14060169 CITY OF (CUP ERTINO BUILDING PERMIT
BUILDING ADDRESS: 20833 STEVENS CREEK BLVD CONTRACTOR:DEVCON PERMIT NO: 14060169
CONSTRUCTION INC
OWNER'S NAME: STEVENS CREEK OFFICE CENTER ASSOC 690 GIBRALTAR DR DATE ISSUED:06/26/2014
OWNER'S PHONE: 7078884307 MILPITAS,CA 95035 PHONE NO:(408)942-8200
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
C11
l_ APPLE T.I.TO DEMO& AIT WALLS&DOORS TO
License ClassgyII
_ Lic.# 39 _y3 / INCREASE
Contractor
1. J?�'(-U� Date z6h LAD SIZE FOR 2 LOCATIONS
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:$100000
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:32632053.00 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 WITHIN 180 DAYS OFISSUANCE ®�
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 E ASS' ED 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:
with all non-point source regulations per Cupertino Municipal Code,Sectio
9.18.
Signatu a Date / ;ltAll roofs shall be inspected pri 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
I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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. 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 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, i s25505, 533,a 5534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized a ent Date: w
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 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 cCUP EIf RANO
FEE ESTIMATOR— BUILDING DIVISION
r- ADDRESS: 20833 STEVENS CREEK BLVD DATE: 06/26/2014 REVIEWED BY: MELISSA
APN: 326 32 053 BP#: / �7O�lp `VALUATION: 1$100,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
___7PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B Th
WORK APPLE T.I. TO DEMO & ADD WALLS & DOORS TO INCREASE LAB SIZE FOR 2 LOCATIONS
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE IID BP FEES BP FEE IID
CONSTR. s.f.
B (Tenant Improvements) II-B,111-B,IV,V-B 1,726 $2,140.12 IBTIPLNCK $1,601.91 IBTIINSP
TOTALS: 1,726 $2,140.12 $1,601.91
MIIEC>1•Il,HOURLY 0 Yes (D No FLUM[1B,HOURLY 0 Yes E) No IELIEC,HOURLY Q Yes O No
Alec. i'lan Check
i. i ''ihf.c ,. l'ii%1, Re,l Y7lI l'Ce /',/ec l'trwif Fee,.
Lj1 01`110'1!h'cJna7>.
h1q, 1._("
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . TheseLees are based on the relimina information available and are onl an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7i11Q FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,140.12 Select a Misc Bldg/Structure
Suppl. PC Fee: (D Reg. 0 OT Q.Q hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,601.91
Suppl. Insp. Feer Reg. C OT Q Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
CIC'/i 0;1 1 Ll.i.
_F_T
Work Without Permit? 0 Yes ) No $0.00 E)
Advanced PlanninL Fee: $0.00 Select a Non-Residential
Building or Structure
d
Strong;Motion Fee: IBSEISMICO $21.00 Select an Administrative Item
Bldp,Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $3,767.03 $0.00 TOTAL FEE: f $3,767.03
Revised: 04/01/2014