150500441A
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10165 N DE ANZA BLVD
CONTRACTOR: INFINITE LOOP HOTEL
PERMIT NO: 15050044
LLC
OWNER'S NAME: INFINITE LOOP HOTEL LLC
20660 STEVENS CREEK BLVD #331
DATE ISSUED: 11/10/2015
OWNER'S PHONE: 4088168759
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
ALOFT - T.I. TO CREATE (N) DINING AREA (450 S.F.)
License Class Lie. #
LOCATION: BIN A6
Contractor Date
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 declm•ntions:
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: $67500
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: 32634057.00
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 1$0 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
1$0 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
e
granting of this permit. Additionally, the applicant understands and will comply
Issued by: _ JC r v Date:
with all non -point source regulations 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.
OWNER -BUILDER DECLARATION
-Signature o 'Applicant:. ate:
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
I, 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)
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 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 Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2 V53a, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dater Ca CJ
.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, l 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 1 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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 g ations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
,D
Signature Date r /IS
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
19
ADDRESS: 10165 N DE ANZA BLVD
DATE: 05107/2015
REVIEWED BY: SEAN
PC FEE ID
APN:
BP#:
VALUATION: 1$67,500
*PERMIT TYPE: Building Permit
PLAN CHECKTYPE; Tenant Improvement
PRIMARY Commercial Building
USE:
IATIPLNCK
PENTAMATION 1A TI
PERMIT TYPE:
WORK
TENANT IMPROVEMENT IN BAR/LOBBY TO CREATE PIZZA DINING AREA 450 SQ FT).
SCOPE
Suppl. Insp. Fee(Reg. (:) OT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
A (Tenant Improvements)
II-A,111-A,V-A
450
$3,047.00
IATIPLNCK
$742.00
1ATIINSP
-L-{n-c Inst}I r:
$742.00
Suppl. Insp. Fee(Reg. (:) OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
ConswuCtion ax:
'Idministratiue Yee.
0
E)
Work Without Permit? Yes Q No
$0.00
TOTALS:
450
1 $3,047.00
TtC�Vel(�C'iitP2c"'.7Ztltld(.777 F(CS:
$742.00
Strong; Motion. Fee: IBSEISMICO
MECH, HOURLY" - IFes O No
PLUMB HOURLY . Yes : • ' No :'
, � .,,�
ELEC HOURLY Yes No" ;'
: , !� •
Meoh. Plan Chuck
l'bunb_ Man Clrcck
1'.7ec..l'1an (Ylecic
19edr. pernift fee;
1'*lamb. f'rrnit I; ser
# vc. 1'V.nnia l e
Ohter A'Iech, lisp
Other F 1virlb Imp.
01}1�?r• L:lec. Irup. Li
$0.00
1''hpa tli, I. •l , 1 .e�:
-L-{n-c Inst}I r:
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 oreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,047.00
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: (E) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$742.00
Suppl. Insp. Fee(Reg. (:) OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
ConswuCtion ax:
'Idministratiue Yee.
0
E)
Work Without Permit? Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
A
TtC�Vel(�C'iitP2c"'.7Ztltld(.777 F(CS:
Strong; Motion. Fee: IBSEISMICO
$18.90
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS..
$3,810.90
$0.00 TOTAL FEE:
1 $3,810.90
Revised: 0410112016