15040144CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10201 TORRE AVE
CONTRACTOR: DPR CONSTRUCTION, A
PERMIT NO: 15040144
GENERAL
OWNER'S NAME: I & G DIRECT REAL ESTATE 21 LP
1450 VETERANS BLVD
DATE ISSUED: 06/042015
OWNER'S PHONE: 6505923960
REDWOOD CITY, CA 94063
PHONE NO: (650)474 -1450
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
INSTALLATION OF (2) NEW CHAMBERS (FIRST FLOOR)
R /
License Class $ Lic. # 1 6[ p
(WAS REVISION #3 UNDER PERMIT 14060205)
Contractor C) rT?— ! C-TC.Xkate U - 4 • Z ° t r
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
Sq. Ft Floor Area:
Valuation: $7500
ppSonmnce of the work for which this permit is issued.
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: 36941005.00
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
WITHIN 180 DA 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
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
Date: t7
granting of th is p dditionall ,the applicant understands and will comply
with all non -p nt source ions er the Cupertino Municipal Code, Section
9.18.
�—
RE- ROOFS:
Signature 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(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 Cu Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 5505 25 , an Ii534.
Section 3700 of the Labor Code, for the performance of the work for which this
/
Owner or authorized agent: Date: �+
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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I 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
CUPERTINO
/� 0 � �)) 11-/ �
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building 5( cupertino.orq
❑ NEW CONSTRUCTION ❑ ADDITION M ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRES1 o2ol [J �X(� A
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APN tl �� L // • ��
OWNER NAME /^
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E-MAIL
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CITY, STATE IP FAX
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PHON�/97
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STREET ADDRESSW G4 Ave— ` S
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CITY, STATE, ZIP ;640
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 1:1 ENGINEER El DEVELOPER El TENANT
CONTRACTO E �'� ' }� LICt �( LICENSE TYPE
BUS LIC 0
FAX
COMPANY NAME E -MAIL
STU, %ADDRE °p _ J
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CITY ATE, ZIP
.yam � �s�
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
A
DESCRIPTION OF WORK 10
I elx,r'sh`
EXISTING
r
PROPO SE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
(j /�
// /J
EXISTG
NEW FLOOR,
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
-
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
El ATTACH
#DWELLINGUNITS:
IS A SECOND UNIT [3 YES
SECOND STORY [3 YES
BEING ADDED? []NO
ADDITION? []NO
PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APPL'0. ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN El YES
EICHLER HOME? ❑ NO
RECEIVED .,, aa, x
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have p v' ed ' co9—P, e read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bui c n t horize representatives of Cupertino to enter the above-i entifie property for inspection purposes.
Signature of Applicant/Agent: Date: 2,0
SUPPLEMENTAL INFORMATION REQUIRED
PLAIZCHECKTYPE r,. ,
:, RotrrINCSL>p
❑ OVERTHZ<COUhTER ;
BUIIDINGPLANREVIEW y
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior t0 issuance Of building
Sr
-
permit for new building.
❑ ExPRESS�
�x'
rLAxAINGPLaNREiIEw
_Commercial Bldgs Provide a completed Hazardous Materials Disclosure
sTnIVDARD
yam=
❑PU13LicwoRxs
form if any Hazardous Materials are being used as part of this project.
s
LARGE
4� k�
FSRRDEPT �4
Copy Planning Approval Letter Meeting Planning t0
Mih S 'C,*
J k Af
_ Of Or with prior
submittal of Building Permit application.
❑ MA70R }- °{,";.>ti' -+
s€ r
�9ANiTARYSEFYERDISTRICT�- ,
. ❑..,ENVIROIVIYIENTXL'HEALTHrJ
BldgApp_201 ].doe revised 06121111
CITY OF CUPERTINO
Fm-N FEE ESTIMATOR - BUILDING DIVISION
kaADDRESS: 10201 TORRE AVE
DATE: 04/23/2015
REVIEWED BY: SEAN
APN:
BP #: SO
'VALUATION:
1$7,500
*PERMIT TYPE: Building Permit
0.0
PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY
USE: Commercial Building
o
Civil / Religious activities
inBQzone.
� � Yes Q No
PENTAMATION
PERMIT TYPE: 1GENCOM
WORK
INSTALLATION OF 2 CHAMBERS IN AUDIO CHAMBER RM 134.
Suppl. Insp. Fee-.0 Reg. Q OT
SCOPE
1 hrs
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Lff.' ;/1,%131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes Q No
$0.00
® hours Plan Check, Hourly
$572.00 ISTPLNCK
ET
0.0
hrs
$0.00
o
E
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Lff.' ;/1,%131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes Q No
$0.00
® hours Plan Check, Hourly
$572.00 ISTPLNCK
Suppl. PC Fee: � Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-.0 Reg. Q OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
0
E)
Work Without Permit? 0 Yes Q No
$0.00
Advanced Plannii Fee:
$0.00
Select a Non - Residential Q
Building or Structure
Strong- Motion Fee: IBSEISMICO
$2.10
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.001
SUBTOTALS:
$3.10
$572.00 TOTAL FEE:
1 $575.10
Revised: 04/01/2015
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 - 777 -3333
utf rQl (S
o
JOB ADDRESS: 1 D 2-61 ' r r2 Q Uc-:,
PERMIT # y
OWNER'S NAME:' p' �,+
.ES� +r- 2.1 L P
PHONE # 5'0 417-V- N5--D
GENERAL CONTRACTOR:
G onS r4U o vi .
BUSINESS LICENSE # J3 3 0 R
ADDRESS: 1 y5-0 e e ►r4✓1
L-VD, ,i L,
CITY /ZIPCODE: e a
G3
*Our municipal code requires all businesses working in the city to have a City of Cupertino business licdnse.
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:
Signature Date
Please check applicable subcontractors and complete the following information:
-1114a�64� .14 621.
Owner / Contractor Signature Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
ement Finishing
Electrical
t.l cor tc_
.2 q 70
Excavation
F -ncing
Flooring / Carpeting
6 G u J Gl i Cr O .
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
asonry
Painting / Wallpaper
0i -� (Vi -"'
;Z
Paving
Plastering
Plumbing
Roofing
S tic Tank
Sheet Metal
Sheet Rock
Tile
-1114a�64� .14 621.
Owner / Contractor Signature Date