13010058I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10477 S DE ANZA BLVD
OWNER'S NAME: BDC HAYWARD L.P.
OWNER'S PHONE: 9255882225
LICENSED CONTRACTOR'S DECLARATION
License Class '� Lic. # }(2 2 Z S
Co .v,E R N
Contractor4LAQo N L. Date Z 6
Cr N-j / N
I hereby a irm that am licensed finder the provisions of C pter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
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
permit is issued.
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.r ions per the Cupertino Municipal Code, Section
9.18.. l7 _ 17 %) ,
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License 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)
I, 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, 1
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 1 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.
CONTRACTOR: CORNERSTONE PERMIT NO: 13010058
ENVIRONMENTAL
3527 MT DIABLO BLVD DATE ISSUED: 02/26/2013
LAFAYETTE, CA 94549 PHONE NO: (925)299-9225
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
INSTALL VAPOR EXTRACTION TREATMENT SYSTEM,
PANEL
UPGRADE 100 AMP
Sq. Ft Floor Area: Valuation: $63000
APN Number: 35917019.10477 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA OM LAST CALLED IN SPE TION.
Issued by: Kid Date: �.
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
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. '1 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 9.11 and
the Health & Safety Code, Sections 255g55533, and 255J4.
Owner or authorized agent: / Date:Z Z (.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10477 S DE ANZA BLVD DATE: 01/09/2013 REVIEWED BY: MENDEZ
APN: I BP#: O "VALUATION: $63,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION
USE: PERMIT TYPE:
WORK INSTALL VAPOR EXTRACTION TREATMENT SYSTEM
SCOPE
10EAP2
Xlf ch. flan Check
Phunb. Plan Check
Elec. Plan Check 0.0 hrs $0.00
Nreci'l. Permit Fee:
Plumb, Permit Fie.
Elec. Permit Fee: IEPERMIT
Other Mech, Imp.
Ocher Plumb Insp.
Other Elea Insp. 0.0 hrs $45.00
Hech. Insp. Fee:
Phvnb, h;sp. 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). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Elf. 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
1 007 amps
$45.00
Electrical
1ECT<200 Services
.Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee:
IADMIN
$42.00
0
O
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
1 hours
$133.00
Plan Check, Hourly
ISTPLNCK
0
0
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee:
IBSEISMICO
$13.23
= hrs
$266.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$148.23
$444.00
TOTAL FEE,:
$592.23
Revised: 10/01/2012