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15010126CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR: DEVCON PERMIT NO: 15010126 CONSTRUCTION INC OWNER'S NAME: CUPERTINO TANTAU LLC 690 GIBRALTAR DR DATE ISSUED: 01/23/2015 OWNER'S PHONE: 4084990223 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ APPLE TENANT IMPROVEMENT (FIRST FLOOR) (10240 SQ License Class 6�1 L'1 L Lic. # �j &%, % (p ,�5 FT). Contractor Date 2 I hereby affirm that I am licensed under the rovisions 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: $150000 performance 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: 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. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS-0f PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned for inspection (We) agree to save 180 DAYS FRO AI LMT CALLED INSPECTION. property purposes. indemnify and keep harmless the City of Cupertino against liabilities, judgments, s costs, and expenses which may accrue against said City in consequence of the 1 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: �. 1 �':-" with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signature_ Date 1 23 Irj RE-ROOFS: 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) t, 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 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sect' s O5, 25533, ai 34. t 2-3115 Owner or authorized agent: Date: 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, [ 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. 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 l 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 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.orq NEW CONSTRUCTION ❑ ADDITION lbJ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 0 PROJECT D DRESS0 ALL- APN H // T D OYR NAME �<NU �—�J • /F7J� ` C3&,—o PHONE LLr�Gt •� J . d Z�� E-MAIL ��DO STREV AD RESS CITY, STATE, ZIP FAX CONTACT NAME PHONE -MAIL >✓ MdDRE" YOB' �•D� STREET ADDRESS // ✓ / o CITY, ST!% ZIP r✓a G119 FAX ❑ OWNER. ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO T1 G CONS7R u C7�b LICENSEfe / �'{ ((%% / LICENSE TYPE BUS. LIC k CQ PANYNAy�% dA C) C ��� �1 E-MAIL FAX STREET ADDRESS /!L71tA bA. CITY, STATE, ZIP CIA- 7S83 P140 .Z427- .Z5S ARC . rECT/ENGJT,N'EER N M LICENSE NUMBER BUS LIC k L1 NAME COMP4 NAM S C /Y E-MAIL k11^ X u� S FAX / . ' -6S-l' V STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE k STO S ,r - a- 1 / USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER '.. REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH ''. # DWELLING UNITS: IS A SECOND UNIT C3 YES SECOND STORY []YES_ BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY - , TOTAL VALV„A;pl, u: PLANNING APPL AI ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO , 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 al I applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified roperty for inspection purposes. Signature of Applicant/Agent: °°'�~ Date:/Z� �5 SUPPLEMENTAL fNFORMATION + , PLAN CHECKTYPE RpC]TIIVG SLI . Q,�iR T1 E -q 'TER " BIJILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demo rtlon permit for existing building(s). Demolition permit is required prior to issuance of building° permit for new building. ,:. ,. ©' Ex REss ❑"PI ANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q STANDARD ' 1 ° PTIBLIC WORKS form if any Hazardous Materials are being used as part of this project. ET LARGEFIRE DEPT„ �rSANITARY Copy of Planning Approval Letter or Meeting with Planning prior to `,S, submittal of Building Permit application. srwERDIsxRICT CD> ENVYRQNMENTAL HEALTH BIdg,4pp_2011.doe revised 06/21/11 v -f CITY OF CUPERTINO FM_71 FEE ESTIMATOR -BUILDING DIVISION ADDRESS: 10900 n tantau-ave TYPE OF CONSTR. DATE: 01/22/2015 REVIEWED BY: Mendez APN: BP#: It 5VO `VALUATION: 1$150,000 `"PERMIT TYPE: Building Permit II-B,III-B,IV,V-B PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAMATION PERMIT TYPE: 1 B TI WORK comm ti 10240 sq ft $0.00 SCOPE Lj -L- OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA ss. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 10,240 $2,719.06 IBTIPLNCK $6,679.05 1BTIINSP hrs $0.00 PME Plan Check: Lj -L- EJ Permit Fee: $6,679.05 SuppL Insp. Fee:Q Reg. Q OT F0,0Thrs $0.00 PME Unit Fee: $0.00 TOTALS: 10,240 $2,719.06 $0.00 $6,679.05 MECH, HOURLY 0 Yes 0 No `' PLUMB, HOURLY ® Yes Q No ELEC, HOURLY ® Yes 0 No Swimming Pool Vinyl -Lined i Suppl. PC Fee: 0 Reg. 0 OT FO.0 hrs $0.00 PME Plan Check: Lj -L- EJ Permit Fee: $6,679.05 SuppL Insp. Fee:Q Reg. Q OT 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 nreliminary information available and are onlv an estimate. Can tact the Dent for addn'l info. FEE ITEMS (Fee Resolulion 11-053 Eft. T'11'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,719.06 :1 s.f. $0.00 Swimming Pool Vinyl -Lined i Suppl. PC Fee: 0 Reg. 0 OT FO.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $6,679.05 SuppL Insp. Fee:Q Reg. Q OT F0,0Thrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Q Strom Motion Fee: IBSEISNIICO $42.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $9,446.11 $0.00 TOTAL FEE: $9,446.11 Revised: 01/06/2015 CUPERTINO CONTRACTOR TOR / SIBC®ia1'I'RACTOIB LIST Building Department City Of Cupertino 10300 Torre Avenin Cupertino, CA 95014-3255 Telephone: 408-777-3223 Fax: 408-777-3333 JOB ADDRESS:__0-cl-2 V'I2�,i�,- OWNER'S NAME: I C',� �.._ _ _ €,ENIEIRALCONTRAC'T R� F, ��,v1 -- PERIMIT-4 t S°1612 - j"HONE rt Lf1L° `I `7 Z � 2 00 BUSINESSLICEN-SE# -- Ant RESS: (Qcl b BUSINESS LICENSE # CITYIZIPCOUE: l4 I 1 9s ?Y5 *Out- municipal code requires all hosinesses working in the city to h,rve a City of Cupertino business license. NO BUILDING FINAL OR FINAL. OCCURkNCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL: SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I ant not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following iinfor ri ation: V SUBCONTRACTOR BUSINESS NAME � — BUSINESS LICENSE # Cabinets & Millwork Cement Finishing V Electrical ' Excavation Fencing Flooring I Carpeting Linoleum / Wood Glass / Glazing Heating JnWlation Landscaping Lathing Masonry v/ Painting! Wallpaper -- . Paving Plastering Plumbing Roofing _ _ Y Septic Tank Sheet Metal yr j k60/ Me V c_k_,__.___._ S11eeC RoCI< (�i J^2 LI� l�✓L%L��t Tile T _�.. -- ---------- 5 ZG /5 OWDer / Contractor Signature Date CUPERTINO TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 a FAX (408) 777-3333 • building@cuper ino.orq APM'l / U Z b Y DATE. Q �s, Zp VALLUPOJATION: $ (� D1 Q O v SITE ADDRESS: OWNER'S NAME: /2 �/7 G PHONE #: FEE' $286.00/m0 FAX #: MAILING ADDRESS (if different from site ddress):00 � CONTRACTOR: �_,c 'Dew erYl co-eis�tlolm PHONE* O& cf Z 2 on FAX#: 06'2&2 23C12- 3yzCONTACT: CONTACT: /CG (,Z/ I nV d tt Z2i PHONE #: FAX #: TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND AMOUNT (1% VALUATIONS6� U �' DSONDSJ CODE El' CHECK El CASH BOND OF BOND: SK min -10K max EDITION: TCO EXPIRATION g /S FEE' $286.00/m0 TOTAL FEE: $ S �'Z [1TEMPOCCJ DATE (6 MONTHS MAX): USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT >e�S 12y 132-21 iia ❑ APPROVED WITH CONDITIONS" Signature:...................................................... Date:...................... other ❑ APPROVED ❑ APPROVED WITH CONDITIONS" Signature:......................................................... Date:...................... OTHER DEPW1106T I AGENCY APPROVALS: / annrng .../ / .......... Date: Sinature; ........................................... L15...APPROVED ❑ APPROVED WITH CONDITIONS" Fire r nature; ...... . .. .................... Date:....... / 5 ❑ APPROVED ......... ❑ APPROVED WITH CONDITIONS' 'Public Works ❑ APPROVED ❑ APPROVED WITH CONDITIONS" Signature:...................................................... Date:...................... other ❑ APPROVED ❑ APPROVED WITH CONDITIONS" Signature:......................................................... Date:...................... *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each Item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non-compliance may result in an enforcement a ion. Owner Contractor f/ S SianatWSAMMt.IU.Ikd.V Date:�.Signature:.................................. Date: ... This temporary certificate a ures tha I fi rote�on and life safety systems have been completed, inspected, successfully tested and -rproved for the specific it e f the ui g eafied above to provide a reasonable degree of safety to the occupants from fire and .milar emergencies, BuildingOfficial:.. . . ............ Print: AllP ........... Date:..6 .....� 4 ......... DEPARTMENT ACTION: After d rminafio?V copies to: 1) applicant, 2) permit file TempOccForm_2013. doc revised 717114