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10050172CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR: APPLIED PERMIT NO: 10050172 CONSTRUCTION TECH OWNER'S NAME: TANTAU INVESTMENT, LLC 1230 OAKMEAD PKWY DATE ISSUED: 06/04/2010 OWNER'S PHONE: 4082474900 SUNNYVALE, CA 94085 PHONE NO: (408)252-9990 ❑ LICENSED CONTRACTOR'S DECLARATION r- BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 113 Lic.# O MECH RESIDENTIAL COMMERCIAL ContractorfA Date / JOB DESCRIPTION: T.I FM-200 SYSTEM IN THE ELEVATOR CONTROL ROOM TO I her aff t at I am licensed under the provisions of Chapter 9 INCLUDE (M,E) (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 Sq. Ft Floor Area: Valuation: $20000 performance of the work for whichthis 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 wh APN Number: 31609029.00 Occupancy Type: permit is issued. 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 WI TIEIIN 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 w ' may accrue against said City in consequence of the granting of this pe t. dditionally, the applicant understands and will comply Issued by: Date: with all non -poi s r e regulations per the Cupertino Municipal Code, Section 9.I8. RE -ROOFS: Sign Date 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. ❑ 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 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 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( 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 1 performance of the work for which this permit is issued. will maintain compliance wit a Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 the Labor Code, for the of the work for which this the Health &Safety Code, S c ' ins 25505, 533, and 25534. rn of performance Owner or authorized ag t: Date: permit is issued. 1 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,) 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting 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 CITY OF CUPERTINO BUILDING PEY8MT"" " BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR: APPLIED CO O: 10050172 TECH OWNER'S NAME: TANTAU INVESTMENT, LLC 11230 OAKMEAD Pk -WV I DATE ISSUED: 06/04/2010 1 OWNER'S PHONE: 4082474900 1 SUNNYVALE, CA 94085 1 PHONE NO: (408)252-9990 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # ') 310 9 Z Contractor i�pp) ; e C1S�TtdC --1 Date Z.Z ZD1d' I hereby affirm that I am licensed 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. 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 regulations per the Cupertino Municipal Code, Section 9.18. Signature r Date ZZ 7010. ❑ 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) 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 r ELECT r PLUMB r MECH F— RESIDENTIAL F— COMMERCIAL F— JOB DESCRIPTION: T.I FM-200 SYSTEM IN THE ELEVATOR CONTROL ROOM TO INCC UDE (ME)rn- n _ `�(� 4 �Qr: �.l tl r•� � d� �-r 44 5, F. `r_ � ram„ �,L p`a- ,�. r-�• Fyn za L'3 i-0 s,`t-lc ul S�t S . Sq. Ft Floor Area: I Valuation: $20000 APN Number: 31609029.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECCTION. Issued by: 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 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(a) 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. Date: D Z Zo t0 r 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 La= I understand my plans shall be used as public records. Fm-F CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10900 N. Tantau Ave DATE: 06/17/2010 REVIEWED BY: building APN: BP#: "VALUATION: 1$26,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building IISF.: /07,..L I700 .1hF,1. APPLICATION TYPE: MECHANICAL 0. Yes LN=aPLUMBING, 0 Yes 0 No ELECTRICAL © Yes 0 No wrpmoyp he "wet" sprinkler head in a 9sf Elevator Control Room rpplqc*nq the wet head with a 00 an FM200 d system. 3Q OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s .ft. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,MV-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 1. '.. ". NOTE. These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 09-051 Eff.' 711"%09) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? © Yes 0 No $0.00 Plannin Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: IBSEISMICO hrs $252 Product Review IPRODREVIE Bldg Stds Commission Fee: 1BCBSC SUBTOTALS: —4=652.00 TOTAL FEE: $259.46 Revised: 5/27/2010