12070016CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON CONSTRUCTION PERMIT NO: 12070016
OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT 19608 PRUNER[DGE AVE APT 5104 DATE ISSUED: 08/07/2.012
OWNER'S PHONE: CUPERTINO, CA 95014 PHONE NO: (949) 429-6740
El LICENSED CONTRACTOR'S DECLARATION
G BUILDING PERMIT INFO: BLDG ELECT r— PLUMB r
License Class Lie. #
Contractor %rt1-im✓ wl-sra r,-�ate 2
I hereby affirm that l am licensed under the provisions of Chapter 9
(commencing with Scction 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.
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
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this applieation and state that the above information is
correct. 1 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 Iiabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
grantingXnon-oi
. Additionally, the applieant understands and will comply
with all u a regulationspe Cupertino Municipal Code, Section
9.18.
Signatuate %
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt From the Contractor's Lieense Law for one 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 (See.7044, Business & Professions Code).
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 Sectiou 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
eorrect. I agree to eomply 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
MECH F_ RESIDENTIAL r— COMMERCIAL f—
JOB DESCRIPTION: TEMPORARY OFFICE CONSTRUCTION TRAILER
Sq. Ft Floor Area: I Valuation: $15000
APN Number: 31620037.00 1 Occupaney Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: _ E- r✓ gate:
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
f have read the hazardous materials requirements under Chapter 6.95 of the
California IIealth & Safety Code, See [ion s 25505, 25533, and 25534. [ will maintain
compliance with the Cupertino Municipal Code, Chapter9.12 and the Health &
Safety Code, Section 25S32(a) should I store or handle hazardous material.
Additionally, should l nse equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management Distriet I will
maintain compliance with the Cupertino Munieipal Code, Chapter 9.12 and the
Ilealth & a ety Code, S ions 25505, 25533, and 25534.
O r author'
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a eonstruction lending agency for the performance of uork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Ad
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
0, FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 19800 Vallco Parkway
DATE: 07/03/2012
REVIEWED BY: Sean
APN:
BP##:
`VALUATION: 1$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
USE: Commercial Building
Civil 1 Religious activities
in BQ zone?Q Yes • � No
PENTAMATION
PERMIT TYPE: �
WORK
Installation of a tem ora office during construction.
SCOPE
Mach, Plan Check
Phrrnh, Plan Ck-ek
Elec. Plan Chock
rLfech. Permil C'c>Es:
Plumb, fermi! ree:
Flec. Permit Pce:
Other Much, !rasp.
Odic)- Plumb Insp.
Udrer Eke. Insp.
Ale:rh, lash, rec:
Phouh, lash. Fee:
F.lec. Imp. Fee:
NOTE: This estimate does not include fees clue to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0,00
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: +D Reg. O OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp, Feefl Reg. Q OT
070
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTRXC
$0.00
Administrative Fee:
�
Work Without Permit? Yes (j) No
$0,00
Advanced Planning Tee:
$0.00
0 #
$799.00
Modular Structures
IMODUSTRU
t
Travel Dvctrtnentution Fees:
Strong Motion Fee: IBSEISMICO
$3.15
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $4.15
$799.00
TOTAL FEE:
$803.15
Revised: 07/01/2012