13110156CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10590 N TANTAU AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 131 10156
OWNER'S NAME: 10590 TANTAU INVS LLC
851 BUCKEYE CT
DATE ISSUED: 11/22/2013
OWNER'S PHONE:
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
LICENSED CONTRACTOR'S DECLARATION
i
BLDG
lie Class Lic. # &yl Lkso
BUILDING PERMIT' INFO: ELECT PLUMB
F_ �a
r
MECH RESIDENTIAL COMMERCIAL
Contractor 'kL Date uI'2211� 3
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: Tl PREP -INTERIOR DEMO
(commencing with Section 7000) of Division 3 of the Business & Professions
SEE PERMIT 13110018 Tl IN PLAN REVIEW
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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: $0
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
permit is issued.
APN Number: 31618035.10590
Occupancy Type:
APPLICANT CERTIFICATION
I certify that l 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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and xp rises which may accrue against said City in of the
180 DAYS FROM LAST CALLED INSPECTION.
granting o tlti permit. Additionally, the applicant understands and will comply
with all n -poi t source the Cupertino Municipal Code, Section
Oer
9.18.
Issued by: �d�/ A® Date:
Signature Date h 8L f
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
1, 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
1 hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Ilealth & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(x) should 1 store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additi pally, should 1 use equipment or devices which emit hazardous air
permit is issued.
conta i ants as defined by the Bay Area Air Quality Management District 1 will
main ain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Ilea h & Safety Code, Sections 25505, 25533, and 25534.
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
Ow r authori agent:
become subject to the Worker's Compensation provisions of the Labor Code, I must
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. 1 agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ARCIi1TECT'S DECLARATION
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
1 understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CUPER'T'INO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 ^ building a(kugertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #i
PROTECT ADDRESS �7
APAN #
OWNER NAME
PHONE
E-MAIL
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STREET ADDRESS CITY, STATE, ZIP
FAX
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
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COMPANY NAME
E-MAIL
FAX
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ARC HITECT/EN GIN EER NAM E
LICENSE NUMBER
BUS. LIC #
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COMPANY NAME
E-MAILpp
FAX
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
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DESCRIPTION OF WORK
p +n '
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
"T J
+�
/ ; j
r
(GJ s/
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODEL AREA
REMODE
PORCH AREA
DECK AREA TOTAL DECK/PO
A GARAGE AREA: LJ DETACH
❑ ATTACH
# DWELLING UNITS:
ECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEINGADDED? ONO
ADDITION? DNO
PRE-AUJ.Ie' TION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN [3 YES
RECE BY:, ,. TOTAL VA TION:
PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
he following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
By my signature below, I certilhavprovided
application and the informatiois correct. have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relafg constructio . I authorize representatives of Cupertino to enter the ab ve-identified property for inspection purposes.
Signature of Applicant/Agent: Date: I- 17
SUPPLEME TAL INFORMATION RE UIRED
,PLAN CHECK TYPE1,
`iOUruac SLIP
OVER -THE COUNTER
BU[LD*dPI kN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition pen -nit is required prior to issuance of building
permit for new building.
''EaPRESS` '
❑ PLANNING PLAN REVIEW '.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
❑ - PUBLIC I''oRKs.. ,
form if any Hazardous Materials are being used as part of this project.
inucii
" ❑ .FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
El
❑
_
submittal of Building Permit application.
,111AIOR
SANITARY SEN4ER"mSTItICT -
• ENVIRONIITENTALHEALTH
BldgApp_201 ].doe revised 06/21/11
!l'�YrF'+R7 .tea -91 .f Tr T1Fb1r77'n1VV TfrT
NOTE: This estimate does not include fees due to other Departments (i.e. 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 addn7 info.
FEE ITEMS (Fee Resolution 11-053 fff 711113)
IL -A IL A XLP-W 41.lai A Alin IL RI N VJ/
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10590 N Tantau Ave DATE: 11/22/2013 REW EW1ED BY: Sean
Plrunh. Plan Check
APN:
I.BP#:
-VALUATION: Iso
PERMIT TYPE: Building, Permit
PILAN CHECfC TYPE: Alteration /Addition /Repair
PRIMARY Commercial Building
USE:PERMRT
Other Elec. Insp.
PENTAMATUON 1TIPREP
TYPE:
WORK
TI Pre 17630 sq ft
SCOPE
$0.00
Suppl. Insp. Feer Reg. 0 OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
COnS1177Cti0n TcTV.
Administrative free:
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Travel Doeumentation Fe&�V
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$405.00
TOTAL FEE:
$405.00
NOTE: This estimate does not include fees due to other Departments (i.e. 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 addn7 info.
FEE ITEMS (Fee Resolution 11-053 fff 711113)
L1ec%. Plan Check
Plrunh. Plan Check
Elec. Plan Check
Mach. Perrnil Fee:
Plumb. Permil Fete:
Elec. Permit Fee:
O{hei HeCh..Imp.
Other Plumb Insp.
Other Elec. Insp.
�ldcch. Insp. Fee:
Plumb. hrsp. Feet:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. 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 addn7 info.
FEE ITEMS (Fee Resolution 11-053 fff 711113)
FEE
QTY[FE]E
MISC RTEMS
Plan Check Fee:
$0.00
=# Tenant Improvement Prep
$405.00 ITIPREP
Suppl: PC Fee: (E) Reg. Q OT El
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
COnS1177Cti0n TcTV.
Administrative free:
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Travel Doeumentation Fe&�V
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$405.00
TOTAL FEE:
$405.00
Revised: 10/01/2013