13020109CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10590 N TANTAU AVE I CONTRACTOR: XL CONSTRUCTION PERMIT NO: 13020109
OWNER'S NAME: 10590 TANTAU INVS LLC
OWNER'S PHONE: 4089961010
❑ LICENSED CONTRACTOR'S DECLARATION
License Class .� Lic. # 6 0 - gso
Contractor v c')Il l uji ._Date 3 t 3
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 Worke '
Compensation, as provided for by Section 3700 of the Labor CodlDo.
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provid d vY by
Section 3700 of the Labor Code, for the performance of the work f . 1 -this'
y
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and ,expen which may
accrue against said City in consequence of the
granting of thi pe it. Additionally, the applicant understands and will comply
with all non- oint urce re777DateiM
o Municipal Code, Section
9.18.
Signature
/S
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two. reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
I have and ,will maintain Worker'sCompensation Insurance, as provided for by
Section 3700 of the,Labor Code, for the performance of the work for which this
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, I
become.subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
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 non -point source regulations per the Cupertino Municipal Code, Section
9.18.
851 BUCKEYE CT I DATE ISSUED: 02/20/2013
MILPITAS, CA 95035 I PHONE NO: (408) 240-6000
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS
T.I. APPLE -TO CREATE NEW OFFICE SPACES 1,011 SQFT
4/4/2013 - DEFERRED #1 FOR MECHANICAL ROOF TOP
UNIT AND FIRST FLOOR SLAB ANCHORAGE ISSD-
4/23/2013
Valuation: $149397
APN Number: 31618035.10590 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WIT 180 DAYS OF PERMIT ISSUANCE OR
180 D ROM LAST CALLED INSPECTION.
Issued byc Date7iI
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I (,)equipment or devices which emit hazardous
air contaminants as defined by e y Area Air, Quality Management District I .
will maintain compliance with the C pertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sec ions 5505,2 533, an 25534.
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Date
_ CITY OF CUPERTINO
F.F. ESTIMATOR — BUILDING DIVISION
DDRESS: 10590 tantau ave.
DATE: 04/04/2013
REVIEWED BY: bobs.
jj
rA1PN:
BP#: J dv
*VALUATION: Iso
YPERMIT TYPE: Building Permit
PLAN CHECK PE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
PENTAMATION 1 GENCOM
PERMIT TYPE: i
WORK
deferred submittal for mechanical roof top anchorage, and first floor slab anchorage.
SCOPE
Xfcch, Plon Check
Dhow. Plcm Check
Dec. Plant Check
Afech. Permit Fee:
Phimb. Permit Fee:
Elec. Permit Fee:
Other Alech. Irsp.El
Other Phmab Map.
Other Flee. Itup.
Heck lisp. Fee:
Phmth. lasp. Fee:
Elec. Gasp, Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. rtanntng, ruotic works, -Fire, ou."nny oe,ve, �.�•••• ��,���•
n"d nro n"tv on Pvthnafil_ Contact the Dept for addn'l info.
vtstrtey etc . Inese ees cite u"se" u.e ...c ...............
FEE ITEMS (Fee Resolution 11-053 E . 7f /f 1112)
.,• •,,•....�...........�.-..
FEE
-
QTY/FEE
-
MISC ITEMS
Plan Check Fee: Hourly Only? (D Yes Q No
$0.00
® hours Plan Check, Hourly
$532.00 1STPLNCK
Suppl. PC Fee: D Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Adufinistralive Fee:
0
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
® hours Inspections
$532.00 ISTINSP Inspection, Hourly
G
0
Traiw/ DocrutjFentotrori Fees:
Strong Motion Fee:
$0.00
Select an Administrative
Item:
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$1,064.00
TOTALFEE:
1
$1,064,00
ere I I Revised: 04/01 /2013
��,��� CITY OF CUPERTINO
1!�1r" I75 UUU 1 CTTMATn_P — RTTIT DING DIVISION
ADDRESS: 10590 N TANTAU AVE
DATE: 02/20/2013
REVIEWED BY: MELISSA
lia
APN: 316 18 035
BP#: 0,-) -(j 0
*VALUATION: 1$149,397
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
PENTAMATION 113 TI
PERMIT TYPE: i
WORK
NEW T.I. TO CREATE NEW OFFICE SPACES
SCOPE
OCCUPANCY TYPE:
OF
TR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
F1I-B,III-B,IV,V-B
1,011
$1,989.20
1BTIPLNCK
$1,055.56
IBTIINSP
TOTALS:
1,011
$1,989.20
$1,055.56
MECH, HOURLY ()Yes (E) No
PLUMB, HOURLY ® Yes (F) No
ELEC, HOURLY ® Yes E No
htech. P1a17 Checkck
Elec, Plata Check
�lfech. 912t
nlnh. Permit Fee:
L7ec. Permit Fee:
Outer 1l/ech. Insp.p.
Other Elec. Insp.
lec/1. h1sp. Fee::
Elec. Insp. Fee:
NOTE. This estimate does notinclude fees due to other Departments (i.e. Planning, Puallc morns, rare, Utntsussy Ucrvc..�.o.. .. y
--lnhlo ."d nra nithV On ow;"tatP_ Contact the Dent for addn'l info.
District, e[C . lnese ees (ire auseu un use seu..ss.ns.
FEE ITEMS (Fee Resolution 11-053 Eff. 7111121
..s v....a... ...........
FEE
. ......... _
QTY/FEE
-.- --- ----
MISC ITEMS
Plan Check Fee:
$1,989.20
Select a Misc Bldg/Structure
or Element of a Building ,
Suppl. PC Fee: Q) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,055.56
Suppl: Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax.
14L1n7illistpative Fee:
G
Work Without Permit? Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
A
Tr(wel Docionentotion Fees:
Strong Motion Fee: 1BSEISMICO
$31.37
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$6.00
SUBTOTALS:
1 $3,082.13
$0.00 TOTAL FEE:
$3,082.13
Revised: 01/01/2013