15040194CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10355 N DE ANZA BLVD
CONTRACTOR: SC BUILDERS INC
PERMIT NO: 15040194
OWNER'S NAME: VIDOVICH-CUPERTINO LIMITED PARTNERS
910 THOMPSON PL
DATE ISSUED: 04/27/2015
OWNER'S PHONE: 4084721275
SUNNYVALE, CA 94085
PHONE NO: (408)328-0688
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 0
INSTALL (4) NEW HEAT PUMPS/AC FOR FIRST AND
License Class Lic. 4
SECOND
Contractor � U »0-3 Date C>4 ,�-i I
FLOOR LABS.
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: $5400000
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
APN Number: 32633113.00
Occup e:
p y Typ
permit is issued.
APPLICANT CERTIFICATION
I certify that l 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
WITHIN 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 DAYS FROM 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
f
Issued b pate: f
granting of this permit. Additionally, the applicant understands and will comply
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with all non -point source regulatip a Cupertino Municipal Code, Section
9.18.
-' —
RE -ROOFS:
Signature Date 1
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. 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(x) 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 Cupertino 'cipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 550 , 2 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: eA , � 1 _
I
permit is issued.
I certify that in the performance of the work for which this permit is issued, l 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
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
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building o1icupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION . '9 ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS
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OWNER ❑. OWNER -BUILDER ❑ OIAWER AGENT ,CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TAPE
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COMPANY NAME
E-MAIL
FAX
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CITY, STATE, ZIP
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DESCRIPTION OF WORK
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TYPE
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VALUATION (S)
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TOTAL
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AREA
NET AREA
BATHROOM
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REMODEL AREA
REMODEL AREA REMODEL AREA
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DECK AREA
TOTAL DECK/PORCH P.REA
GARAGE AREA: LJDETACH
AREA]
❑ ATTACH
DWELLING UNITS:
ISA SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? El NO
PRE -APPLICATION ❑ YES EF YES, PROVIDE COPY OF
PLANI3NG APPL# ❑NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? E] NO
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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 provided is co the Description of Work and verify it is accurate. I agree to comply with all applicable local
'ctiiray4Lread
ordinances and state laws relating to building con ct' author e representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofApp[icant/Agent: Date:
SUPPLEMENTAL INTO ION RED
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New SFD or Multifamily d%vellings: Apply for demolition permit for
is issuance building
existing building(s). Demolition permit required prior to of
per -mit for new building
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_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form ifany Hazardous Materials are being used as part of this project.
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_ Copy of Planning Approval Letter or Meeting with Planning prior to �
submittal of Building Permit application,
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B1dg4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FPS, FEE ESTIMATOR - BUILDING DIVISION
10
ADDRESS: 10355 N DE ANZA BLVD
DATE: 04/27/2015
REVIEWED BY: SEAN
UNITS
APN:
BP#: 15040194
`VALUATION: 1$540,000
"PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
#
PENTAMATION FURN/AC
PERMIT TYPE:
WORKINSTALL
4 NEW HEAT PUMPS & 4 AC FOR FIRST & SECOND FLOOR LABS
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
,�'��«,��� (�a `�'r� ;,
QTY
UNITS
BP FEES
A/C Units (>1OK cfm)
hr,,
I"C, I,!P.
4
#
$572
Heat Pump (>1OK cfm)
4
#
$572
PME Unit Fee:
PME Permit Fee:
$
Administrative Fee:
IADMIN
$45.00
$0.00
Work Without Permit? O Yes (D No
TOTALS:
0
Travel Documentation Fee: /TRA VDOC
1 $1,144.00
IBSE/SMICO
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
Mech. Plan Check 0.0 hrs $0.00
,�'��«,��� (�a `�'r� ;,
Mech. Permit Fee: IMPERiI/T
Other Mech. Insp. 0.0 hrs $4 . 0
hr,,
I"C, I,!P.
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
FEE QTYIFEE
MISC ITEMS
Pion Cdr"(.l)"":,:
PME Plan Check:
$0.00
$1,144.00
PME Unit Fee:
PME Permit Fee:
$
Administrative Fee:
IADMIN
$45.00
$0.00
Work Without Permit? O Yes (D No
0
Travel Documentation Fee: /TRA VDOC
Strom, Motion Fee.
IBSE/SMICO
) ,
$22.00
Select an Administrative Item
la�fr�o
Bldg Stds Commission Fee: IBCBSC
SUBTOTAL
$0.00
; TOTAL FEE:
/,)—W Z 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
JOB ADDRESS:
OWNER'S NAME:
PERMIT # h 5--0— 4U15 4
PHONE # O
GENERAL CONTRACTOR: SC p"S �,
BUSINESS LICENSE #
ADDRESS: 910
CITY/ZIPCODE: e_ 9 01357
*Our municipal code requires all businesses working in the city to have a City of Cupertino business Iicense.
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
Please check applicable subcontractors and complete the following information:
Date
ontractor Signature
I'D
Date
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
L
2-111)
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
�' L L
l S co
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
u iG �t 117
Paving
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
S- ARS
!
Tile
ontractor Signature
I'D
Date
Date