15050065CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10001 N DE ANZA BLVD
CONTRACTOR: VULCAN
PERMIT NO: 15050065
CONSTRUCTION INC
OWNER'S NAME: TAMBELLINI DEANZA PROPERTIES
346 MATHEW ST
DATE ISSUED: 05/13/2015
OWNER'S PHONE: 8314395457
SANTA CLARA, CA 95050
PHONE NO: (408) 499-6039
LICENSED CONTRACTOR'S DECLARATION
r F
®
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. # 7i1 i�
,f `
Contractor V l�{d ate ��
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: SEAGATE - T. I. TO ADD (N) DOORS TO (E) LOBBY (50
S.F.)
I hereby affirm that 1 am licensed under the provisions of hapter 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
ompensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $7765
erformance 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
APN Number: 32634074.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 DAYS OF PE 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
180 DAYS STC INSPECT ON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
13
granting of this permit. Additionally, the applicant understands and will comp y
Issued by: ate: IT.I
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
ROO
Signature � .Bate -®�
All roofs shall be inspected pr' o mg material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ ONNNER-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
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
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. I 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 1 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 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505 ,3&33'3; : 34.
Section 3700 of the Labor Code, for the performance of the work for which this
we•
Owner Date
permit is issued.:
or authorized agent: J
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION h�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 o buildingC6cupertino.org
F7 NpW f'.nN.STRI 1nTTnN I7 ADDMON XI ALTERATION / Ti F] REVISION / DEFERRED ORIGINAL PERMIT 9
PROJECT ADDRESS
APN# � 2fo
i �
OWNERNAME\1 1 11 06 a I ` D G P8' –� — S-ys?
�!; 6Y�T
EMAIL
"+ii
STREET ADDRESS
SS
i�H' L W �J `�
JW
CITY, STATE, ZIP �tT 12 a FAX
CONTACT NAME - PHO
fE.MAIL�C)?
0 �" LCA(,J
STREET ADDRESS
CITY, STATE, ZIP
FAX
13 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNANjEa ,� LICENSE ER
S
LICEN 7YPE
BUS LIC � Cr
�l'1 1-1
COMPANYN� �QiVS 1
`•�! _ �d
EMAIL
J�
FAX
STREET AD S ��
CITY, TAT , ZI
PHO
l S�
ARCHITECT/ENGINEER N O
LICENSE NUMBER 2�
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET AD�SSt
CITY TATE
PH U 3 0 l G0
DESCRIPTION OF WORK
l01?lC7J o !- u
EXISTING USE
PROPOSED USE
CONSTR TYPE
#STORIES
USE TYPE OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
R
50
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECOND STORY [J YES
BEING ADDED! ❑NO
ADDrFION7 ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY of
IS THE BLDG AN
REC D B im" "� �- - 7 AL VALU 4TION:
PLANNI]QG APPL# ❑NO PLANNING APPROVAL LETTER
EICHLER HOM1IE7 ❑NO
-� �F��i. ���i ate; F� 6
.�, y
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 provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ic)�ug-eenstruotiGla rtze tives of Cupertino to enter the above -identified proper jor inspection purposes.
Signature of Applicant/Agent: ` Date:
SUPPLEMENTAL INFORMATION REQUIRED
zaP C�kcri-TrnE a}
„�.? ROUTIG SBS
OVERTHi:<COUhTER.i. �.
� '�^
New SFD or Multifamily dwellings: Apply for demolition permit forr
existing building(s). Demolition permit is required prior to issuance of building&0,1.1111-21.41I
� �^ E I,
�1�.�BTJ7LDINGPLANREVIEW
r
permit for new building.3
� � ��^` �,'� 5
�� �LANhIIVG PLANREVLLW� . -
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
VA"EXPRESSt�i
sT Main
PUBLTCWORKS U
_ffig
form if any HazardousMaterials are being used as part ofthis project.
S}-
is ®�`�ARGS!� �a• �.z t,, � r.. �
' ❑�FIRE,D�PT �� �$ y � 4��3 ��
_ Copy of Planning Approval Letter or Meeting with Planning prior to:.
submittal of Building Permit application.
ti r
St�h7TARXSERERDISTRrcTx`
,..❑;fENyII20NIrrEI�TAZ:'HEA'LTHr�,--a;,��...;.
1011.doc
CITY OF CUPERTINO
WE FEE ESTIMATOR - BUILDING DIVISION
i0iADDRESS:
10001 N DE ANZA BLVD
FLR AREA
s.f.
50
DATE: 05/12/2015
REVIEWED BY: MELISSA
BP FEES
$588.00
APN: 326 34 074
BP#:*VALUATION:
Flee. Permit Pee:
1$7,765
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
Pluwb, lusp. Fee:
PENTAMATION 113 1'1
I PERMIT TYPE: A
WORK SEAGATE - T.I. TO ADD N DOORS TOE
LOBBY 50 S.F.
SCOPE
L 7OCCUPANCY TYPE:
B (Tenant Improvements)
TYPE OF
CONSTR.
II-B,III-B,IV,V-B
FLR AREA
s.f.
50
PC FEES
$2,097.00
PC FEE ID
IBTIPLNCK
BP FEES
$588.00
BP FEE ID
IBTIINSP
Plumh. Perrnu Fee:
Flee. Permit Pee:
Daher Alec1r. harp.Ll I
0/her Plumb harp.
Other I;ler.°. Insp.El
ldech. Insp. Fee:
Pluwb, lusp. Fee:
Elec Insp,
PME Plan Check:
$0.00
Permit Fee:
$588.00
Suppl. Insp. Fee -0 Reg. Q OT
LEhrs
$0.00
TOTALS:
50
$2,097.00
$0.00
$588.00
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY ® Yes (F) No
ELEC, HOURLY Yes E) No
,11ech. Plan Check
Plrmrh. Pian Cheek
Elec. flan Check.
11ech. Penviil lee.
Plumh. Perrnu Fee:
Flee. Permit Pee:
Daher Alec1r. harp.Ll I
0/her Plumb harp.
Other I;ler.°. Insp.El
ldech. Insp. Fee:
Pluwb, lusp. Fee:
Elec Insp,
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 nreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ejf. 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: (!)Reg. 0 OT
R-01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$588.00
Suppl. Insp. Fee -0 Reg. Q OT
LEhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
El(bnin streative Fee:
0
0
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
Travel Dc7curM.ernlatir,7rf Fees:0
Strong Motion Fee: IBSEISMICO
$2.17
Select an Administrative Item
Bldg Stds Commission .Fee: 1BCBSC
$1.00
SUBTOTALS:
$2,688.17
$0.00
TOTAL FEE:
1 $2,688.17
Revised: 04/01/2015
CONTRACTOR / SUBCONTRACTOR LEST
]Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
PERMIT # 0 3 D
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FILIAL OCCUPANCY RNSPIECTION(S) WILL BE SCHEDULED UNTIL T1E111E
GENERAL CONTRACTOR OIEB RNID ALL SUl[$CON ll 63A I RS IIAYIE OBTAINEDA CITY �' OF CU IEIB� INO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature ate
Mease check appfleaWe subcontractors and compllete the ffollllownng information:
d
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date