14040059-EXPIREDCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10385 S DE ANZA BLVD
CONTRACTOR: US DEMO AND HAULING
PERMIT NO: 14040059
INC
OWNER'S NAME: BDC HAYWARD LP
1 CORTE DEL REY
DATE ISSUED: 04/10/2014
OWNER'S PHONE: 9255882222
ORINDA, CA 94563
PHONE NO: (925) 376-3050
ur LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
T.I. PREP - REMOVE FLOORING, PARTITION WALL,
License ClassLic. #
CEILING GRID (1,771 S.F.)
nC6
Contractor (,u ADr,� Date
1 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: $6600
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: 35917019.10385
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 PE SUANCE 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�FR�LED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the/J.`6
/
granting of this permit. Additionally, the applicant understands and will comply
I ss a e:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
4,16 /�
RE -ROOFS:
Signature Date Q
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 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)
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(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 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: _ �,��L� Date_0�12P�_
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 (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
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 regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
ICUPERTINO 1
—1
I I NFW (YINSTRI ICTinw
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408-)) 777-3228 • FAX (408) 777-3333 • buildinq(a?cupertino.orq
r
I I AnT)TTION VAT.TFR ATTON / TT 71 RFVTRTCIN / DF.FFRRFT)
1
00
N
nRT61NAT, PERMIT #
PROJECT ADDRESS /O 2 \ D � A lu L ^ p LV ^
% J J �t r� %
TAPN# , r,I Y ' �] _ O ' p
-` jE-MAIL I
OWNER NAME PHONE
� _OI.nM/�!•M 1JEV,�,'L.0PM�ivT 9'a_S-S8�S-22ZZ
Sbhhl`e�(��ro��Mti c�trel� ,.en
STREET ADDRESS C�
�� S', Q�?A g&kb
CITY ST TE, ZIP
FAX
{ D
L0PaP_l-tNO I LI -A
CONTACT NAME SCO I -T 17V71 17 o �I r^ � e
i
PHONE
91 63-�-
E-MAIL � r
sbvl,rerC.6�w��nderelo �,�,r.
STREET ADDRESS iS.56 1' 4,RK,_T1 b O A,V\F_
CITY, STATE, ZIP WkLNUr CLf- ( [k W16
FAX
VWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME I ( J_l L "L- "
LICENSE NUMBER �� (-o
CIC SE TYPE
BUS. LIC #
COMPANYNAME/C6� r�
�g,
E-MAIL
FAX �y�S� 3 �L•�O
STREET ADDRESS///
CITY, STATE, ZIP
PHONE
.43^
(#
�I
v/ l
t4 6,t
3 W "
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK -{- f) r� ` N I F-0 U ^E Of `'A ZII T\ o Ai S CKI LW 6, &-Z (I) J✓Loci EI'VC,
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
USE TYPE OCC. SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: UDETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑NO
ADDITION? NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
VED N:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
V
'00
By my signature below, I certify to each of the following: I am the property owner or au orized agent to act the prope timer's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is agree to comply with all applicable local
ordinances and state laws relating to building con ction. I alllborize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:Date: 10
SUPPLEMENTAL INFORMATIO QUIRED
PLAN CHECK T]TE
ROUTING SLIP
❑ OVER-Tr--IE-coUNTER
❑ BUILDING PLAN REVIEW
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.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC NVORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE''
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER 11 DISTRICT
submittal of Building Permit application.
❑ ENVIRONNIENTALHEALTH :-
BIdgApp_2011.doc revised 06/21/11
tco
Pon
CITY OF CUPERTINO
FM__7 FEE ESTIMATOR — BUILDING DIVISION
1A,
ADDRESS: 10385 S DE ANZA BLVD
DATE: 04/10/2014
REVIEWED BY: MELISSA
APN: 359 17 019
BP#: O S
"VALUATION: 1$6,600
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
i
PENTAMATION
PERMIT TYPE: 1TIPRE
WORK
T.I. PREP - REMOVE FLOORING PARTITION WALL, CEILING GRID (1,771 S.F.
SCOPE
PME Plan Check:
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 prelinddna information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$405.00
Tenant Improvement Prep
ITIPREP
i
Suppl. PC Fee: Reg. Q U"t'
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg.
Q OT
0.0
lirs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
n Tax:
'Icbn?r1011'utirC FCC.
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
O
i
Strong Motion Fee:
IBSEISMICO
$1.39
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.39
$405.00
TOTAL FEE:
F $407.39
Revised: 04/01/2014
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 1 03 S S 9LV0 PERMIT # O YO OS-
OWNER'SNAME: PHONE#
GENERAL CONTRACTOR: ),VC BUSINESS LICENSE #
ADDRESS: IZ,, 10 1tVAt,-t 9-Cark CITY/ZIPCODE:
*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. ` l
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
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