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13020148CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRI SS: 10600 N TANTAU AVE CONTRACTOR: XL CONSTRUCTION PERMIT NO: 13020148 OWNER'S NAME: 10590 TANTAU INVS LLC 851 BUCKEYE CT DATE ISSUED: 02/27/2013 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 OWNER'S PHONE- .4089961010 RESIDENTIAL ❑ COMMERCIALS JOB DESCRIPTION: ❑ LICENSED CONTRACTOR'S DECLARATION ' APPLE- COMM.T.I 600 SQ FT TO ENGINEER LAB ' License Class `J Lic. # 1 Contractor ccla^�f€'JCDate I hereby affirm thatII 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 Sq. Ft Floor Area: Valuation: $62350 performance.of the work for which this permit is issued. 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: 31618035.10600 Occupancy Type: permit is issued. APPLICANT CERTIFICATION is PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building: construction, and hereby authorize representatives of this city to enter (We) agree to save 180 DAY ROM LAST CALLED INSPECTION. upon the abovementioned property for inspection purposes. indemnify and'keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may acerue against said City in consequence of the Additionally, the applicant understands and will comply Issued by: Date: granting of this permit. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. p 1 Signature /� ' � 4 , ,A Date 2�Z� 3 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is inspection, I agree to remove all new materials for 1� installed without first obtaining an inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) HAZARDOUS MATERIALS DISCLOSURE 1, as owner of the property, am exclusively. contracting with licensed contractors to Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the 1 construct the project (Sec.7044, California Health & Safety Code, Sections 25505, 25533, and 25534. 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 Section 25532(a) should I store or handle hazardous declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, material. Additionally, should I use equipment or devices which emit hazardous Management the I 3ay Area Air strict I Compensation, as provided for by Section 3700 of the Labor Code, for the ythe Cupertino Municipal ode, Chapter 9uality '12.and ill maintain compliance nts as defined performance of the work for which this permit is issued. the Health &Safety Code, Sections 25505, 25 3� and 25534. I have and will maintain Worker's Compensation Insurance, as provided for by this �. Date: 1 i f the Labor Code for the performance of the work for which Section 370,0 o t Owner or authorized agent: �/ 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of C.) become subject to the Worker's or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ forthwith comply with such provisions Lender's Name APPLICANT CERTIFICATION Lender's Address I certify thathave read this application and state that the above information is .1 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, may accrue against said City in consequence of the I understand my plans shall be used as public records. costs, and expenses which 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: 10600 N TANTAU DATE: 02/27/2013 REVIEWED BY: MENDEZ APN: BP#: �� ��z VALUATION: $62,350 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement --rPRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: WORK COMM. T.I 600 SQ FT TO ENGINEER LAB SCOPE OCCUPANCY TYPE: B (Tenant Improvements) 1 B TI TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. n-B,fll-BjV,v-B 0 $0.00 $0.00 TOTALS: 1 0 I $0.00 $0.00 rl-fec:h, Plcni C'heclr Plruub, Plcor Check Elec. Plnrr Cheep ilech. Pcrmil Fee: Plttrrrb, Permit Fee'. E"I Perrrrit T c=e: Daher AdecJ7. Ivry/�. Other Phaiab tnsp. Lj Other Elee. Insp, 11Lech. Insp. Fee: Phwib, hasp. Fee: Elec, Insp. Fee: Public Works, Fire, Sanitary Server District, School NOTE: This estimate does not include fees due to other Departments (i.e. Planning, information available and are onlyan estimate Contact the Dept or addn'1 in o. District, eta . These fees are based on the relimdna MISC ITEMS FEE ITEMS. (Fee Resohition 11-053 Eff. 711112) FEE QTY/FEE Plan Check Fee: Hourly Only? 0 Yes e)No $0.00 L —2 J hours Plan Check, Hourly Suppl. PC Fee: ( Reg. Q OT 0.0 hrs $0.00 $266.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee:. Hourly Only? (C)) Yes No $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 © hours Inspections T, (n>el Docznr�entutian Fees: $798.00 ISTINSP Inspection, Hourly Strong Motion Fee: IBSEISMICO $13.09 Select an Administrative Item [Bldg Stds Commission Fee. IBCBSC $3.00 X SUBTOTALS: $16.09 $1,064.00 TOTAL FEE: $1,080.09 Revised: 01/01/2013