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11010156 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10105 S DE ANZA BLVD CONTRACTOR: PERMIT NO: 11010156 IDETERTIMED OWNER'S NAME: PONDEROSA ASSOC LLP 4�� VM DATE ISSUED:01/31/2011 VN 'S PHONE: 9254490077 , CU -T UC-1) 0 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lic.# (0ocyno�— RE-ROUTE UNDERGROUND WATER TO OVERHEAD OPEN WALL Contractor V t Date 3\ Z.t9�I IF NEED TO CAP UNDERGROUND I hereby affirm hat I am Ilicensed under the provisions of Chapter 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. Sq.Ft Floor Area: Valuation:$6000 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:35909017.00 Occupancy Type: permit is issued. wf?vcC_� 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 180 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 DAYS FROM 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. �nl� RE-ROOFS: Signature Date L n 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. J 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. 1 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 Cod , tions 255 , 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agen Date,�L5_41C,20 I 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 CONSTRUCTION LENDING AGENCY 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 ^demnify and keep harmless the City of Cupertino against liabilities,judgments, ,.is,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ,ranting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date - r } y fRAL Assessors Parcel Number: Name of business. `�,�r,�Y Project address. l O l O S S Z Contact person.�� tJ Phone. �'c� S R Fax. `Z Current use of space. C__� � 1� 0�,� G� Proposed use. - Building construction type. Occupancy Group(s) MOT, Occupancy Load. Square footage of remodeled area. Is the building equipped with: Fire sprinkles? �' Fire alarm system? Y-N Number of floors in the building? _ On what floor(s) is work being done? Brief description of work. V�tC) � -4V ('�r�►IMQxc.► �1 h\�� --`�u�t-�- � �T.s-�'� Qszd'`b3'cx�r.r Code editions:2008 CBC N)2008 CFC (Y -N)2008 CMC (Y-N) 2008 CPC N)2008 NEC (Y -N) Effective 1/1/08 Are there any chemicals/hazardous materials to be stored at site? Y If above answer is yes,provide a list of materials and qumati�A�,An CU VdTl I NE_ CITY of ('UrFRTINO COL,i AN)ORD:NAN(._:_ If job is involves food service,provide 3 extra plan sets foriMmIth_ Department review. SIGNE This set of plans and stions MUSTPw be kept on the lot)at all rn .s anct it is untawfui to maize any changes or alterations on same without written permission from the Building DePartment. City of Cupertino. The stamping of this plan and specifications HAL L NOT be held t; permit or to be an approval of the;✓c l;t' :>f -v provisions {t an !`U Commercial Plan Review Process Work BookPage-10-revised 1/1/08 ° 3 3 W U — W I ' aiMo CXL Y+ .✓ IFMOO o � n I d cn a V! o CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION R*PERMITTYPE: ADDRESS: 10105 s. de anza blvd DATE: 01/31/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $6,000 Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION SFD or Duplex USE: PERMIT TYPE: WORK reroute 60ft under round water line to overhead at commercial bldq to first floor restrooms. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1 # �G TOTALS: $11.00 lfcch. Plan('xt<: kPlumb.Plan Check 0.0 hrs $0.00 1-'lu Phan Chc,k vi 1,_ Peau c 1�>��: Plumb.Permit Fee: IPPERMIT c`;l<c Prmi"FA C1 rho-Akc h, Other Plumb Insp. 0.0 hrs $42.00 01h,"r ie< 1 m p, Wk"h. h.:l. Fc 1/Imih. b?"p. I: ]'/Cr Irtsr. FCC,. NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 09-05I E . 7/1/10) FEE QTY/FEE MISC ITEMS flan C hcch Fc,e: Sltppl. PC.'1=-12C PME Plan Check: $0.00 Permit f ec Supp/. hisp 1"ee PME Unit Fee: $11.00 PME Permit Fee: $42.00 C'011s0r11ctio7 ZC'I:y ,lcouslic"•al tic view 1'cV: Work Without Permit? 0 Yes 0 No $0.00 1'lannirz� Fees: Travel Documentation Fee: ITRA VDOC $42.00 Strong:Motion Fee: IBSEISMICR $0.60 Select an Administrative Iteem Bldg;Stds Commission Fee: IBCBSC $1.00 Ala SUBTOTALS: $96.60 $0.00 TOTAL FEE: 6�0 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 ELI] Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 10 p5 S � A,UZ-Ar -;�>l-J PERMIT# OWNER'S NAME:pbroos'&' PHONE# d `377' C�tD-2 7 GENERAL CONTRACTOR: ylt - BUSINESS LICENSE# ADDRESS:A9 MK 01 C ce- CITY/ZIPCODE: C S uV1c72� � *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 2 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 35909017. 00 DATE ISSUED. . . . . . . : 01/31/2011 RECEIPT #. . . . . . . . . BS000012610 REFERENCE ID # . . . : 11010156 SITE ADDRESS . . . . . : 10105 S DE ANZA BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PONDEROSA ASSOC LLP ADDRESS 10105 S DE ANZA BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DONALD COOPER CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 000 .00 1 . 00 0 .00 1. 00 0. 00 1BPREPIPE NO OF FIXTURE 1. 00 6 . 00 0 .00 6 . 00 0. 00 1BSEISMICO VALUATION 6, 000 . 00 1.26 0 . 00 1.26 0.00 1BUSLIC FLAT RATE 1.00 115. 00 0 .00 115. 00 0 . 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 207 .26 0 .00 207.26 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 207 .26 VISA --------------- TOTAL RECEIPT 207.26 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE C U P E RT I N O PERMIT APPLICATION FORM APN#-f; 9 9 01-7 ND Date: Building Address: S K::�E N t� A� Ow 's Name: Phone#: Contractor: -r_-_ Phone#: Q� S. A G —14 9 8 -T7 ,A O0 �\ �A G , Fax#: 9 g 5 7 Contact . Phone#:q 2 5 7 0 A OC.:) Fax/e-mailcnl�C'b Ott e ccK> Contractor License#: Yq Cupertino Business License#: Job Description: Residential ❑ Commercial Valuationf� Ga I CnXD Project Size: CounterFJ Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity . Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERA11T Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 12/06/10