13090148 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10001 NDE ANZA BLVD CONTRACTOR:VULCAN PERMIT NO: 13090148
CONSTRUCTION INC
OWNER'S NAME: TAMBELLINI DEANZA PROPERTIES 346 MATHEW ST DATE ISSUED: 10/10/2013
OWNER'S P : 4085728857 SANTA CLARA,CA 95050 PHONE NO:(408)499-6039
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL0
License Class Lic.# / Z S SEAGATE-SUITE 100 COMM.T.I 3,842 TO INCLUDE
NEW OFFICES AND RESTROOMS
Contractor V I�,L��1 ��1��N� Date /h• �O •t'j
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
Com as provided for by Section 3700 of the Labor Code,for the
rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$483000
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:32634074.00 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 `7�1IT1IIN0 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 DA F OM 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 /�
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatur Date /O •/ 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
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 rcad 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
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 r
permit is issued. . Owner or authorized ag �•/0.
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 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
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10001 N DE ANZA BLVD#100 DATE: 0912012013 REVIEWED BY: Mendez
APN: BP#: /�� Q "VALUATION: 1$483,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 B TI
USE: PERMIT TYPE:
WORK SEAGATE- SUITE 100 COMM. T.I 3,842 TO INCLUDE NEW OFFICES AND RESTROOMS
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. sJ.
B (Tenant Improvements) II-B,111-B,IV,V-B 3,842 $2,339.59 IBTIPLNCK $3,253.31 IBTIINSP
TOTALS: 3,842 $2,339.59 $3,253.31
MECH,HOURLY Q Yes 0 No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No
Nfech. Plan(:heck Phrn L Plan Check Elee.Plan Check
rLfeclr. Perrnil F`ec' Plumb.Permit Fite: Elec. Permit Fee:
Other rb9ech. Insp. Other Plumb Insr). Li Other Elec. Insp.
dVe-ch. /n.;p. Fee: Plunrb. hisp. 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). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E f.' 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,339.59 Select a Misc Bldg/Structure
Suppl. PC Fee: (F) Reg. Q OT 0,0 1 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $3,253.31
Suppl. Insp. Fee-0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
,4dlninistrative Fee: Q
Work Without Permit? Q Yes E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential Q
%Mvel Documentafion Tees: Building or Structure Q
Strom; Motion Fee: IBSEISMICO $101.43 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $20.00
SUBTOTALS: $5,714.33 $0.00 TOTAL FEE: 1 $5,714.33
Revised: 0810112013