14060143 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10001 N DE ANZA BLVD CONTRACTOR:VULCAN PERMIT NO: 14060143
CONSTRUCTION INC
OWNER'S NAME: TAMBELLINI DEANZA PROPERTIES 346 MATHEW ST DATE ISSUED: 12/16/2014
OWNER'S PHONE: 4082134270 SANTA CLARA,CA 95050 PHONE NO:(408)499-6039
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
G� q SEAGATE, INSTALL 5 EX RECEPTACLES IN GARAGE
License Class � Lic.# ( � l
Contractor VU(„-,gry Lo(y517La�(1yDate L /(v /
I hereby affirm that I am licensed under the provisions of&pter 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$9500
ave 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 1 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 Igo D MIT 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 OM LAS ALL,ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgm – —
costs,and expenses which may accrue against said City in consequence of e Z
granting of this permit. Additionally,the applicant understands and will comp[ ue y: 6
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
/t: / All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature Date /Z
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
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 25505,2 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date:
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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
WPERMIT
DDRESS: 10001 n de anza blvd DATE: 06/23/2014 REVIEWED BY: Mendez
PN: BP#: 'VALUATION: $9,500
PE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 CEAP
WORK sea ate install 5 e/u receptacles
SCOPE
Elec. Plan Check 1 0.0 hrs $0.00
Elec.Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District, etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-05.3 Eft' 7%1%1.3) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Electrical
Suppl. PC Fee: ) Reg. Q OTI 0.0 1 hrs $0.00 $695.00 1BREMMISC Apparatus
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Administrative Fee: ]ADMIN $44.00 0
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning- Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure 0
Stronp, Motion Fee: 1BSEISMICO $2.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $141.00 $695.00 TOTAL FEE: 1 $836.00
Revised: 04/0112014