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13090008 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10900 N TANTAU AVE CONTRACTOR:DEVCON PERMIT NO: 13090008 CONSTRUCTION INC OWNER'S NAME: CUPERTINO TANTAU LLC 690 GIBRALTAR DR DATE ISSUED:09/03/2013 OWNER'S PHONE: 4083933929 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL1:1 COMMERCIAL License Class__ Lic.# � /(O LIGHTING GRID RELOCATION INTO(E)CAMERA LAB Contractor l c��. 1) I hereby affirm that I am licensed under the provisio of hapter 9 (commencing with Section 7000)of Division 3 of the Busi ess&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:$23000 G4 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:31609029.00 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 RMIT 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 ALLED INSPECTIO . indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 3 granting of this permit. Additionally,the applicant understands and will comply Iss Date: with all non-point so gulatio per t ertino Municipal Code,Se ion 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 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) 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(x)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 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section�1734. Section 3700 of the Labor Code,for the performance of the work for which this 3 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 of exemption,l 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. w'ork'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 CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION C� D 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 /� l CUPERT[NO (408) 777-3228• FAX (408)777-3333•build ing(a cupertino.org r+lir \ ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT k PROJECT ADDRESS I dAl I� L� dor APN# / / _ o O '7 OWNER NAME �"/e�'� 'e IvvTw. �,o (O�Tfd� Ca - 5(-i F MAII L STREET ADDRESS 'o f ^ L•a CITY, TATE,ZIP w /j" ^e FAX CONTACT NAME �K LG 3'9 I PHONE 6�y._ E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Jr l 3, K LICENSE NUM ER LICENSE TYPE BUS.LIC# COMPANY NAME I (- E-MAIL FAX +��ori �'�� • s Q We vebn - Co/!s c STREET ADDRESS CITY STAT ZIP PHONE 9v 06 ,D,- G11 ros s— a�- .3 • 9 ARCHITECT/E INEER NAME LICENSE B BUS.LIC# COMPANYNAMFJ!:�tVVe.0n eob4ol &MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE O I►rn, r�a-r o . s � S 404 DESCRIPTION OF WORK �•� �,• I C j EXISTING USE PROPOSED USE CONSTR TYPE #STORIES N 11_R 3 USE TYPE OCC. SQ.FT. VALUATION(S) EXIST(AREA G NEW�!q D AREAFLOOR_6 DR TOTAL BATHROOM KITCHENOTHER REMODEL AREA REMODEL AREA REMOD�jL AREA PORCH AREA DECK AREA__J_TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT [I YES SECOND STORY ❑YES BEING ADDED? ENO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES B VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑N o 0 �l By my signature below,I certify to each of the following: I am the property owner or authoriznt to n th erty owner's behalf. I have read this (� application and the information I have provided is correct. I have read the Description of Work and veri accurate. I agree to comply with all applicable local ordinances and state laws relating to building c representatives of Cupertino to enter the above-iden 'fled operty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INF ION RE D PLAN CHECK TYPE ROUTING SLIP New SFD Or Multifamily dv pply for demolition permit for 141JVER-THGCOUNTER ❑ BUILDING PLAN REVIEW 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 WORKS 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 DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10900 N TANTAU DR DATE: 09/03/2013 REVIEWED BY: MELISSA APN: 316 09 029 BP#: "VALUATION: 1$23,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK LIGHTING GRID RELOCATION INTOE CAMERA LAB SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,111-B,IV,V-B 440 $2,046.22 IBTIPLNCK $703.74 1BTRNSP TOTALS: 440 $2,046.22 $703.74 MECH,HOURLY () Yes 0 No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes (F)No "2,(h r' . Pori i./rr°ril lihc' Plat?Chccr; ivrecli. Permit I CC: Plumb. Permit Fee: Gle: . Permil Fee 01her M ech. Insp. Ocher Plumb Imp. Ohher Elec.It?y. Lj hlech. Insp. Fee: Plumb. Iusp. Fee: Elec,Insp. Fee NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District,eta). These-fees 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 LL 12, FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,046.22 Select a Misc Bldg/Structure Suppl. PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $703.74 Suppl.Insp. Fee:O Reg. 0 OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax Administrative Fee: Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fees: Building or Structure 0 Strong Motion Fee: IBSEISMICO $4.83 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2,755.79 $0.00 TOTAL FEE: $2,755.79 Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: /0 IV. i! Qir. PERMIT# d DOd OWNER'S NAME: PHONE# Vy• F,3• GENERAL CONTRAC OR: BUSINESS LICENSE# ADDRESS: ,- CITY/ZIPCODE: �Q3 *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. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical s do It r.' ., . 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 f _ 9 .13111, Own ontr: Signature ate