12020059CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20380 STEVENS CREEK BLVD
CONTRACTOR: CORNERSTONE SELECT PERNHT NO: 12020059
BUILDERS
OWNER'S NAME: CUPERTiNO CITY CENTER APARTMENTS 11
3490 UNION ST STE B DATE ISSUED: 03/14/2012
OWNER'S PHONE: 5106779855
FRENIONI', CA 94538 PHONE NO: (510)490-791 t
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG' ELECT PLUMB
License Class ) _ Lic.# 910
MECH RESIDENTIAL � COMMERCIAL �
t �
( Date --27z^ 1
Contractor G E!n0_g ; �t
JOB DESCRIPTION: APT COMPLEX -UNITS 109,I15,206,305,307,309,314,406,
I hereby affirm that I am licensed under the provisions of Chapter 9
414,501,509,513 RE- MODEL KiTCHEN(70SQFT) AND
(commencing with Section 7000) of Division 3 of the Business & Professions
BATH(40SQFT)REMODEI,,ADD A/C AND WASHER/DRYER
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.
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
Sq. Ft Floor Area: Valuation: $136000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 36901026.00 Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18,
Issued by: Date: f
Date '—(— 2 7— / Z
Signature
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
first an inspection, I agree to remove all new materials for
the following two reasons:
installed without obtaining
i, as owner of the property, or my employees with wages as their sole compensation,
inspection,
do the work, and the structure is not intended or offered for sale (Sec.7044'
will
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALI, ROOF COVERINGS TO BE CLASS "A" OR BEYI'ER
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS NIATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
for by Section 3700 of t he Labor Code, for the
I have read the hazardous materials requirements under Chapter of the
Compensation, as provided
performance of the work for which this permit is issued.
4.91
California Health &Safety Code, Sections 25505, 25533, and 2553. I will maintain
the Cupertino Municipal Code, Chapter 9.12 and the health &
I have and will maintain Worker's Compensation insurance, as provided for by
with
compliance wit
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should i use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, 1 shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 2.5534.
Compensation laws of California. If, after making this certificate of exemption, I
of the Labor Code, i must
Own r autlt,o I end , ent:
7
become subject to the Worker's Compensation provisions
; Date: (°
forthwith comply with such provisions or this permit shall be deemed revoked.
,�
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
affirm that there is a construction lending agency for the performance of work's
i hereby a
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9 18
Signature Date
Licensed Professional
CITY OF CUT TIC
17, A---C
FEE ESTIMATOR BUILDING DIVISION
1.10i ;
ADDRESS:')6- C'14C—
DATE: 02/14/2012
REVIEWED BY: bobs.
a �
jj'ffiL
APN: G
BP#:
'VALUATION: $136,000
PLANCtIEC1,
*PERNUT TYPE: Building Permit PLAN CHECK TYPE:
It
Alteration Repair
PRIMARY Multi -Family Dwelling
s
Buildinca is 0,
: Stories 0 yes (2) No
>3 Stories
PENTAMATtON
1 R2REM
PERMIT TYPE:
USE:
bath r(
R�-2qom �Iex kitchen and bath remodel and A/C, W/D hook-up.
�wVoRx_
SCOPE
NOTE. This estimate does "Of 111<7111aeJe"s title lu ""' --F ... ...
These ees are based on the relindnar, in 1-nultion available and are oul an estintaie.- Contact the DMLO gtt tit O.
➢istrdct, etc..
FEE ITEMS (Fee Rsoliefloi� 11-053 fff 711/111
FEE
QTY/FEE
MISC ITEMS
$0.00
70 s.f.
Remodel, Kitchen (<�--300 sf)
Plan Check Fee:
Suppt. PC Fee: (j) Reg, 0 OT
0.0
hrs
$0.00
$588.00
IREMRESKJT
PME Plan Check:
$0.00
40
S-f.
Remodel, Bath (<--300 sf)
Permit Fee: Hourly Only? Q Yes 0 No
$0.00
$588.00
1REMRESBAT
V1
Suppl, Ins.o. Fee.e Reg. 0 OT
0.0
hrs
$0.00
1 #
Meehanicat
nal"c"'
PME Unit Fee:
$0.00
$65.001 IBREMAIR
Z�
A/C Units (<--tOK efin)
PME Permit Fee:
$44.00
1 #
Mechanical
$65.00
IBAPPLOT
Other Appliance/Equip
Administrative Fee:
JADMIN
Work Without Permit?
0 Yes G No
L�_dv�!mne_(Jpkak_ll L1w_E-1L
Travel Documentation Fee:
]TRAVD0C
S I 1; ivi 01 _io 11 EOeL
S CotymCission Fee:
IBSEIS-AlflCR
IBCBSC
SUBTOTALS:
$0.00 1 1
$0.00 F--2-2-] flours Inspections
$44.00 =,$2,86�OLOO ISTINSP inspection, Hourly
(tiq 60 Select an Administrative Item
$6.00
$148.60 $4,166.00
1 0