14040183 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10001 N DE ANZA BLVD CONTRACTOR:VULCAN PERMIT NO: 14040183
CONSTRUCTION INC
OWNER'S NAME: TAMBELLINI DEANZA PROPERTIES 346 MATHEW ST DATE ISSUED:04/28/2014
OWNER'S PHONE: 4086581602 SANTA CLARA,CA 95050 PHONE NO:(408)499-6039
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
SEAGATE-T.I.-(N)OPENING IN(E)DIMISING WALL
License Class L Lic.#12- 5'fi,9-
Contractorate
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2279
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:32634074.00 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 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 A SPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the .
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point source regulation er the Cupertino Municipal Code,Secti
9.18. ,
Anfi4: ngmOFS:
Signature Date 0 All roofs shall be inspected po aterial 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:
f 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)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 ofthe 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 25,505,-1563_3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �.
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 ofexemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must l 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
CONSTRUCTION PERMIT APPLICATION
r COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION Bl'�a
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 t�V
CUPERTINO 1
(408)777-3228• FAX (408)777-3333• bullding(a)-cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS f DCS l 'L,E /4',-SA —B, I 1/` APN# — 3 , I _ O
OWNER NAME PHONE �G E-144,11,1,
S� l Z
STREET ADDRESS /O^ �M• CITY, STATE,ZIP FAX
CONTACT NAME-9k,,,,-,,
/, ,,A /-�-^:; PHONE4Dr1 E-MAIL
STREET ADDRESS � CITY,STATE, ZIP FAX
❑ OWT'ER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME / LICENSE NUMBER LICENS PE BUS.LIC#
s�J
COMPANY NAME E-MAIL AX
v
STREET ADDR.ESS3r CITY,STATE IP PHONEG,
ARCHITECT/E EE AME LICENSE Z � BUS.LIC#
COMPA N ME E-MAIL FAX
�6T ET REStS� CITY,STATE�ZIP PHQNE
(J +
DESCRIPTION OF WORK I�
EXISTING USE PROPOSED USE CONSTR TYPE d STORIES
USE TYPE OCC. SQ.FT. VALUATION(5)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA �()
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREATOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
k DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ONO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES IOTA VALUATION
PLANNING APPI-9 ❑NO PLANNING APPROVAL LETTER EICHLER HOPIE? ❑NO
By my signature below,I certify to each of the followi : I am the property owner or authorized agent to e prope owner's be a ead this
application and the information I have providIt torr t. ave read the Description of Work and verify it is accur I agree to corn I all applica sal,__
ordinances and state laws relating to bui]dinru f Cupertino to enter the abo `o/perry for inspection purposes.
Signature of Applicant/Agent: Date: `J
SUPPLEMENTAL IMF ATION.REQUIRED rtpE�`c>�CK �E = xOVTING"srP .,.;,F _
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER TaE cout*IrER " '' suu v�G rT REQ IEW
existing building(s). Demolition permit is required prior to issuance of building ks# No
AN
permit for new building. ❑`EXPRESSO -IRPLAA IN CrPLA11RESTEW '
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �:sTD � � � ruB14Ic voRlts � t
6.0
form if any Hazardous Materials are being used as part of this project. 33 �
_Copy of Planning Approval Letter or Meeting with Planning prior to
MAJORS ❑ SANITARYSEIVERDISTRtCT ''
submittal of Building Permit application,
r.,s - ❑..:EIQVIR014NIENTAIs.FIEALTH a.x,��...'
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ILI ADDRESS: 10001 N DE ANZA BLVD DATE: 04/28/2014 REVIEWED BY: MELISSA
APN: 326 34 074 BP#: *VALUATION: 1$2,279
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK SEAGATE -T.I. - N OPENING IN E DIMISING WALL
SCOPE
F-1 LJ Lj
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7-'1:73) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes (j) No $0.00 1 hours Plan Check, Hourly
Suppl. PC Fee: Q Reg. 0 OT 1 0.0 1 hrs $0.00 $139.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
T-T-
Work Without Permit? 0 Yes ) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure 0
i
Strong Motion Fee: IBSEISMICO $0.50 2.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $278.00 ISTINSP Inspection,Hourly
SUBTOTALS: 1 $1.50 $417.00 TOTAL FEE: 1 $418.50
Revised: 04/01/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: I c�O I tJ PERMIT# I L-f J 4401
OWNER'S NAME:TAAA b-e41 c PpP: PHONE# Q Ll
GENERAL CONTRACTOR: VU S BUSINESS LICENSE# 31- c?
ADDRESS:` `3L( �-� CITY/ZIPCODE: GI
*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 SUBCONTRAC AVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: t
Signature date
Please check applicable subcontractors and complete the following information:
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
Tile
Owner/Contractor Signature Date