13060088CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10435 N TANTAU AVE
CONTRACTOR: DPR SKANSKA, A JOINT
PERMIT NO: 13060088
VENTURE
OWNER'S NAME: CAMPUS HOLDING INC
1450 VETERANS BLVD
DATE ISSUED: 06/25%2013
OWNER'S PHONE:
REDWOOD CITY, CA 94063
PHONE NO: (650) 474-1450
Er LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL1:
�� )
License Class Lic. H � IG'
APPLE- TEMPORARY MOCK UP- TO DISPLAY BUILDING
Contractor Date dj
FINISHES
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: $340000
performance of the work for which this permit is issued.
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: 31606039.00
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 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 ;S T+� LED INSPECTION.
indemnifyand kee h less the Ci of Cupertino against liabilities, judgments,
P City p g J gm
costs, and expenses � 'ch may accrue against said City in consequence of the
°m
granting of this pe i Additionally, the applicant understands and will comply
Y Date:
with all no ins per the Cupertino Municipal Code, Section
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Zrgulati
9.18. ^�
.�„
Signat v Date"� / — 7
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
1 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)
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) ! Id 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 eq ent or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Ba ea Air uality Management District I
performance of the work for which this permit is issued.
will maintain compliance wit the C rtino M n ipal Code, Chapter 9.12 and
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
the Health & Safety Code, c ' 5505 553 nd 25534.
4
Owner or authorized a en •, 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, 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 (See. 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 0
all (408) 777-3228 • FAX (408) 777-3333 • building(cDcuperbrIL rg
CUP£RTINO
NEW CONSTRUCTION ❑ ADDITION 'tkALTFRATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS j\ i
APN # `� I 676n O
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OWNER NAME / 'r /�vvl' G �r 'tJ �
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FAX
CONTACT NAMEN�GY
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FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ifCONIRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ^ r� �L L_
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LICENSE NUMBER
LICENSE TYPE BUS. LIC #
COMP NAME
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CITY STATE , ZIP �� V O 6 PHONE
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ARCHTTECT/ENGINEERNAME
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LICENSEMEMBERG z���O
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COMPANY NAME0 -p�z- 1- O^LT�
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PAXSTREET
STATE, - 6A 1743,0E
DESCRDMON OF WORK This"4h_ik L`_YylKe �S� 6 � 2 �� CL
'��i✓Y1�D��G1
1�-it•/(�� ft � rSl�es
EXISTING USE
OPOSED USE
CONS R_ TYPE
I STORIES
4igz � U
USE
TYPE
OCC.
SQ.FT.
VALUATION
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KrrCHEN OTHER
REMODEL AREA
REMODEL AREA REMODEL AREA
PORCH AREA
DECK AREA
DECK/PORCH ARE
GARAGE AREA: LIDETACH
=AL
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED', ❑NO
ADDITION? []NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES"
EICHLER HOME? ❑ NO
���� ����
9 'f� I�
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TAL VALUATION:
i900�
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 haver I the Descri Von of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin s cti n a ze ese trves of Cupertino to enter the above -identified ope% for inspection purposes. ,
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION UIRED
ti,r
_New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
r�
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
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,❑^� NViItG1�iMEN �;�iom,l�'�'
BldgApp_2011.doc revised 06/21/11
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CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
10435 N TANTAU
TYPE OF
CONSTR.
DATE: 0611212013
REVIEWED BY: MENDEZ
11alADDRESS:
APN:
BP#: &I 8- 0
"VALUATION: 1$340,000
*PERMIT TYPE: Building Permit
II-B,III-B,Iv,v-B
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
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PENTAMATION
PERMIT TYPE: 1 B T�
WORK
APPLE- TEMPORARY MOCK UP- TO DISPLAY BUILDING FINISHES
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,Iv,v-B
0
$0.00
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El--t--
$0.00
1'17fw1f. hop, bcc��
?��`� bmp. /"'c.
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
0
$0.00
$0.00
4
FEE
C, HOURLY
A/c,,It, Pkirl C
C'lrrr th 1'/ou Chccf,
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llho th. l'""w1 1 l''ce'
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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 preliminary information available and are only an estimate. Contact the Dept.for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 71112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes No
$0.00
2 hours Plan Check, Hourly
$266.00 ISTPCNCx
Suppl. PC Fee: 0 Reg. 0 OTJ
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
d. r7FZ.5/P"PPf'PXtJIi �C7:i
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
're -c vcl Dvcf:Prrenicuio rl
Strong Motion Fee: IBSEISMICO
$71.40
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$14.00
ti
R,
$85.40
$266.00
$351.40
Revised: 04/29/2013
CUPERTINO
CQNTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: I V 0 KI " Ceu eu-�
PER-N/11T# (3O6OaY
OWNER'S NAME:
PHONE#
GENERAL CONTRACTOR:, >
BUSINESS LICENSE #
.ADDRESS: V'�qO�-AeVCA-A`> Qt,0(--C1TY/Z1PCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
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
V
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
A
Tileh
'A%.5
Own . er / Cjtr'actor Signature Date