11070072 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD STE 150 CONTRACTOR:GIDEL AND KOCAL PERMIT NO: 11070072
OWNER'S NAME: CUPERTINO CITY CENTER 574 DIVISION ST DATE ISSUED:07/12/2011
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01'VNER'S PHONE: CAMPBELL, CA 95008 PHONE NO:(408)370-0287
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LICENSED CONT'RACTOR'S DECLARATION
_ BUILDING PERi•4IT INFO; BLDG ELECT PLUMB
License Class Lie.#
NIECH RESIDENTIAL CONIMERCIAL
Contractor ( J t o Date
JOB DESCRIPTION: SUITE 150-T.l PREP OF 900 SQ FT NON-STRUCTURAL
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2700
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 _ATN Number:36901028.150 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRE S.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 Issued Yi Date:
granting of this permit. Additionally,the applicant understands and will comply y'
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,I agree to remove all new materials for
inspection.
❑ 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
I,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 licensed contractors to HAZARDOUS \4ATERIALS 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 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 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534, rr�.
Section 3700 of the Labor Code,for the performance of the work for which this Date: t
permit is issued. Owner o authorized agent:
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 ONSTRUCT[ON LENDING GENCY
A
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 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 j
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
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DCITY OF CUPERTINO i
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20400 stuns crk blvd. DATE: 07/12/2011 REVIEWED BY:
APN: BP#: '"VALUATION: 1$2,700 —�
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rPERMIT TYPE: Demolition Permit
PRIMARY Commercial Building PENTAMATION 1COMMLDEM
USE: PERMIT TYPE:
WORK IT.1. prep 900 sq ft commercial offices ace non structural.
SCOPE
FEE ID FLR AREA
s.f.
1DEMOCOM 900
ilrc�r. )i e F-.r,{ ?i: <c,
c�1;ii:°. }it{.',�l.l f11itPT1`lit:{:,';;t�ii}.
NOTE. Theseees are based on the preliminary in ormation available and are onlyan estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resohition 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS
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Ott 177{{ {f1
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Permit Fee: $523.00
Suppl.Insp.Feer Reg. 0 OT 0.0 hrs $0.00
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Strong Motion Fee: IBSEISMICO $0.57 Select an Administrative Item
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Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $524.57 $0.00 TOTAL FEE:;
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Revised: 07/04/2011
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