,054 $14,467.07 IBTIPLNCK $51,368.13 IBTIINSP TOTALS: 115,054 $14,467.07 $51,368.13 MECH,HOURLY 0 Yes (j) No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes Q No Mech.Plan Check2.0 hrs $252.00 -',',,,,,?,. "Ir��<:k tc=�,.I hv? t ", I IF 1MECPLNCMech.Permit Fee: IMPERMIT f'<i!0, r`, ._<? rex:: Other Mech.Insp. 1 2.0 1 hrs Mech.Insp.Fee: IMECHINSP $252.00 131.,,,.4. .3:,. v"", ?., NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (1{ee Resolution 09-051 Eff. 7/1/10 FEE QTY/FEE MISC ITEMS Plan Check Fee: $14,467.07 = # Window/Sliding Glass Door Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 $380.00 1WINREP Replacement PME Plan Check: $252.001= # Mechanical Permit Fee: $51,368.13 $95.00 1BREMVENs Ventilation System Suppl.Insp.Feer Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $294.00 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Planning Fee: $0,00 Select a Non-Residential Q Travel Documentation Fee: 1TRAVDOC $42.00 Building or Structure 0 A StronF4 Motion Fee: IBSEISMICO $1,470.00 Select an Administrative Item i Bldg Stds Commission Fee: 1BCBSC $280.00 SUBTOTALS: 68,173.20 $475.00 TOTAL FEE: $68,648.20 Revised: 01/15/2011 i i CITY OF CITY OF CUPERTINO j GENERAL BUILDING uPERTINo PERMIT APPLICATION FORM _ APN# � � � � � � . Date: Building Address: Z C) 300 e.-.4 tvCµ> C VV-e k Z�V -/ �� C `J 01714 )Yld Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA If Residential, is house an Eichler? Yes ❑ No ❑ If yes,needs planning approval. Owner's Name: Mw; ihvI �t�.vti+� e�,v V1 �'� Phone#: G SO) C.� A �v lGC ��1H Contractor: Phone: O 47, " Fax: eAA 0 Z. Contractor License#: 71� , G Cupertino Business License#: Contact: Phone: !®sV da Fax/e-mail: Residential ❑ Commercial i 1 k � j Iti Job Description: tl F VCWry �/�f®1�S C�1 hlq. 4 Is+�t 1 �J�W' kj J Ai Nt.s.'a W CP r&W 00 V. cc, i;k �10zoaiM Building Permit Info: Bldg Elect Plumb Mech Type of Construction (Usage Class): Occupancy Type: 1-A, I-B ❑ IUIII/V-A II/III B,IV-HT,V-B ❑ Valuation: � Square Footage: 4� 6' 0 61 LF Project Size: Counter❑ Express ❑ Standard E]"�' Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable,include in plan set&the sheet index. Points Achieved: For help, contact Build it Green at www.buildit reen.or G Revised 12/06/10