15100079CITY OF CUPERTINO BUILDING
PERMIT
BUILDING ADDRESS: 10201 TORRE AVE
CONTRACTOR:
DPR CONSTRUCTION, A
PERMIT NO: 15100079
GENERAL
OWNER'S NAME: I & G DIRECT REAL ESTATE 21 LP
1450 VETER=
BLVD
DATE ISSUED: 10/12/2015
OWNER'S PHONE: 4086560289
REDWOOD CITY!,
CA 94063
PHONE NO: (650)474-1450
Ld" LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION:
INSTALL (N) HVAC
RESIDENTIAL ❑ COMMERCIAL ❑
SPLIT SYSTEM WITH ROOFTOP
2
License Class Lic. # `1
INSTALL (N) RECEPTACLES
UNIT;
- QTY 7; INSTALL (N) ESD
Contractor 1✓1yi�Y4.t2e� Date (o
D to/ /
FLOORING IN LAB
#308A & LAB #347
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
1. I have and will maintain a certificate of consent to self -insure for Worker's
Sq. Ft Floor Area
Valuation: $100000
Compensation, as provided for by Section 3700 of the Labor Code, for the
APN Number: 36?41005:00
Occupancy Type:
performance of the work for which this permit is issued.
2. 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.
PERMIT.
EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
I certify that I have read this application andstate that the above information is
WITHIN
180 DAYS OF PERMIT ISSUANCE OR
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
180 D A V
3 FROM LAST C LED INSPECTION
upon the above mentioned property for inspection purposes. (We) agree to sav7e
indemnify and keep harmless the City of Cupertino against liabilities,
Issued by:
Date:
,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
j
all non -point sour regulations per the Cupertino Municipal Code, Section 9.18.
i RE -ROOFS:
Signature V�"1 —' Date f o i
All roofs shall be i�spected
prior to any roofing material being installed. If a roof is
installed without fist
obtaining an inspection, I agree to remove all new materials for
inspection.
Q OWNER -BUILDER DECLARATION
Signature ofAppliqant:
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
9. I, as owner of the property, or my employees with wages as their sole
;HAZARDOUS MATERIALS DISCLOSURE
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
I have read the hazardous
California Health j&
materials requirements under Chapter 6.95 of the
Safety Code, Sections 25505, 25533, and 25534. I will maintain
construct the project (Sec.7044, Business & Professions Code).
compliance with the
Cupertino Municipal Code, Chapter 9.12 and the Health &
I hereby affirm under penalty of perjury one of the following three declarations:
Safety Code, Section
25532(a) should I store or handle hazardous material.
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Additionally, should
contaminants as dlefrned
I use equipment or devices which emit hazardous air
by the Bay Area Air Quality Management District I will
Compensation,
Compensation, as provided for by Section 3700 of the Labor Code, for the
maintain compliafice
with the Cupertino Municipal Code, Chapter 9.12 and the
of the. work for which this permit is issued.
p p
Health & Safety Code,
Sections 25505, 25533, and 25534.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
f
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or!Authorizecl
agent:
Id Z
permit is issued.
Date:
a. 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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I hereby affirm thaf
there is construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code, I
for which this per�it
is issued (Sec. 3097, Civ C.)
must forthwith comply with such provisions or this permit shall be deemed
Lender's Nam_ e
revoked.
Lender's Address
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
i
ARCHITECT'S DECLARATION
correct. I agree to comply with all city and county ordinances and state laws relating
I understand my plans
shall be used as public records.
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Licensed Professional
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
I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT ® BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3251
(408) 777-3228 • FAX (408) 777-3333 a buildingacupertino org
770M I 1 e illIT111 r 11 _
u n V IO IN / Unrntctcbu UKRANAL PEI? MIT #
ADDRESS e `' 3 Jq APN # Q
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CITY, STATE, ZIP >Of .
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❑ OWNER ❑OWNER -BUILDER ,OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT
❑ ARCHITECT ❑ ENGINEER O DEVELOPER ❑ TENANT
CONTRACTOR NAME ='•
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LICENSE NUMBER L� .�i.E
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LICENSE TYPE ?
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BUS, LIC #
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CITY, STATE, ZIPJ
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LICENSE NUMBER
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PHONE -
DESCRIPTION OF WORKi ,7
' W"WIwev Y C. " � � � `ej�i ll+r' "� � 3�s
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t6o 4
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXLSTG -
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
i
BATHROOM KITCHEN
REMODEL AREA REMODEL AREA
OTHER
REMODEL AREA -
- -
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: EIDETACH
-
❑ ATTACH
I
DWELLING UNITS:
LS A SECOND UNIT OYES
SECOND STORY ❑:YES
-
-
BEING ADDED? fE[NO
ADDITION? M0
I
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
PLANNINGAPPL# ONO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES'
EICHLERHOME? FNO
RE" : D
Y.; y 4
{.
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent t
application and the information I have provided is correct. I have read the Description of Work and verify
) act on the property owner's behalf. I have read this
it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin onstruction. I authorize representatives of Cupertino to enter
the above-identifie property for inspection purposes.
Signature of Applicant/Agent: A� " P PDate:
SUPPLEMENTAL INFORMATION REQUIRED
PLA
: CHECK TYmE
ROUTmIIaLIR ,
New SFD or Multifamily dwellings: Apply for demolition permit for
building(s). Demolition is issuance building
OVER-'V3E-c010vT1
R
BUILDING
existing permit required prior to of
permit for new building.
,
E[ EXPPtSS.,
❑. PLnNNINGPEarIREv>Ew
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Q' PUBLIC w.oxxs
form if any Hazardous Materials are being used as part of this project.
CI LARGE,
❑FIREDEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
Q'
ElsAmy&kysEwnlsxlci
'submittal of Building Permit application.
v ❑ ENVIRONMENTAL HEALTH• '
BIdgApp_20I Ldoc revised 06/21/11
I
CITY OF CUPERTINO 15100091
FEE ESTIMATOR — BUILDING DIVISION
y < ADDRESS: 10201 Torre Ave DATE: 10/12/2015 REVIEWED BY: PAUL
APN: 369 41 005 BP#: 'VALUATION: $100,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Civil / Religious activities i PENTAMATION
Commercial Building � i
USE: g in BQ zone? 0 Yes No PERMIT TYPE: FURN/A C
WORK Install N HVAC split sstem with rooftopunit; Install N rece tacles - Qt 7• Install N ESD flooringin
SCOPE Lab #308A & Lab #347
Mech. Plan Check 0.0 hrs $0.00 I'li%frzo. i'lan r."O�eC Elec. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: IMPERMIT Phanb. Pernih,lee: Elea Permit Fee: IEPERMIT
Other Mech. Insp. F0701hrs 1 $48.00 otiler I'tumb .inssla. Other Elea Insp. F0.0 hrs 1 $48.00
:trc✓. Ii,sp1 Fee: ' I'1armb. Inv), Fee: I f1ec. Irup, Fee: '
NOTE: This estimate does not include fees due to other Departments (i.e. Planninj, Public Works, Fire, Sanitary Sewer District, School
1)icfrint otn ► Th.— f- n hnenA nz. fbn >o7ic,-,�s. s. fnruantin niJnhln nra 11 nro -h, n ociimnto Cnnf"n t iho Dani far adfi1n 17 info_
FEE ITEMS (Fee Resolution 11-053 Ef'. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (F) No
$0.00
# Mechanical
$143.00 IMFR=<100 Furnace, Forced -Air
Suppl. PC Fee: (E) Reg. 0 OT
0,0
hrs
$0.00
PME Plan Check:
$0.00
1 # Mechanical
$143.(0 1 IMCAIRHAN A/C Units (>I OK cfin)
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. O
OT
0•0
I hrs
$0.00
7 Electrical
$48.00 IBIEMRECEP Recep/Switch/Outlets
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
Construction Tax: IBCONSTAXC171
$0.00
Administrative Fee:
]ADMIN
$45.00
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
hours Plan Check, Hourly
'�'$286.Q0 ISTPLNCK
A
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee:
IBSEISMICO
$28.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SF7BT(?TAES
$221.001
$620.00OTA7:1+'EE..
$841.00
Revisea: 1 u7u1 7zui o