12080261CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10001 N DE ANZA BLVD
OWNER'S NAME: TAMBELLINI UA
OWNER'S PHONE: 4085941557
❑ LICENSED CONTRACTOR'S DECLARATION
License Class /R Lic. # ` pI)- I (1 5
Contractor 1%u[win b45trkJ- T'nG. Date _
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.
1 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.
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
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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. p
Signature Date
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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).
1 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's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
1 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.
CONTRACTOR: VULCAN CONSTRUCTION PERMIT NO: 12080261
INC
346 MATHEW ST DATE ISSUED: 09/27/2012
SANTA CLARA, CA 95050
PHONE NO: (408) 499-6039
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB I"
MECH r RESH)ENTIAL r COMMERCIAL r
JOB DESCRIPTION: SUITES 210 229,240 & 300 - COMMERCIAL TENANT
IMPROVEMENT (9769 SQFT}EXISTING OFFICE SPACE, NEW
WALLS, ELECTRIC AND HVAC DISTRIBUTION FROM
Sq. Ft Floor Area: I Valuation: $410000
APN Number: 32634074.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION. Z Issued by: � irl/ 7 7rd Date: 9.97 l,:�
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
1 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 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
agthor�t
���� Date:�1
_
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of mork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Ad
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional,
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10001 N DE ANZA BLVD
CONTRACTOR: VULCAN CONSTRUCTION
PERMIT NO: 12080261
INC
OWNER'S NAME: TAMBELLINI UA
346 MATHEW ST
DATE ISSUED: 09/27/2012
OWNER'S PHONE: 4085941557
SANTA CLARA, CA 95050
PHONE NO: (408) 499-6039
❑ LICENSED CONTRACTOR'S DECLARATION
F F 7
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lic. 0 of ��S^�
F F i
MECH RESIDENTIAL COMMERCIAL
Contractor C.st.�- Date �(� — %— ��-
1 hereby affirm tha am licensed under the provisions of Chapter 9
JOB DESCRIPTION: SUITES 210,229,240 & 300 - COMMERCIAL TENANT
(commencing with Section 7000) of Division 3 of the Business & Professions
IMPROVEMENT (9769 SQFT)-EXISTING OFFICE SPACE, NEW
Code and that my license is in full force and effect.
WALLS, ELECTRIC AND HVAC DISTRIBUTION FROM
I hereby affirm under penalty of perjury one of the following two declarations:
10/9/12 DEFERRED 0 ]-ACCESSIBLE PARKING & ALTERNATE MATERIALS AND
I have and will maintain a certificate of consent to self -insure for Worker's
METHODS MODIFICIATION FORM.ISSUED 10/9/12
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's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $410000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32634074.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9. 18.
Issued by:.� %G Date: / Q- 4•l
Signature Date
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 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
HAZARDOUS MATERIALS DISCLOSURE,
Compensation, as provided for by Section 3700 of the Labor Code, for the
1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
1 have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Ow er or autl rig d agen
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
RM-1 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10001 N. De Anza Blvd
DATE: 08/27/2012
REVIEWED BY: Sean
APN:
BP#:
*VALUATION: $410,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
Tenant Improvement is suites 210 229 240 and 300 9769 sq ft .
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
9,769
$2,503.52
IBTIPLNCK
$6,037.12
IBTIINSP
TOTALS:
9,769
$2,503.52
1 $6,037.12
MECK HOURLY 0 Yes (E) No
PILIA-V113„ 1-1_OUItLY O Yes Q No
ELEC, HOURLY 0 Y'es QNo
Afech. Plan Check
Phimb. Plan Check
Dec. Plan Chuck
Afech. Permit Fee:
Plumb. Permit hire:
--I-
!sec. Permit Fee:
Other Alech. Insp.E:F-L-
Other Plumh Insp.Lj
Usher Elec, Insp. Li
ALech. Insp, Fee:
Plumb. hop. 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 Dreliminary information available and are only an estimate. Contact the Dent for addn'1 into.
FEE ITEMS (Fee Resolution II-053 Eft 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,503.52
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$6,037.12
Suppl. Insp. Fee:Q Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consiruction .Tax:
Administrative Fec.:
0
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning- Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
�
Tru�>ca Docznnenlution Fees:
Strong Motion Fee: IBSEISMICO
$86.10
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$17.00
SUBTOTALS:
$8,643.74
$0.00
TOTAL FEE: 1 $8,643.74
Revised: 07/01/2012
DEFERRED # .-I-
CITY OF CUPERTINO _pp
FS-ME FEE ESTIMATOR — BUILDING DIVISIOR TE /a yhq'_
ADDRESS: 10001 N. De Anza Blvd
DATE: 10/09/2012
REVIEWED BY: Sean
APN:
BP#: 12080261
*VALUATION:
Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
PENTAMATION 1 DS
PERMIT TYPE:
WORK
Accessible Parking Deferred Submittal and Alternate Materials and Methods/Modification Form.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
Deferred Submittal (Not R-3)
II-B,III-l3JV,V-B
0
$0.00
$0.00
TOTALS:
0
$0.00
$0.00
MECH, HOURLY ' Yes E) No
PLUMB, HOURLY 0 Yes e) No
ELEC, HOURLY y"° Q No
Xlech. Plan Check
Plumb. Plan Check
Elec. Plan Check
FLtech. Pennil Fee:
Plumb. Permit Fee:
Flec. Permit Fee:
Other ;Wec h. Insp.
Ocher Plumb Insp.Li
Other Etec. /nsp. Li
Heck Insp. Fee;
Plumb. hal). Fee:
Elec. Insn. 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn I info.
FEE ITEMS (Fee Resolution 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F-2407 s.f.
$666.00
Deferred Submittal
IDF
Suppl. PC Fee: Q Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consimc lion Tax:
Adrninistrutive.Fee :
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0 �
Travel Docr.uncntuiion Fees:
Strong Motion Fee:
$0.00
1 #
$174.00
Alternate Materials and Methods
]ALTM T
Bldg Stds Commission Fee:
$0.00
SUBTOTAL:
$0.00
$840.00
TOTAL, FEE;
$840.00
Revised: 10/01 /2012