11100043CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS. 20605 VALLEY GREEN DR CONTRACTOR: DRYCO CONSTRUCTION PERMIT NO: It 100043
ONNNER'S NAME: BERG FAMILY PARTNERS, L.P. 42745 BOSCELL RD DATE ISSUED: 01/17/2012
OWNER'S PHONE: 4089741126 FREMONT, CA 94538 PHONE NO. (510) 438-6500
11 LICENSED CONTRACTOWS DECLARATION
License Class ---A— Lie. # 5 40 37� I -
Contractor 1W60 6,—Date /—I
I I hereby affirm that I am licensed tinder 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 tinder penalty of per 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
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 sail City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all Ron-poil urcere a-tions per the Cupertino Municipal Code, Section
918.
Signature_ DateJ
13 N
I fierebyaffirin that I ant exempt from the Contractor's License Law for one of
the following two reasons:
I, Lq 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." 044,
Business & Profession,-; 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 lblIONViRg three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Nklorker's
Compensation, sass provided for by Section 3700 of the Labor Code, for the
performance of Ilse work for which this permit is issued.
I have and will maintainATorker'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 suhiect to the Worker's
Compensation taws of California. If, after making this certificate of exemption, I
become sulslect 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 arid 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 tire City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, tire applicant understands and will comply
o
with all non -point source regulations per the Cupertino Municipal Code, Section
9A8.
F, rice:
—
BUILDING PERMIT INFO: BLDG ELECT PLUMB'
MECH r RESIDENTIAL r COMMERCIAL, r—
JOB DESCRIPTION: APPLE - EXTERIOR ACCESSIBILITY UPGRADES TO
EXISTING COMIAERCIAL PROPERTY
Sq. Ft Floor Area: Valuation: $25000
I
APN Number: 32610046.20005 Occupancy Type -
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bv:_ 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:
I have read the hazardous inaterials requirements tinder Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505,25533, and 25534.
OZ-:�er �uthor)athy
Date. _e
CONSTRUCTION LENDINGA�QENCV
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (See. 3097, Civ C.)
Lender's Name
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records,
Date- I Licensed Professional
M 6 1 i I
I •=11,1014111 1 0
ADDRESS: 20605 valley green dr. 10/0612011
Jim APN: B V:
REVIEWED BY: bobs.
"VALUATION:
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
Commercial Building
USE:
PENTAMATION IGE
PERMIT TYPE: NCOM
I 19
l"
WORK
accessibility upgrades to existing commercial property.
SCOPE
lexterior
ofher
NOTE. This estimate does not include fees Clue to other Departments (ie. Planning, Public Worb, Fire, Sanitary Sewer District, School
District, etc.). Iftesefees are based on the preliminary in formation available and are only an estimate. c;onlactthe wept for aaan-t info.
FEE ITEMS (1,ee Resolution 11-053 Eff L/1/111
FEE
QTY/FEE
11 MISC ITEMS
Plan Check Fee: Hourly Only? (E) Yes 0 No
$0.00
=
hours Plan Check, Hourly
Suppl. PC Fee: (j) Reg. 0 OT
F-0.6 I
hrs
$0.00
$520.0
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes 0 No
-1
$0.00
Suppl. Insp. Feel a Reg. 0 OT
L0-0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Convlru'Ih"n ""'aA
4 'Ir
0
Work Without Permit? 0 Yes (j) No
$0.00
E)
Adyanced Planning F
�ee.
$0.00
hours Inspections
®hours
E)
$260.0 01
1 STT rs--P
Inspection, Hourly
0
j
IBSEISAffCO
$5.25
[--075—]
hrs Admin./Clerical Fee
Bldg,S'tds Commission Fee: IBCBSC
$1.00
$41.00 1-4DMN
77777
$6.25
"A','
$821.00 L
$82725