13050068 CITY OF 1CU PIERTIINO BIIJIDLIlD NG PERMIT
BUILDING ADDRESS: 16 RESULTS WAY CONTRACTOR:XL CONSTRUCTION PERMIT NO: 13050068
OWNER'S NAME: ECI TWO RESULTS LLC 851 BUCKEYE CT DATE ISSUED:08/27/2013
OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class 43 Lic.# [o y l qgO EXTERIOR PATIO DEMOLITION,GRADING,
/ / CONSTRUCTIONContractor 1CL l—rivc s�ler� Date TO CREATE AN OUTDOOR BASKETBALL COURT&
I hereby affirm that I am licensed under the provisions of Chapter 9 PATIO.
(commencing with Section 7000)of Division 3 of the Business&Professions REMOVAL OF RETAINING WALLS,SLAB AND TREES,
Code and that my license is in full force and effect.
T 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:$250000
1 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:35720042.16 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
ED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN IlS®DABS®� PERMIT ISSUANCE OR
building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAA M(LAST CALLED IINS PlE �'ON.
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 Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature -7zDate to 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 DECLARA'T'ION
I hereby affirm that I 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
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. 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
I 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 4/ Z
Owner or authorized agent: /,/4� t l Date:
permit is issued.
1 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,1 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
indemnify and keep harmless the City of Cupertino against 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
MY OF SCUP ERTffNO
FEE IESTMATOR- BUff LADING DIVISION
E27kADDRESS: 98 RE$ULT$WAYDATE: 05/08/2093 REVIEWEDBY: MENDEZ
PN: BP#: *VALUATION: $250,000
*PERMIIT TYPE: Building Permit P1LAN CIIIIECK TYPE: Tenant Improvement
PRIMARY 1PIENTAMATIION
USE: PERMIT Building PERMIT TYPE: 1A T®
WORK EXTERIOR PATIO DEMOLITION GRADING CONSTRUCTION TO CREATE AN OUTDOOR
SCOPE BASKETBALL COURT& PATIO. REMOVAL OF RETAINING WALLS, SLAB AND TREES, ADDITIOI3
OCCUPANCY TYPE: TYPE OF F1LR AREA PC FEES PC FEE IID BP FEES BP FEE IID
CONSTR. s.f.
A(Tenant Improvements) II-B,111-B,IV,V-B 4,010 $2,485.08 IATIPLNCK $2,042.72 1ATIIIVSP
TOTALS: 4,010 1 $2,485.08 $2,042.72
MECI3,HOURLY Yes No PLUMB,HOURLY ® Yes (F) No ELEC,HOURLY Q Yes .Q No
Xfech. Plon Check Plumb. Plun Check Elec.Plan Check
ibfeclt. Permit Fee: Plumb. Permit Fee: Flec. Permit Fee:
Other.lfech. Insp. C Other Plumb Insp. Other Elec.Insp. ELI
;llcch.Insp.Fee. Plumh. lisp.Fee: Elec.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the preliminaaigLormation available and are on! an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 711112) FEE QTY/FEE MIISC ITEMS
Plan Check Fee: $2,485.08 Select a Misc Bldg/Structure
Suppl. PC Fee: E) Reg. 0 OT L0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $2,042.72
Suppl. Insp. Fee-.0 Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee:. $0.00
PME Permit Fee: $0.00
Conswuction .Tax:
Administrative Fee: Q
Work Without Permit? 0 Yes E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential O
Travel Documentarion Fees: Building or Structure. O
Strong Motion Fee: 1BSEISMICO $52.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $10.00
SUBTOTALS: $4,590.30 $0.00 TOTAL FEE: $4,590.30
Revised: 04/29/2013