12010094CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: [6RESULTS WAY CONTRACTOR: XL CONSTRUCTION PERMIT NO: 12010094
OWNER'S NAME: ECI TWO RESULTS LLC 851 BUCKEYE CT DATE ISSUED: 01/12/2012
OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408) 240-6000
LICENSED CONTRACTOB'S_DECLARATION-
License Class_ Liic..� # D
Contractor 41'�f q/t.W�-.. Date '1
I hereby affirm that I am licensed under the provisions Ch pter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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.
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
permit is issued.
APPLICANT CERTIFICATION
I certifv 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
indemnity 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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER -BUILD DECL TION
I hereby affirm that I am exempt from the Contractor's License Law forone of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG ELECT 1 PLUMBS
MECH F RESIDENTIAL I COMMERCIAL r—
JOB DESCRIPTION: APPLE - COMMERCIAL TENANT IMPROVEMENT
PREP;NON-STRUCTURAL
7Z - /o?D/O/,�.
Sq. Ft Floor Area: I Valuation: $95000
APN Number: 35720041.1ip I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b
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(s) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
O ne • rued agent•
Dater
N RUCTION LENDING AGENCY
I hereby affirm that er ' a construction lending agency for the performance of Mrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Date
Licensed
W��,','�''''',,� CITY OF CUPERTINO
-W FEF, ESTIMATOR - BUILDING DIVISION
ADDRESS: 147results way
DATE: 01/1212012
REVIEWED BY: bobs.
PN:
Bi'#:
'VALUATION: 000
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
PENTAMATION 1TIPREP
PERMIT TYPE:
WORK
t.i. prep commercial offices ace non structural.
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer Distric4 School
nietriet_ etc ►_ Thoso fool aro hacod an tho nrolininaru infarimlinn availahln and aro nnly an octi►mnlo_ Cm2tart tho Dont far addn'l into.
FEE ITEMS (f'ee Resolution 11-053 E f 711/11,)
FEE
QTYXEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$380.00
Tenant Improvement Prep
ITIPREP
Suppl. PC Fee: Reg. ®OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.e Reg.
® OT
F0.0
r hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? C) Yes (D No
$0.00
Advanced Planning_ Fee:
$0.00
Select a Non -Residential
Building or Structure
Strong Motion Fee:
IBSEISAdICO
$19.951
Select an Administrative Item
MAP, Stds Co►x;mission Fee: IBCBSC
$4.00
SUBTOTALS:
$23.95
$380.00
TOTAL FEE:
$403.95
Revised: 1101 /2012