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15110185dl CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20700 STEVENS CREEK BLVD CONTRACTOR: DUPLAN PERMIT NO: 15110185 CONSTRUCTION INC. OWNER'S NAME: BYER PROPERTIES LP 390 INDUSTRIAL ST DATE ISSUED: 12102/2015 OWNER'S PHONE: CAMPBELL, CA 95008 PHONE NO: (408)866-6682 41�— n LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL F� DEMO INTERIOR NON-BEARING WALLS AND MINOR License Class Lic. 4_� ?511, V ELECTRICAL/MECHANICAL (DUCTS); ADD (N) T-BAR CEILING; PREP FOR FUTURE TI. Contractor2�4�__ Datl/A� 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: $25000 performance of the work for which this permit is issued. ; 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. 35908028.20700 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXP RK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating W1 $O DA 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 ff YS CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments costs, and expenses which may accrue against said City in consequence / 7.- granting of this permit. Additionally, the applicant understands and will co ss y: ate: with all non-point source regulations per the Cupertino Municipal C e, Section 9.18. RE-ROOFS- Date l 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 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 licensed contractors to 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. Iwill 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 fbr by Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, - Sections 25505, 25533, and 25534. 12 Owner or authorized agcnr�-�.. Date: -4-14S- 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 (See, 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 with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9,18, Signature Date C0MM1UNr-1Y DEVELOPMiENT DEPART1\4ENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3223 - FAX (408) 777-3333 - buildinoL5).guDettmgrg [I NEW CONSTRUCTION ED AMMON 1 *,511()1'5<- ORICHNAL PER-VJ7 4" Bidg,4P,P-2011. tYoc revised 06121111 S-11=-, A-MUSS C-14 Y, -3TA71---,Z1? FAX C0\71ACT NAW-TE -1MD!0 07 CITY �- — 1? - C-Mrr COMMACTOR NAWB OUPLAIQ Li =-SENUI/M L1C ScTYFB BUS71ci STMT ADD RZ-SS PHO17Z & Gi ARC: -C N*, -Mk BUS. LIC 9 &nEmw, Af�a*-z--cl-r E-,V1Awfta4qr-0 ch I D?HC4r �1 �jv 304P -0- 6( fa)-V JAM j CA 4qG1 13 qOY JYr&O 3 5em� mmlo(�, PkO t�w 6( tsge�. agLe rae Et-)r(,))ee7 Tr-Am-mr igmo EMS-17-NG U� I elr-) i CCIIST& TYPE 'I • STor iRm E TYPE 0M 1 51M v- SQ1T, ISQ-FT, VALUATION (S) Fl�s TO # ,4jaA 1+-70 I �Iv FLOOR 1 ARBA 4-10 DEh/o TO AR--k KITC-1-r-EN RV,40DEL,ARB-A POMODELAPTA R M), i OD, B L . C, < --- A PORCH AREA DECK ARBA TOTAL DECKIPOP C.1 A.PZA G-1-11.AGZ-1-.KZk: DETACH I I A-, TACIi I I DWELMIGUNZYM ISASECONDUNIT 0 Y:-� S S LCONDSTORY nY S 13MG ADDED? 13 No ADD171-ION? r-1,I,,o PAZ-,AYI,I-TakTjON IF r::S'.P.Rovzo- copy OF PLA-\Nr.,'G,I.PPL-, [D-1,10 IS T-eF BLDG AN M YES FICFLERHOME? [3NO D' -awe By 'my Signature belov", I certify to each of the following: I am tae property o%kper or awthoriaed t application and the information" have providedis,crect, llhaver,ai the-- Description of work an � 'erl-yt ordinances and state la vs re ildi IF -prosern ts-o� -I. nter t 'go ut C per no oc 11n �bu SimatumofApplica nt ft. Date ST. J PPLEI ANT TF OR 2 A T 10 N �_P i3 -RED IRAN Multifammily dveellinp: Apply fq,- de-molitio., em t -o -\75w,SFD or'. -In em �noc� existing building S). Dern, olitionpe,mit is -o -d di -6 -t�W F "TUMM-0- ic =-m ,u-7- ofbui g N, penr it for building. 02- Comm ercial B ld g s: Provide a com D 1 et d Haz akt il s ?Materials D; s clo SUT- -M W form f M, 1 Y H az ar d o 'l s 4 at e ra 1 s a7 b i n used as art T o f t h: s D r C j t. Copy or PlaImin.g Ap TOVal I-Cfte7 or Meeting xith Plzznm�m, prior to ofBufldirg Permit application. 0 Bidg,4P,P-2011. tYoc revised 06121111 Hi-b-C I on OCCUPANCY TYPE: ... .... ..... TYPE OF CONST.. M F 4., 1=4 Plan Check Fee: $2,160.12 Me,c,h. 1,1c"Vi C, �1171147 1 B (Tenant Improvements) Dec" Alan Cl�eck i, tee: plumb, F C: Elec, Perl�.�if 1,408.3 0"he'r fl=slx LIM1,14, _hlv 10711.,,?" Phonb� b sp, F�,el E'Iec. in""p" 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (,Onsirucfion Tax: F .A�hnin.4vrafh,,e fate: 0 is Work Without Permit? 0 Yes (j) No $0.00 Advanced Plannin g Fee: $0.00 Select a Non-Residential • Building or Structure 0 Dwve , 1.Docuniewarion Fees: Strong Motion Fee: IBSEISMICO yw ... ..... .. . .. M F 4., 1=4 Plan Check Fee: $2,160.12 Me,c,h. 1,1c"Vi C, �1171147 1�ian Chee!', Dec" Alan Cl�eck i, tee: plumb, F C: Elec, Perl�.�if $0.00 0"he'r fl=slx LIM1,14, _hlv 10711.,,?" Phonb� b sp, F�,el E'Iec. in""p" NUPE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School DRtript- -tr- )- Thov,, foot arp havoil a" tho nrolimi""ry i"Mrm"iin" myyil"hlo "Yyd "ro n"Iv "" ovdm"io f'n "Mrf th, A—f fA, "d.4.11 info FEE ITEMS (Fee Resolution 11-053 Eff'711113 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,160.12 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: (•) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,408.32_ Suppl. Insp. Fee. (E) Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (,Onsirucfion Tax: F .A�hnin.4vrafh,,e fate: 0 is Work Without Permit? 0 Yes (j) No $0.00 Advanced Plannin g Fee: $0.00 Select a Non-Residential • Building or Structure 0 Dwve , 1.Docuniewarion Fees: Strong Motion Fee: IBSEISMICO $7.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 P 1" $3,576.44 $0,001 $3,576.44 Revised: 10/0112015