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13030094 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR:APPLIED PERMIT NO: 13030094 CONSTRUCTION TECH OWNER'S NAME: CUPERTINO TANTAU LLC 1230 OAKMEAD PKWY DATE ISSUED:03/19/2013 OWNER'S PHONE: 4089551411 SUNNYVALE,CA 94085 PHONE NO:(408)252-9990 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class______ Lic.# 7 (D"� PANASONIC-2ND FLOOR-RELOCATE ELECTRICAL CIRCUIT Contractor 7ma` AND SUPPLY DUCT IN CVCA LAB I hereby aM' that I am licensed under the provisions of Chapter (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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1975 1 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:31609029.00 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.1 agree to comply with all city and county ordinances and state laws relating WIT 180 DAYS 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 180 DA ROM 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 �q 13 granting of this permit. Additionally,the applicant understands and will comply Issued by: Dat ti with all non-point source per 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. ❑ ER-BUILDER DECLARATION [hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: , 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) 1,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 I store or handle hazardous I have and will maintain aCertificate 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 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 255 8533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this /Q Owner or authorized agent: Date: permit is issued. (7 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 RU ION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must l 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. 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 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. Date rrAA CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 b� CUPERTINO la (408)777-3228•FAX(408)777-3333•building cupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ctAiPN# `1G ()� yCv OWNER E PONE v7i yc V E-MAILAi STREET ADD CjTY,STATE,ZIP t �} FAX H 111 CONTACT NAME C PHONE `'E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OwNER-BUIIAER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �+ LICENSE NUM E LI SE TYPE COMPANY AME E-MAIL FAX CI"L }�� T —1—:.. 2 5Q2-- REE DRESS �]� ZCJTY,ST E,ZIP151 PHONE n ARCHITECT/ENGINEER NAME �F— LICENSENUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK i G/GA �1 EXISTING USE PROPOSED USE CONSTR TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION($) 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: U DETACH []ATTACH #DWELLING UNrrs: IS A SECOND UNrr ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIV B TOTAL VtIM PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? []NO By my signature below,I certify to each of the following: I am the property owner or authorizedagIRto act on the property owner's behalf. I have read this application and the information I have provided ic e read the Description of Work and rify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' ons . I t ze representatives of Cupertino to enter the above-identiped property r m ection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTA FO ON REQUIRED ON CHECK TYPE ROUTING SLIP _New SFD or Multifami dwellin . pply for demolition permit for existing building(s). Demolition pe is required prior to issuance of building OVER-THE-COUNTER BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD El PUBLICWORKS 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 BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10900 N TANTAU DATE: 03/19/2013 REVIEWED BY: MENDEZ APN: BP#: 'VALUATION: 1$1,975 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1CMAP1 USE: PERMIT TYPE: WORK SCOPE Mech,Plan Check 0.0 hrs $0.00 frrrri%= ��_`��,s E,�{,� Elec.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Elec.Permit Fee: IEPERMIT Other Mech.Insp. 0.0 hrs $45.00 �>�l�t-> f'Iz,E �:lr:�i� OtherElec.Insp. 0-0Jhrs $45.00 NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These eqes are based on the relimina information available and are on l an estimate. Contact the Dept or addn'l info, FEE ITEMS Lee Resolution 11-053 Eff 7,%1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 1 # Mechanical Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $67.00 IBAPPLOT Other Appliance/Equip PME Plan Check: $0.00 1 Electrical Permit Fee: $0.00 $133.00 1 IBREMMIsC Special Circuits Suppl. Insp. Fee.0 Reg. Q OT 0 0 hrs $0.00 PME Unit Feer $0.00 PME Permit Fee: $90.00 ,olvNwactton It V. Administrative Fee: 1ADMIN $42.00 0 Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRA VDOC $45.00 Building or Structure 0 i Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SLBI'UTALS: $178.50 $200.00 TOTAL FEES $378.50 Revised: 01/01/2013