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13100108CI*Y OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10805 N WOLFE RD CONTRACTOR: ROBERTS MANAGING PERMIT NO: 13100108 CONTRACTORS INC OWNER'S NAME: CUPERTINO VILLAGE LP 5045 E MCKINLEY AVE DATE ISSUED: 10/21/2014 OWNER'S PHONE: 6507467504 FRESNO, CA 93727 PHONE NO: (559) 252-6000 LICENSED CONTRACTOR'S DE LARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL E] RETAIL B- CONSTRUCT SHELL BUILDING 8,232 SQ FT License Class_ Lie. #�- ContractorDate I hereby affirm that I am licensed un:,r the provisi ns 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 llowing two declarations: I have and will maintain a certificate of consent to self- nsure 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. 4 have and will maintain Worker's Compensation Insur mce, as provided for by Section 3700 of the Labor Code, for the performance o the work for which this permit is issued. APPLICANT CERTIFICAION I certify that I have read this application and state that t e above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize represen atives of this city to enter upon the above mentioned property for inspection pure ses. (We) agree to save indemnify and keep harmless the City of Cupertino ago inst liabilities, judgments, costs, and expenses.4vkich may accrue against said Ci in consequence of the granting of this rmit. dition ally, the applicant understands and will comply with all non -point so a reg per the C rtino Municipal Code, Section 9.18. 7 Signature Date " ❑ O NER-BUILDER DECLARATI N I hereby affirm that I am exempt from the Contrac or's License Law for one of the following two reasons: i, as owner of the property, or my employees with wag s as their sole compensation, will do the work, and the structure is not intended or o ered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Profession Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to sel -insure for Worker's Compensation, as provided for by Section 3700 of the abor Code, for the performance of the work for which this permit is issue . I have and will maintain Worker's Compensation Insu ance, as provided for by Section 3700 of the Labor Code, for the performance the work for which this permit is issued. I certify that in the performance of the work for which is permit is issued, I shall not employ any person in any manner so as to become ubject to the Worker's Compensation laws of California. If, after making thi certificate of exemption, I become subject to the Worker's Compensation provisi ns of the Labor Code, I must forthwith comply with such provisions or this permits iall be deemed revoked. APPLICANT CERTIFICA ION I certify that I have read this application and state that he above information is correct. I agree to comply with all city and county ord' iances and state laws relating to building construction, and hereby authorize represer tatives of this city to enter upon the above mentioned property for inspection purl oses. (We) agree to save indemnify and keep harmless the City of Cupertino ag tinst liabilities, judgments, costs, and expenses which may accrue against said Cit V in consequence of the granting of this permit. Additionally, the applicant un rstands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature ate Sq. Ft Floor Area: Valuation: $1293000 APN Number: 31605056.10805 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS T ISSUANCE OR 180 DAYS F AST LED INSPECTION. Date: UJ2L J 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: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay rear Quality Management District I will maintain compliance with the C e o Municipal de, Chapter 9.12 and the Health & Safety Code, Section 55 33 and 34. 4 Owner or authorized agent: Date:9;?l%, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name — Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO L`T T V CTiM A TnlQ — RI III ,DING DIVISION OCCUPANCY TYPE: 1' L'LJJ lJ1J a a1. as � a v ADDRESS: 10869 N Wolfe Rd - DATE: 10/15/2013 REVIEWED BY: Mendez PC FEE ID APN: BP#; 3 I *VALUATION: $1,293,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? ©Yes No PENTAMATION 1 SHELLBLDG PERMIT TYPE: WORK Retail b- construct shell building 8,232 sq ft SCOPE 0,0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID Shell Bldgs II-8,111-B,1V,v-B 8,232 $9,282.56 IOSPLNCK $8,395.51 IOSINSP Permit Fee: S D' tr' t Schoo[ Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $23,214.24 ,1 dininistrative Fee: E) Work Without Permit? 0 Yes No $0.00 TOTALS: 8,232 $9,282.56 /rat 1>octunen/utj/777TCPA': $8,395.51 - Strong Motion Fee: 1BSEISMICO NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Ftre, Sanitary ewer es rc , .._ _ _ _r..__:..,._.:..s;......s:..., .. ..:/..6/o n..d .re nn/v nn v.V --imat0_ Contact the Dept for addn'l info. District, eta). inese fees are aasea un Inc reunu..u. FEE ITEMS (Fee Resolution 11-053 Eff. 7111132 " Mon ('i"El . -.•- -. QTY/FEE .�..,. Plan Check Fee: $9,282.56 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: S D' tr' t Schoo[ NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Ftre, Sanitary ewer es rc , .._ _ _ _r..__:..,._.:..s;......s:..., .. ..:/..6/o n..d .re nn/v nn v.V --imat0_ Contact the Dept for addn'l info. District, eta). inese fees are aasea un Inc reunu..u. FEE ITEMS (Fee Resolution 11-053 Eff. 7111132 .,• �.,,•..•• ,.......» FEE . -.•- -. QTY/FEE .__ _-- ---- -- - MISC ITEMS Plan Check Fee: $9,282.56 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $8,395.51 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $23,214.24 ,1 dininistrative Fee: E) Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: 1PLLoNGC $2,304.96 Select a Non -Residential Building or Structure L I /rat 1>octunen/utj/777TCPA': - Strong Motion Fee: 1BSEISMICO $271.53 Select an Administrative Item Bldg Stds Commission Fee: 1RCBSC $52.00 SUBTOTALS: V43,520.801 $0.00 TOTAL FEE: $43,520.80 Revised: 10/01/2013 LL CI Y OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10805 N WOLFE RD CONTRACTOR: ROBERTS MANAGING PERMIT NO: 13100108 CONTRACTORS INC OWNER'S NAME: CUPERTINO VILLAGE LP 5045 E MCKINLEY AVE DATE ISSUED: 10/21/2014 OWNER'S PHONE: 6507467504 FRESNO, CA 93727 PHONE NO: (559) 252-6000 CY LICENSED CONTRACTOR'S DEC ION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] RETAIL B- CONSTRUCT SHELL BUILDING 8,232 SQ FT License Class Lic. # 44Z INCLUDES UTILITIES/SITE WORK ON PLANS. DEF # 1- TRUSSES - ISSUED 4/29/15 _ Contractor ate DEF # 2 - METAL STUD SYSTEM ISSUED 4/29/15 I hereby affir 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: $1293000 performance of the work for which this permit is issulance, I have and will maintain Worker's Compensation Ins as provided for by ection 3700 of the Labor Code, for the performancethe work for which this APN Number: 31605056.10805 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that he above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordi iances and state laws relating WITHIN 180 DAYS IT ISSUANCE OR to building construction, and hereby authorize represei tatives of this city to enter upon the above mentioned property for inspection purl ses. (We) agree to save 180 DAY LLED INSPECTION. indemnify and keep harmless the City of Cupertino ag 'nst liabilities, judgments, costs, and expenses ykisb may accrue against said City in consequence of the Date: Z granting of this p it. ditionally, the applicant understands and will comply - with all non -poi sour c regulat' er the Cup rt ino Municipal Code, Section too 9.18. RE -ROOFS: Signature r Iate 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. ❑ O EIt-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 wags as their sole compensation, will do the work, and the structure is not intended oro ered 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 & Profession Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the llowing 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 sell' -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 B a Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the aper no ipal o e, Chapter 9.12 and I have and will maintain Worker's Compensation Insur ince, as provided for by the Health & Safety Code, Sectio s 255 533, d 2 4. Section 3700 of the Labor Code, for the performance o the work for which this Owner or authorized agent: Dater 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 (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICAT,�ON 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 represen tives of this city to enter upon the above mentioned property for inspection pure ses. (We) agree to save indemnify and keep harmless the City of Cupertino aga nst liabilities, judgments, ARCHITECT'S DECLARATION 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 X1 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 16iADDRESS: 10805 N WOLFE RD DATE: 04/10/2015 REVIEWED BY: MELISSA i APN: 316 05 052.10869 BP#: 13100108 `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial BuildingCivil USE: / Religious activities in BQ zone? O Yes Q No PENTAMATION 1 GENCOM PERMIT TYPE: WORK BLDG B - DEFERRED # 1 FOR TRUSS SYSTEMS SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Fire, sanitary sewer District, acnoot n:�..:. e.,. Thorn fooe oro hncod nn tho nroliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1'13) FEE %lUt7�. �iL1Y1 (�%le'CL MISC ITEMS Plan Check Fee: $0.00 ,.-rrC.`7' Plumb /rrs�=Li Deferred Submittal IDEFSUBM Suppl. PC Fee: O Reg. O OT 0.0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Fire, sanitary sewer District, acnoot n:�..:. e.,. Thorn fooe oro hncod nn tho nroliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: O Reg. O 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 Construction Tax: IBCONSTAXC $0.00 (.. "PI ;�i O 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure (F) Strong Motion Fee: $0.00 Select an Administrative Item BldgStds Commission Fee: $0.00 SUB OTALS: $0.00 $286.00 TOTAL FEE: $286.00 Revised: 04/01/2015 ,��,��� CITY OF CUPERTINO 1�1'"'�Gll�l FF.F. FQTIMATOR — RIIII,DING DIVISION im,ADDRESS: 10805 N WOLFE RD DATE: 04/10/2015 REVIEWED BY: MELISSA APN: 316 05 052.10869 BP#: 13100108 "VALUATION: Iso xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial BuildingCivil USE: / Religious activities in BQ zone? 0 Yes (F) No PENTAMATION 1GENCOM PERMIT TYPE: WORK BLDG B - DEFERRED # 2 FOR METAL STUD SYSTEMS SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pere, 3anitaly Sewer tnstrect, 3enoot LCantart tho Dont for addn'l info. FEE ITEMS (Fee Resolution 11-053 a.' 7,'1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $286.00 Deferred Submittal IOEFSUBNr Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 1 1 0 0 Work Without Permit? © Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure O 0 Stronp, Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee:$0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE: F $286.00 Revised: 04/01/2015 CITY OF CUPERTINO WNW FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10815 N Wolfe Rd la FEE DATE: 10/28/2015 REVIEWED BY: PAUL APN: 316 05 056 BP#: "VALUATION: Iso *PERMIT TYPE: Building Permit 0.0 PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1GENRE PERMIT TYPE: WORK Revision #1 - RFI's and As Builts - Reference Permit #13100109 Retail A & #13100108 Retail B SCOPE Suppl. Insp. Fee.0 Reg. Q OT 0.0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrict_ otr_ )_ Thoco fooc aro hawd an tho nroliminary information availahlo and are only an estimate_ Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E : 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 10 hours Plan Check, Hourly $1,430.00 1STPLNCK Suppl. PC Fee: Q Reg. () 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 =.('it?it'£ft:(fC3f1 ttf.'i: E) Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Q Building or Structure Strong Motion Fee: $0.00 Select an Administrative Item 1 Bldg Stds Commission Fee: $0.001 SUB OTALS: $0.001$1,430.00 TOTAL FEE: $1,430.00 Revised: 10/01/2015 Ti CCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10805 N WOLFE RD CONTRACTOR: ROBERTS MANAGING PERMIT NO: 13100108 CONTRACTORS INC OWNER'S NAME: CUPERTINO VILLAGE LP 5045 E MCKINLEY AVE DATE ISSUED: 10/21/2014 OWNER'S PHONE: 6507467504 FRESNO, CA 93727 PHONE NO: (559) 252-6000 IL7 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL RETAIL B- CONSTRUCT SHELL BUILDING 8,232 SQ FT License Class Lic. # INCLUDES UTILITIES/SITE WORK ON PLANS. DEF # 1- TRUSSES - ISSUED 4/29/15 Contractor Date DEF # 2 - METAL STUD SYSTEM ISSUED 4/29/15 1 hereby affirm that I am licensed under the provish ins 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 theollowing 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 issue . Sq. Ft Floor Area: Valuation: $1293000 have and will maintain Worker's Compensation Insur ince, as provided for by Section 3700 of the Labor Code, for the performance o the work for which this APN Number: 31605056.10805 Occupancy Type: permit is issued. APPLICANT CERTIFICA ON I certify that I have read this application and state that ie 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 WITHIN 180 DAY RMIT ISSUANCE OR to building construction, and hereby authorize represen atives of this city to enter upon the above mentioned property for inspection pure ses. (We) agree to save 180 DAYS CALLED INSPECTION. indemnify and keep harmless the City of Cupertino age nst liabilities, judgments, costs, and expenses which may accrue against said Cit3 in consequence of the Date: Z granting of this pe dditionally, the applicant and rstands and will comply with all non -point ou regulations per the pertino Aunicipal Code, Section 9.18. 4e- RE -ROOFS: Signature ate 4 2� /J! 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: 1 hereby affirm that I am exempt from the Contract is 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 wags as their sole compensation, will do the work, and the structure is not intended oro ered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting ith licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Profession Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 ea Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the upe ino Mmincipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio s 25 533 and 2 4. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which is permit is issued, I shall not employ any person in any manner so as to become E ubject to the Worker's Compensation laws of California. If, after making this rtificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisio is 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 A Al be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICAT ON Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordiriances and state laws relating to building construction, and hereby authorize represen Ives of this city to enter upon the above mentioned property for inspection pure ses. (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 undcrstands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature E ate