1308014801
MY OF (CUP ERTff G BBI LE INN P Ell MRT
BUILDING ADDRESS: 20380 STEVENS CREEK BLVD
CONTRACTOR: CORNERSTONE SELECT PERMIT NO: 13080148
BUILDERS
OWNER'S NAME: CUPERTINO CITY CENTER APARTMENTS 11
3490 UNION ST STE B DATE ISSUED: 10/11/2013
OWNER'S PHONE: 6509313400
FREMONT, CA 94538 PHONE NO: (510)490-7911
❑ LICENSED CONTRACTOR'S ➢DECLARATION
JOB (DESCRIPTION: RESIIDENTIAIL. COMMERCIAL
License Class_ Lic. # 19 8
TENANT IMPROVEMENT EMIENT DIE'' 1C' X]ISTIING FITNESS AREA
(1659
Contractor
SQ ]FT.
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.
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
APN Number: 36901026.00
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
� �� ��� ���� ®�, IP���,II, ISSUANCE ®�
WITHIN
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 IF AIL.lL1ED 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
granting of this permit. Additionally, the applicant understands and will comply
Date: f` a / /
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature a Date /o —//r/ 3
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)
I, 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. 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(x) 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
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
I
Owner or authorized agent: Date: 1,6
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, [
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
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
CITY OF CUPERTI NO
IM -7 FEE ESTIMATOR - BUILDING DI` ESION
imADDRESS:
20380 STEVENS CREEK BLVD
DATE: 08120/2093
REVIEWED BY: MELISSA
PC =IDBP
APN: 369 01 026
DP#: 8D
"VALUATION:
1$25,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
PENTAMATION
PERMIT TYPE: 1A TI
WORK
REMODEL E FITNESS AREA & RELOCATE E HVAC ROOM & PROVIDE N BIKE
SCOPE
REPAIR/STORAGE ROOM. INCLUDE MISC M.E.P.'S
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.ff.
PC (FEES
PC =IDBP
PEES
]3P FEE ID
A (Tenant Improvements)
I-A,I-B
1,572
$3,608.74
]ATIPLNCK
$1,526.42
1ATIINSP
Elec. 1n.sp, Fee:
$0.00
PME Unit Feer
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Atlininistratl ve .1' e. e:
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure
d
!ravel Doculnentation Fees:
TOTALS:
1,572
$3,608.74
Select an Administrative Item
$1,526.42
$1.00
MECH, HOURLY. 0 Yes E) No
PLUMB, HOURLY Yes ( No
ELEC, HOURLY 0 Yes 0 No
Lfer.%. Plan Cfeer_k
ch. Plan Check7
Plumb, Plan Check
Elec..Plon Cheek
ivfech. Permil Free:
Plumh. Permit Fee:
r,-,,,. Permit Fee:
Other Mech. Ins).
Otlrer Plumb Imp.
Other Elec. lnsp. C
,Woch. Insp.1'ee:
Plumb. hzsp. I'ee:
Elec. 1n.sp, Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. 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 Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,608.74
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,526.42
Suppl. Insp. Fee:Q Reg. 8 OT EQjhrs
$0.00
PME Unit Feer
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Atlininistratl ve .1' e. e:
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure
d
!ravel Doculnentation Fees:
Strong Motion Fee: 1BSEISMICO
$5.25
Select an Administrative Item
Bldg_Stds Commission Fee: 1BCBEC
$1.00
SUBTOTALS:
$5,141.41
$0.00
TOTAL FEE: $5,141.41
Revised: 07/01/2013