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12020014CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10895 S BLANEY AVE CONTRACTOR: BESTBUILD PERMIT NO: 12020014 CONSTRUCTION INC OWNER'S NAME: PACIFIC RIM PARK LLC 1732 143RD AVE DATE ISSUED: 05/10/2012 OWNER'S PHONE: SAN LEANDRO, CA 94578 PHONE NO: (510) 388-5099 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class__ Lic. 4 - / C) F r- MECH RESIDENTIAL COMMERCIAL Contracto Date I hereby affirm that I am I ensed under the provisions of Chapter 9 JOB DESCRIPTION: SHANGHAI DUMPLING COMMERCIAL T.1 RESTAURANT (commencing with Section 7000) of Division 3 of the Business & Professions TO Code and that my license is in full force and effect. INCLUDE M,E,P'S NON-STRUCTURAL 2,950 SQ FT -ALL ROOFTOP EQUIPMENT VISIBLE TO PUBLIC STREET VIEWS 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. 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 Sq. Ft Floor Area: Valuation: $120000 permit is issued. APPLICANT CERTIFICATION APN Number: 36934052.10895 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date _ c�. (*� v 471 Issued by: Date: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETFER declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. 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. Owner orAuthorized agent: Dater APPLICANT CERTIFICATION VOCISTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional - .�vwlLI JL CITY OF CUPERTINO BUILDING PERMjL"" ► Q-1 BUILDING ADDRESS: 10895 S BLANEY AVE CONTRACTOR: BESTBUILD PERMIT NO: 12020014 CONSTRUCTION INC OWNER'S NAME: PACIFIC RIM PARK LLC 1732 143RD AVE DATE ISSUED: 05/10/2012 OWNER'S PHONE: SAN LEANDRO, CA 94578 PHONE NO: (510) 388-5099 LICENSED CONTRACTOR'S DECLARATION F_ r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. H MECH r RESIDENTIAL r— COMMERCIAL Contractor Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SHANGHAI DUMPLING COMMERCIAL T.1 RESTAURANT TO (commencing with Section 7000) of Division 3 of the Business &Professions INCLUDE M,E,P'S NON-STRUCTURAL 2,950 SQ FT -ALL ROOFTOP EQUIPMENT VISIBLE TO PUBLIC STREET VIEWS 8/6/12 -REV N 1- REVERSE TWO DOOR Code and that my license is in full force and effect. OPENING AND ONE DOOR OPENING AT SIDE OF RESTAURANT -8/6/12 REVNI 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 permit is issued. Sq. Ft Floor Area: Valuation: $120100 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number: 36934052.10895 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED 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 with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature � �� Date—� Z_ Issued by: Date: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. 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: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the 1 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(x) should 1 store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, I must Owner or authoriz gent: forthwith comply with such provisions or this permit shall be deemed revoked.—_pate:�/ �— Z APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I herebyarm that there is a construction lending ffig agency for the performance of Hork'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 with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. [understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO r FEE ESTIMATOR - BUILDING DIVISION igADDRESS: 10895 s. blaney ave. DATE: 02/03/2012 REVIEWED BY: bobs. PC FEE ID APN: BP#: "VALUATION: 1$120,000 r PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAMATION 113 TI PERMIT TYPE: WORK t.i. commercial restaurants ace non structural include M E Ps. SCOPE PME Plan Check: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 2,950 $2,167.70 IBTIPLNCK $2,382.30 IBTIINSP hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,382.30 Suppl. Insp. Fee.S Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 TOTALS: 2,950 $2,167.70 $0.00 $2,382.30 MECH, .HOURLY 0 Yes G No PLUM, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No NOTE: This estimate does not include fees due to other Departments (Le. Punning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelininary information available and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Tee Resolution 11-053 Bf/ 7/U11� FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,167.70 Select a Misc Bldg/Structure or Element of a Building Supp/. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,382.30 Suppl. Insp. Fee.S Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 __F_T 0 0 Work Without Permit? ® Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G t Strong Motion Fee: IBSEISMICO $25.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $4,580.20 $0.00 TOTAL FEE: 1 $4,580.20 Revised: 1119/2012 CITY OF CUPERTINO FM -0 FEE ESTIMATOR - BUILDING DIVISION .. ADDRESS: 10895 s. blaney ave DATE: 08/06/2012 REVIEWED BY: larrys PC FEE ID APN: BP#: `VALUATION: $100 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 0.0 PENTAMATION 1A TI PERMIT TYPE: WORK reverse two door opening and one door opening at side of rest. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) II-B,111-B,IV,V-B $0.00 0.0 $0.00 $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 0 �� ;, ' ; �i NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con.eirt,,c(ion Tax: _T7 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Q i Tr<ivcl Docntrientution Fees: Strom; Motion Fee: IBSEISMICO $0.50 1 # $799.00 Revisions IREVSFDWL SFDWL Bldg Stds Commission Fee: IBCBSC $1.00 $1.50 $799.00 , ,,iii/���;�� ;,;�' $800.50 Revised: 07/01/2012