11070115CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10001 N DE ANZA BLVD
CONTRACTOR: OPI COMMERCIAL
PERMIT NO: 110701 15
BUILDERS
ON"N'F,R'S NAME: TAMBELLINI UA
445 LEIGH AVE
DATE ISSUED: 08/10/2011
O. .,R'S PHONE: 415394196
LOS GATOS, CA 95032
PHONE NO: (408)377-4800
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# L�y
1 �
MECH RESIDENTIAL COMMERCIAL
Contractor�Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: STE 350 - COMM. T.l (2257SQFT) INTEROR REMODEL.(NW
(commencing with Section 7000) of Division 3 of the Business & Professions
WALLS,MODIFY ELECTRIC &ADD HVAC)
Code and that my license is in full force and effect.
1 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
Sq. Ft Floor Area:
Valuation: $33285
Section 3700 of the Labor Code, for the performance of die work for which this
permit is issued.
APN Number: 32634074.00
Occupancy "Type:
APPLICANT CERTIFICATION
I certify that 1 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18 _ �.
Signature � � / Date
Issued by: / G"��' �� - Date
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of die work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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 m
Owner or agent:
out ed g
forthwith comply with such provisions or this permit shall be deenmed revoked.
_ — -- `-Da"te: L
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of wwrk's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
in. ` •mify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
C id expenses which may accrue against said City in consequence of the
gr--..;ig of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
10 ADDRESS: 10001 N. De Anza Blvd
TYPE OF
CONSTR.
DATE: 07/18/2011
REVIEWED BY: larry s
APN:
BP#:
BP FEE ID
"VALUATION: 1$33,285
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
IBTIPLNCK
$1,869.76
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
interior remodel to 2257 sq ft offices ace.
SCOPE
$0.00
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
2,257
$2,075.44
IBTIPLNCK
$1,869.76
IBTIINSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,869.76
Suppl. Insp. Feer Reg. 0
OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
2,257
$2,075.44
$1,869.76
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY Q_ Yes 0 No
ELEC, HOURLY Q Yes 0 No
1,°u, h. P"13 t-?
t'��2ft}h. ?MI C.itd'Ct{
t �t .. .Lltf ,�:cff
$2,075.44
Select a Mise Bldg/Structure
or Element of a Building
Supp[. PC Fee: G Reg. 0 OT
F-0,01hrs
$0.00
NOTE. These fees are baser[ on the Prelindnary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (I ee Resohilion .11-053 E f. 711111)..FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,075.44
Select a Mise Bldg/Structure
or Element of a Building
Supp[. PC Fee: G Reg. 0 OT
F-0,01hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,869.76
Suppl. Insp. Feer Reg. 0
OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TC...
Acoustical Fee:
0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
,
tt
t:
-Ce.,
Strong Motion Fee:
1BSEISMICO
$6.99
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$3,954.19
$0.00
TOTAL FEE:
$3,954.19
Revised: 07/04/2011