13070140 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR:GIDEL AND KOCAL PERMIT NO:13070140
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 574 DIVISION ST DATE ISSUED:07/23/2013
OWNER'S PHONE: 4088730121 CAMPBELL,CA 95008 PHONE NO:(408)370-0287
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL[] COMMERCIALE]
License Class Lie.# / �C' ' CU CRC HEALTH-6TH FLOOR- COMM.T.I 405 SQ FT TO
INCLUDE NON-STRUCTURAL WALL,MINOR
Contractor ����2�I�i Cc s� °��`�` ' Date i'71*11 3 MODIFICATIONS
I hereby affirm that I am licensed under the provisions of dapter 9 TO EXISTING CELING LIGHTING,ELECTRICAL,
(commencing with Section 7000)of Division 3 of the Business&Professions FINISHES
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:$7000
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:36901028.00 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 80 DAYS OF 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 180 DA F OM LAST CALLED 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 Issued b Date: °
granting of this permit. Additionally,the applicant understands and will comply y:
with all non-point source regulations per the Cupertino Municipal Code,Section
LZ
9.18.
RE-ROOFS:
Date All roofs shall be inspected prior to an roofing material being installed.If a roof is
Signature p p y g g
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
171 ".1. 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(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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized age s', Date:
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 '-'CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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
i
9.18.
Signature Date
W�, ADDRESS:
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
20400 SCB DATE: 07/23/2013 REVIEWEDBY: Mendez
PN: BP#: /1 *VALUATION: 1$7,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B TA
WORK CRC Health-6th floor- comm. t.i 405 sq ft to include non-structural wall minor modifications to existing
SCOPE celing lighting, electrical, finishes
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY 0 Yes G No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY ® Yes E)No
Xfo:-h, 1'kan Ogeek Plrutrb, Plcrrr Check Dec%Plata Choc%
iilech. Porn/Pec: Plumb, Permit Fee: l;lec. Pe:nnit ree:
(31her AA,ch, hasp. EIF-t- 07hei-phimh Insp. 0/her Elec,Imp.
9Lech, hrsp.Fr:e: I'hmah. fiasp. Fee: Elec.lnsp,P'r:e:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sever District,School
District,etc. . These.fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check,Hourly
Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $417.00 1STPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp.Feer Reg. OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
COIISIPHC1101-1 F71
-4dininistrative.Fee: 0
Work Without Permit? 0 Yes 0 No $0.00 E)
Advanced Planning Fee: $0.00 0 hours Inspections E)
T r ovel DoellMentcrtion I<U Se $695.00 ISTINSP Inspection,Hourly
Strong Motion Fee: IBSEISMICo $1.47 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $2.471$1,112.001 TOTAL FEE: $1,114.47
Revised: 07/01/2013