15020131I CITY OF CUPERTINO BUILDING PERMIT I
BUILDIING ADDRESS: 10201 TORRE AVE CONTRACTOR: DPR CONSTRUCTION, A PERMIT NO: 15020131
OWNER'S NAME: I & G DIRECT REAL ESTATE 21 LP 11450 VETERANS BLVD I DATE ISSUED: 02/23/2015
OWNER'S PHONE: 6505923960 1 REDWOOD CITY, CA 94063 1 PHONE NO: (650)474 -1450 1
Pb LICENSED CONTRACTOR'S DECLARATION
License Class & Lic. # 3 O
Contractor 0A ,o e— C_a19_q 1J (_(e / ✓ Date 7— Z3 1
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:
1 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.
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 l have read this application and state that the above information is
correct. 1 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 expense h,hich may accrue against said City in consequence of tJt�
granting of thi ermit. 7�i ' . tio pplicant understands and will comply
with all non- int source r do er t Cupertino Municipal Code, Section
9.18.
Signature Date 7-' Z$ �
❑ 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)
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.
l 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, 1
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
1 certify that I have read this application and state that the above information is
correct. 1 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.
Date
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
LAB 126 1ST FLR - T.I. TO RECONFIGURE (E) OFFICE
AREA (875 S.F.)
Sq. Ft Floor Area: Valuation: $25000
APN Number: 36941005.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM _L LED INSPECTION.
i"' �2I23�LJ
d bv: 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, l 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 b ay Area Air uality Management District I
will maintain compliance wit the Cu t' unici I Code, Chapter 9.12 and
the Health &Safety Code, Se tions 25 5 33, and 5534.
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
1 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
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10201 TORRE AVE DATE: 02/23/2015 REVIEWED BY: MELISSA
AP 369 41 005 BP #: j�� `VALUATION: $25,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 B TI
USE: PERMIT TYPE:
WORK LAB 126 1ST FLR - T.I. TO RECONFIGURE E OFFICE AREA 875 S.F.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II- B,III- B,IV,V -B
875
$2,128.56
/BTIPLNCK
$998.16
IBTIINSP
L:ilec. Insp. Eee:
$998.16
Suppl. Insp. Fee,0 Reg. Q OT
Lil
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tar:
,ldministrative Fee:
0
0
Work Without Permit? Yes (F) No
$0.00
Advanced Planning Fee:
TOTALS:
1 875
$2,128.56
$998.16
$7.00
MECH, HOURLY O Yes 0 No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
.11ech. Ilan ('heck
phinth. Plan Chec,i
P...Yec..Plan Check
;flo1/1. Perivil Fee:
Plumb , Permit Fee:
Glec, Permit Fee:
Other .11ech. Insp.
01her Pluinh Insp-
Odrer 1-Joc. Insp. L1
A ch. Insp. Fee:
Plurilb. h1sp. Fee:
L:ilec. Insp. Eee:
AUTE This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are hated on the nreliminary information availahle and are aniv an estimate_ Contact the Dent for addn'1 info_
FEE ITEMS free Resolution II -053 U 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,128.56
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: E) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$998.16
Suppl. Insp. Fee,0 Reg. Q OT
Lil
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tar:
,ldministrative Fee:
0
0
Work Without Permit? Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential Q
Building or Structure 0
Travel Documenlatirin Fees:
Strong; Motion Fee: IBSEISMICO
$7.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$3,134.72
$0.00 TOTAL FEE:
1 $3,134.72
Revised: 02/1412015
IF2 CONS RUC i ON PERMIT APPLICATION L� \
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 ° building(cDcupertino.org Aw >
CCUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
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�CONTRACTOR
❑ OWNER ❑ OWNER - BUILDER 0 OWNER AGENT� 11 ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENS%-NUMAER
LICENS TYPE
BUS. LIC #
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AO Q
COMPANY NAME �^ n n D
E -MAIL PA 4A Q2
FAX
STREET ADDRESS
CITY SSTA_T�, ZIIP}.��
PHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
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COMPANY NAME l61(�IJ!-� '
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FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
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�DEICI11T.ON O WORK ,sd
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EXISTING USE
PROPOSED USE CONSTR. TYPE
# STORIES
USE
TYPE
OCC
SQ.FT.
VALUATION {�)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
dl
GXJ
BATHROOM KITCHEN
OTHER
REMODELAREA REMODELAREA
REMODELAREA
PORCH AREA
DECK AREA
TO] AL DECK/PORCH AREA
GARAGE AREA DETACH
[]ATTACH
# DWELLING UNITS;
IS SECOND UNIT ❑YEs
SF.CONDSTORV E]YES
BEING ADDED? [']NO
ADDITION? []NO
PRE - APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN E] YES
TOTAL VALUATION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? [3 NO
-556„ { °�
By my signature below, I certify to each of the following: 1 am the property owner or authorize n the property owner's behalf I have read this
appl ication and the information I have p videj�c rrect. 1 ve read the Description of Work a verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b I in cfon. t orize representatives of Cupertino to enter the above-pen ed propqrty for inspection purposes.
Signature of Applicant/Agent: Date: Q
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER -THE- COUNTER
❑ 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.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
— Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
61dgApp_201 Ldoc revised 06/21/11
lam'
- fir}
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
—�°�a� `��k -c V 2,1 L? Telephone: 408 - 777 -3228
C UPIE TONG �.� Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: 1b 1�' �
PERMIT # 0 7—GIZ-I
OWNER'S NAME:
PHONE # C,-'c0 - -5q2 -- ISGO
GENERAL CONTRACTOR:
BUSINESS LICENSE #
0,
ADD RESS:4,30 '
CITY /ZIPCODE: S
*Our municipal code requires all businesses working in the cit -oto have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CON'1('llBACp'OR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPIEIRTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
PDease check applicable subcontractors and complete the following information:
Date
d
Owner / Contractor Signatuure
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Aj
Electrical
Excavation
Fencing
Flooring / Carpeting
f�
Linoleum / Wood
.Glass / Glazing
Heating -W .Ac—
Insulation
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
C4- r->
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
SQA —,�)el -
Owner / Contractor Signatuure
Date