11010046CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10123 N WOLFE RD
CONTRACTOR: I T CONSTRUCTION PERMIT NO: 11010046
OWNER'S NAME: VALLCO SHOPPING MALL
1720 OCALA AVE STE B DATE ISSUED: 01/07/2011
OWNER'S PHONE: 4087773081
SAN JOSE, CA 95122 PHONE NO: (408) 234-4340
1
JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL❑�
LICENSED CONTRACTOR'S DECLARATION
License Class Lie. #
DEMO 37,813 SQ FT OF DEMISING WALLS
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
Sq. Ft Floor Area:
Valuation: $9500
performance of the work for which this permit is issued.
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: 3162008LMALL
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. I 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 in consequence of the
Date:
granting of this permit. Additionally, the applicant understands and will comply
Issued
with all non -point source regulations per the Cupertino Municipal Code, Section
9.1&
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, I agree to remove all new materials for
inspection.
K 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
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 licenseW;n�
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 I
performance of the work for which this permit is issued,
will maintain compliance with the Cupertino Municipal Code, Chapter 9 an
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti s 2 05 ) an 5534.
7, 7
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Vrlz_� Date: 1
A
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
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 OL
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 regul do per the Cupertino Municipal CoLdeTection
Licensed Professional
9.18.
7
Signature Date
1AX114341#16MI
CITY OF CUPERTINO
11 =71 FEE ESTIMATOR - BUILDING DIVISION
liaADDRESS: 10123 n wolfe rd. DATE: 01/07/2011
APN: I BP#:
REVIEWED BY: bobs.
'VALUATION: 1$9,500
*PERMIT TYPE: Demolition Permit
PRIMARY
Commercial Building
USE:
I
PENTAMATION
1COMMLDEM
PERMIT TYPE:
WORK
demo mercantile space non structural
SCOPE
FEE ID FLR AREA
1DEMOCOM 37,813
-I Check
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Ew,-A Fef?,,
I h"'m5, Peri!p-eo-
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A,&,�Ahlsv, Fec:
Plumb, h..'siv, Fee:
Ekx, Insk), Fee:
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 11 info.
FEE ITEMS (Fee Resolution 0.9
- 0 �51 E, . �7/1/1 0
FEE
QTY/FEE
MISC ITEMS
Plan (7heck,Fec:
A
IlkC 1,,ee
Ll
Check
Permit Fee:
$3,543.00
Suppl. Insp. FeeO Reg. UT
0.0
hrs
$0.00
(Jnif Fee:
Permit Fee:
C'Onslruction Tax
F-1
Acoustical Review,, Fee:
Ifork k'Vithout.Permit"
plannip,g
DWvel Documental"On Fees:
I
Strong Motion Fee: IBSEISAHCO
$2.00
Select an Administrative Item
Bldf-y Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
, $3,546.00,
$0.001 TOTALFEF.=$3,546.00
Revised: 12/07/2010