14030127CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11010 N DE ANZA BLVD
CONTRACTOR:- I=--TC BT! I PERMIT NO: 14030127
OWNER'S NAME: CUPERTINO DE ORO CLUB INC I nAw pf 1y r r-e- I DATE ISSUED: 03/20/2014 I
OWNER'S PHONE: 9162082507 I > ��ij4,�/?1(C11'L I PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class % , c ( 0 1 Lic. # '? 3 S- —_) 13
Contractor 'by V) yV-o y-2 t OV . S." Date
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 reg tions per the Cupertino Municipal Code, Section
9 18,
C10nai11rP Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
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 te
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.
Signature Date
JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL 0
CHEVRON- REPLACE CARWASH EQUIPMENT WITH
LISTED
ELECTRICAL AND PLUMBMING EQUIPMENT LIKE FOR
LIKE
Sq. Ft Floor Area: I Valuation: $25000
APN Number: 30942041.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY R M LAST CALLED INSP CTION.
Issued by: Dated /
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, 255 ,and 25534. r'
Owner or authorized agent: Date: 1 2 `1
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building QQcupertino.orq
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED
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ORIGINAL PERMIT #
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❑ OWNER ❑ OWNER- BUILDER ❑ OWNERAGENT ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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LICENSE NUMBER
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ARCHITECT/ENGINEER NAME
ICENSE NUMBER
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DESCRIPTION OF WORK RkAtoctl
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
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ALUATION ($)
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AREA �A �� s
NEW FLOOR
AREA - _ a
DEMO
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NET AREAO
BATHROOM
KITCHEN
OTHER
REMODEL
REMODEL
REMODE
PORCH AREA
DECK ARE
TOTAL DECK/PORCH AREA
GARAGE AREA:_ DETACH
❑ATTACH
# DWELLING UNITS:
IS ASECOND UNIT ❑YES
SECONDSTORY []YES
BEING ADDED? J@ NO
ADDITION? �WNO
PRE- APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO'
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By my signature below, I certify to each of the following: I am the property owner or authorized agent t on t e" roperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Desc p 'on of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construct I authorize represent i es of Cupertino to enter the above -ide tified property/or inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
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❑- BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
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❑ PLANNING PLAN REVIEW ,
a� yyp�'�d
_ Commercial Bld s: Provide a completed Hazardous Materials Disclosure
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form if any Hazardous Materials are being used as part of this project.
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❑ FIRE D -r` Y'
Copy of Planning Approval Letter or Meeting with Planning prior to��
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❑ xS, ITARYSEWERDISTRICT
submittal of Building Permit application.
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BIdgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10010 On de anza blvd DATE: 03/20/2014 REVIEWED BY: Mendez
APN: BP #: *VALUATION: $25,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION
USE: I I PERMIT TYPE:
wORK chevron- re lace electrical and plumbing equipment
SCOPE
t .Pe,,if FEY.;
other hh' * -h' Iran.
Alec!-, MLs'u. fee:
Phini >. lllwi Check
Other Plumb Insp.
07her Elec' Inc:' .
NOTE: This estimate does not include fees due to other Departments (i e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). I hese_jees are based on the preliminary information available ana are only an estimate. contact the Dept_tor aaan -t into.
FEE ITEMS (Fee Resolution I1 -053 Eff.' 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg /Structure
or Element of a Building
Suppl. PC Fee: (E) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee: Reg. ® OT
I-0-.0-1
hrs
$0.00
PME Unit Fee:
$0.00
PME{ Permit Fee:
$0.00
{',F. ns'truc.tiort 74x.'-
.'1t$rrdm'sTralzIve l'•ee,
0
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
i
? wi,el Documentation a Fees:
Strong Motion Fee:
IBSEISMICO
$5.25
2.0 hrs Inspections
$278.00 ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
%•! 3 y
y ;
•�.,. :fig.
$6.25
$278.00 ::
TOTAL FEE:
$284.25
Revised: 01/15/2014
DUAMO a 0oMro0110e *Ad a %1110 0001MO&I
5916 Shadow oak drive Citrus Heights CA 95621
Dan Salajan
916- 208 -2507
dandcec a). yahoo.com
November 5, 2014
To city of Cupertino building department / permit
And attention to : Patricia Garcia
In regards to building permit application #14030127
Site address: 11010 N. D Anza Blvd.
We deeply apologize for the length of time that went by without a building
inspection.
Unfortunately the reason behind this were insufficient funds , Chevron asked
us Dunmore construction and electric , to let them operate the car wash a little
longer so they can accumulate more funds for this project , then took a month till
we were able to order the equipment We are ready to start this job.
Can you please understand the circumstances and grant us extension for this
permit.
Thank you very much for your understanding and we appreciated your
kindness very much!
Sincerely,
Dan Salajan
916- 208 -2507
Dunmore construction and electric contractor.
dandcecp_Vahoo.com