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14090043CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 TORRE AVE OWNER'S NAME: CUPERTINO CITY OF OWNER'S PHONE: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# Contractor 1 hereby affirm that 1 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 CONTRACTOR: CUPERTINO CITY OF 10800 TORRE AVE CUPERTINO, CA 95014-5701 PERMIT NO: 14090043 DATE ISSUED: 09/09/2014 PHONE NO: BUILDING PERMIT INFO• BLDG F ELECT PLUMB MECH 9RESIDENTIAL COMMERCIAL JOB DESCRIPTION ADD DEMISING WALL & ONE(I)DOOR TO DIVIDE EXISTING OFC INTO TWO(2)OFCS MINOR ELECTRICAL WORK AS NEEDED Sq. Ft Floor Area: I Valuation: $8000 APN Number: 36931033 10300 1 Occupancy Type: ❑ �&RF OWNER -BUILDER DECLARATION 1 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, 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 918 �+j Signature -- Date (�A PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA S FROM L S3"CALLED JNSPECTION. ed by: Date: /1,7,/ T-- Date I Issu 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 1 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. Owner or authorized agent: Date: 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 ARCHIT'ECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO n. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT. DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buiidinaacupertino.org r-7 I T1IT-Mr1%J 11L A I.1 -CD A TTni T / Tr 7 RFVTCTCIN / T)FFFRRED ORIGRNTAL PFRMIT LJ NtW l.VlVJ 1tCUl-llvry LJ 11LL111ViT ta....-a.rv.. ••—-- - A " j / PROJECTADDRESS OT O M�t �/� �'r PHONE G�{•1 �iv exr� N o OWNERNP.ME . %Ty Of/ I E-)J1AII STREET ADDRESS ` 0 ,3 '^'r'M+, �` i t iirl CITY, STATE, ZIP �V �i FAX PHONE CONTACT NP 1,E -1 � O MAIL STREET ADDRESS / O 3 0 TO Q �_(I �r� livir CITY, STATE, ZIP /' t � ��"�) I FAX V❑� Ol�� ER ❑ OV;R ER BUILDER AW -ER. AGENT ❑ CONTRACTOR ❑ CONTRSCTOR AGENT ARCHITECT ❑ ENGINEER ❑ DE\�I OPER ❑ TENAImT CONTRACTOR NAME I LICENSE NUMBER I LICENSE TYPE ( BUS. LIC COMPANY NAME E -MATE I FAX STREET ADDRESS CITY, STATE, ZIP I PHONE ARCHTIECTIENGINEER NAME I LICENSE NUMBER I BUS. LIC 4' COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP' I PHONE DESCRIPTION OF WORK EXISTING USE I PROPOSED LSE CONSTR TYPE m STORIES USE TYPE I OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL I NET AREA 11/ll �O Ait AREA AREA AREA REMODEL ARE0DEL BATHROOM#DECKAR-E-A HEN I OTHER AREA REMODEL AREA PORCHAREATOTALDECK/PORCHAREA GARAGE AREA: DETACH ATTACH m DWELLING UECOND UNIT ❑ YES SECONDSTORY ❑YESGADDED? 13NO ADDITION? E]NO -P4L� APPLICAON-[� l &s—Tt��S. E801IDELOPV DF _IS APPROVAL LETTER I THE BLDG AR n l tS EICHLERHOME? �No PLANNINGAPPLR ❑NO PLAN'N�G IS By my signature below=, I certify to each of the following: I am the property owner or authorized agent to a on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verity it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified properq= for inspection purposes. Signature of Applicant/Agent: ` Date: SUPPLEMENTAL P\TF'ORMATION REQUIRED � �� - CE�CT{_T ZF .. _ ROTJTLNG New SFD or Multifamil dwellings: Apply for demolition permit for )' PP Y P � � F ;§m W- HF- DL�GPL4'�RL��S existing building(s). Demolition permit is required prior to issuance of building Y permit for new building. x r`-'--�s; �Y��_ � ��s� � �L��.NL.G�� xgN 5� Commercial BIdgs: Provide a completed Hazardous Materials Disclosure ��DA� _ form if an Hazardous Materials are being used as art of this project. y P P J ag- Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. �$• Bldg4pp_2 011. doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION I& ADDRESS: 10300 torre ave DATE: 09/09/2014 REVIEWED BY: larrys I APN: BP#: *VALUATION: 1$8,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building 300 PENTAMATION PERMIT TYPE: 1 B TA WORK add demisinq wall and 1 door to divide existing office into two offices. Minor electrical work as needed. SCOPE hrs OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 300 $2,097.00 1BTIPLNCK $588.00 IBTIINSP hrs $0.00 PME Plan Check: $0.00 Permit Fee: $588.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 300 $2,097.00 $588.00 MECH, HO es0- ' ELEC,.HOXTRLY 0 Yes No ,11111"h. %plan CP7e'ci Lie", ", i l<t C `hzCck Plan Check Fee: $2,097.00 Other Nulnb lmpLi L t.. 0.0 hrs NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrir t_ otc L The.ce fees are hated on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 a.* 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,097.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $588.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Co"?.srr,vction E) Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure I G 0 A '/'ot vl 1.1ucld n7 cnituliort Fees: Strom Motion Fee: IBSEISMICO $2.24 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $2,688.24 $0.00 �� ` TO) AL FEE: $2,688.24 Revised: 08/20/2014