13110102CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10445 S DE ANZA BLVD CONTRACTOR: ELEVEN WESTERN PERMIT NO: 13110102
BUILDERS, INC
OWNER'S NAME: BDC HAYWARD LP 2862 EXECUTIVE PL DATE ISSUED: 04/03/2014
OWNER'S PHONE: 9255882219 ESCONDIDO, CA 92029 PHONE NO: (760) 796-6346
P LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
SEPARATE (E) BLDG WITH (N) DEMISING WALL, CREATE
License Class Lic. # �� 0� (N) OPENINGS, MODIFY MEP'S & ADD (N) ADA
Contractor[` LOW 96"r"O (304A%ate 3 / RESTROOM
& UPDATE (E) RESTROOM 12,275 SQ FT
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: $350000
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: 35917019.10445 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 WITHINS 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 DA FROM LAST CALLED 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 Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, ction
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 of Applicant: Date:
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)
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 Owner or authorized agent: Date:
permit is issued.
1 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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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 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
CITY OF CUPERTINO
//jV&,C FF.F, ESTIMATOR - BUILDING DIVISION
19
ADDRESS: ,W95" DE ANZA BLVD
DATE: 11/14/2013
REVIEWED BY: MELISSA
PC FEE ID
APN: 359 17 019
BP#:
I -VALUATION: 1$350,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Buildin
USE: g
IMTIPLNCK
PENTAMATION 1M TI
PERMIT TYPE:
WORK
SEPARATE E BLDG WITH N DEMISING WALL CREATE N OPENINGS MODIFY MEP'S & ADD
SCOPE
(N) ADA RESTROOM & UPDATE (E) RESTROOM 12,275 SQ FT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
M (Tenant Improvements)
II-B,III-B,IV,V-B
12,275
$3,768.49
IMTIPLNCK
$7,044.09
IMTHNSP
�. hn/,). Fee:
PME Plan Check:
$0.00
Permit Fee:
$7,044.09
Suppl. Insp. Fee -0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
12,275
$3,768.49
Conswuction Tax:
$7,044.09
MECH, HOURLY 0 Yes (F) No
PLUMB, HOURLY 0 Yes 0 No
ELEC, HOURLY 0 Yes 0 No
MISC ITEMS
Numb. Plan Cheek I I
I (:c- Plan Check
afer:h 1 .. , _
Plumb. Permit Fee
F.lec. Permit Fee:
Qthc"r Afech. Insp.
0) her Plumb Insp.
01her Elec. Insp.
th�ch.Insp.Iee:
"hruiG. Iusl,. !
�. hn/,). Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary sewer District, school
n:....:. ,,,,. T1. w f o , t,. d gn f4e nFeEmt nano intMrma/inn available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7%1.'13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,768.49
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hes
$0.00
PME Plan Check:
$0.00
Permit Fee:
$7,044.09
Suppl. Insp. Fee -0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Conswuction Tax:
Administrative Fete:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
i
Travel Documentation Fees:
Strong Motion Fee: 1BSEISMICO
$73.50
Select an Administrative Item
Bldg Commission Fee: 1BCBSC
$14.00
SUBTOTALS:
10,900.08
$0.00
TOTAL FEE:
1 $10,900.08
Revised: 10/01/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10445 S DE ANZA BLVD
CONTRACTOR: ELEVEN WESTERN
PERMIT NO: 13110102
BUILDERS, INC
OWNER'S NAME: BDC HAYWARD LP
2862 EXECUTIVE PL
DATE ISSUED: 04/03/2014
OWNER'S PHONE: 9255882219
ESCONDIDO, CA 92029
PHONE NO: (760) 796-6346
LICENSED CONTRACTOR'S DECLARATION
31
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
SEPARATE (E) BLDG WITH (N) DEMISING WALL, CREATE
MEP'S & ADD ADA
License Class Lic. #
(N) OPENINGS, MODIFY (N)
1 ,1 j Qu , J
RESTROOM & UPDATE (E) RESTROOM 12,275 SQ FT
Contractor W I!� Date "`
I hereby affirm that I am licensed under the provisions of Chapter 9
REV # 1 - REDUCTION FROM ORIGINAL SCOP OF WORK -
(commencing with Section 7000) of Division 3 of the Business & Professions
ISSUED 7/17/14
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: $350000
performance of the work for which this permit is issued.
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
kI'V Number: 35917019.10445
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 T 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 LAST LED 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
with all
Y
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-BUIL6 R 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
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)
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
1 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 equipmcn"r devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
he Ba a ality Management District I
air contaminants as define�
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
1 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
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
Building Department
CITY OF CUPERTINO
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
TELEPHONE: (408) 777-3228 - FAX: (408) 777-7606
OFFICIAL NOTIFICATION OF NEW/ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: March 18, 2014
RE: New/Change of Address APN #359-17-019
Please note the following address change: 10455 S De Anza Blvd has been divided into
two units. The new unit will be 10445 S De Anza Blvd and 10455 S DeAnza will remain
the same.
The new address will take effect 30 days from the date of this letter. Please update your
records accordingly. If you have any questions, please call me at (408) 777-3246.
Sincerely,
SGL/
Susan Winslow
Administrative Clerk
Cupertino Building Dept
408-777-3246 or suew@cupertino.org
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