13110169 CITY OF'CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10200 S DE ANZA BLVD CONTRACTOR:VULCAN PERMIT NO:13110169
CONSTRUCTION INC
OWNER'S NAME: SEAGATE TECHNOLOGY LLC 346 MATHEW ST DATE ISSUED.11/26/2013
OWNER'S PHONE: 4086581602 SANTA CLARA,CA 95050 PHONE NO:(408)499-6039
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE]
;i"nse Class_ Lic.# 5 !_ �S_� SEAGATE-IST FLOOR INSTALL IN LINE EXHAUST FAN/
POWER UP FAN IN SHOWER ROOM
Contractor Vi.�Lcha �awl�. �NCDate [1 --Z �' f �
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:
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:$850
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:36901035.00 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 00 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 DAY M 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
Aou
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
a 4t. �?� .,; --s: c�'r? = J� All roofs shall be inspected prior to any roofing material being installed.If a roof is
y. installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
I,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
1 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 contamivants 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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25 34.
Section 3700 of the Labor Code,for the performance of the work for which this or, i!,. 'r`
permit is issued. Own 1` uthor+zed-agen
I certify that in the performance of the work for which this permit is issued,l 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,1 must 1 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
1 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 meutioned 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 accnic 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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �`14
CUI�EIRTINO (408)777-3228•FAX(408)777-3333-buildingCCt7.cuperllno.Orq 1 MISC
PLUMBING MECHANICAL JZELECTRICAL DMISCELLANEOUS
PROJECT ADDRESSO 0 5 T Z J APN
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ARCHTCECTIENGWEER NAME l+ LICENSE NUMBER1 O r� BIDS.LIC 0
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STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD ar DUPLEX ❑ MULTI-FAMILY PROJECT INWI-DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG ATL ❑YES
BUILDING. ❑CONMMCUU. URBAN RRTMACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
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EIVED -
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By my signature below,I eertify to each of the following: I am the property owner or authorized agent to act on t e ji4perty owner's behalf I have read this
application and the information I have provided is correct. 1 have read the D cription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons ion. I authorize r sentatives of Cupertino to enter the above ntified operty for inspection purposes.
Signature
.�
SUPPLEMENTAL i0ORMATION REQUIRED oFFlc> usE otv y- R
`Y"st. THE-COUNTER
; XI'RESS
MEPMisc.4pp_201I.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10200 s de anza blvd DATE: 11/26/2013 REVIEWED BY: Sean
APN: BP#: *VALUATION: $850
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration !Addition 1 Repair
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1CMAP8
WORK sea ate- 1 st floor install in line exhaust fan/ power up fan in shower room
SCOPE
Mech.Plan Chcck 0.0 1 hrs $0.00 Phnr,b. Plan,Check FT Elec.Plan Check 0.0 hrs $0,00
Mech.Permit Fee: IMPERMIT ]'lump,Permit Fee: Elec.Permit Fee: IEPERMIT
Other Mech.Insp. 0.0 �hrs $47 Other Plumb Insp. Other Elea Insp. ETrs $47.00
Ale-ch.Insp.Fee: I Phanb. htsp,Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments r.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These ees are based on the prelimina information available and are only an estimate. Contact lire De t or addn'l info
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl.PC Fee: (F) Reg. Q OT 0.0 1 hrs $0.00 $24.00 1BREMVENF I Ventilation Fan
PME Plan Check: $0.00 1 1 Electrical
Permit Fee: $0.00 $139.00 IBREMMISC Special Circuits
Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $94.00
Conslrrrclion Tax: T7
Administrative Fee: LIDA" $44.00
Work Without Permit? O Yes Q No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure 0
Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $186.50 $163.00 TOTAL FEE: $349.50
Revised: 1010112013