13040131i CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10001 N DE ANZA 13LVD
OWNER'S NAME:
LICENSED CONTRACTOR'S DECLARATION
Licensb Class: _, Lic.
Contractor,t/ GeL W (yb�l !r'}^ 2iV e— Date I -% 13
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 herebyaffirm under penalty of perjury one of the following two declarations:
I have and will maintain a ceitificate'of consent to self -insure for Worker's
Compensation; as provided for by Section 3700 of the Labor Code, for the
petfortWce.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 thetaborCode, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. I agree to comply with all city andcounty 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 permiti Additionally, the applicant understands and will comply
with all r?on=point source!regulations per the Cupertino Municipal Code, Section
9.18. i
Signature
❑ 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:ihe'stmcture is not intended or offered for sale (Sec.7044,
Business &Professions t ode)
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 anti 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
perfoniiance of the.work �or which this permit is issued. .
I have and will main, orker's Compensation Insurance, as provided for by
maintain . .
Section 370Q of the!L�bor Code, for the performance of the work for which this
permit. �'xissued., i
I certify that, in the Qerformanceof the work for which this permit is issued, I shall
riot'employ'any pprapn in any manner so as to become subject to the Worker's
Compeq} 4tion'laws of California. If; after making this certificate of exemption, I
become,subject to the Wgtker'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. 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 theabove mentioned property for inspection purposes. (We) agree to save
indemnify and beep himiless the City of Cupertino against liabilities, judgments,
costs, and expenses w,,hrch may accrue against said City in consequence of the
granting of this,permiti Additionally, the applicant understands and will comply
with all;non=point source fe' lations per the Cupertino Municipal Code, Section
Sigsnattire, Date
CONTRACTOR: VULCAN PERMIT NO: 13040131
CONSTRUCTION INC
346 MATHEW ST DATE ISSUED: 04/1.7/2013
SANTA CLAR& CA 95050 PHONE NO: (408) 499-6039
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
2ND FLOOR- INSTALL 7 OUTLETS INTO EXISTING"
WALLS,
INSTALL 5 DATA RIG & STRING INTO EXISTING WALL
Sq. Ft Floor Area: I Valuation: $1000
APN Number: 32634074.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN IN DAYS OF PERMIT ISSUANCE OR
180 DAY M LAST CALLED INSPECTION.
Issued by: Date: 713.
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. 1 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.
Owner or authorized agen i . Date: % ? 3
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
CITY OF CUPERTINO
ICI FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10001 N De Anza bivd
DATE: 04/17/2013
REVIEWED BY: Mendez
APN:
BP#: QLf� 3
*VALUATION: $1,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 10EAP10
PERMIT TYPE:
WORK
outlets into existing walls install 5 data rig & string into existing wall
�install7
SCOPE
Alec:)i..I'lan Check
Phunb. Plun Check Elec. Plan Check 0.0 hrs $0.00
Perini! Fee:
Plumb. Permit Fee. Elec. Permit Fee: 1EPE/2MIT
Other ,Nfech. Insp.
Oilier Plumb Insp. Other Elec. Insp. 0.0 his $45.00
Mech. Insp. Fee:
Phsn7b. Lisp, Fee: Elec. Insp. Fee:
NOTE. This estimate does not inchtde fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt etr_►_ Thoco foo_c aro hated on the nreliminary information availahle and aro only an octimnta_ CantaM the Dent far addn'l info_
FEE ITEMS, (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:'
$0.00
F 12 #
$45.00
Electrical
IBREMRECEP Recep/Switch/Outlets
Suppl. PC Fee.' O Reg. Q OT
0.0
hrs
$0.00
.PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: 1ADMIN
$42.00
Q
Work Without Permit? Q Yes Q No
$0.00
Advanced Planning
$0.00
Select a Non -Residential
Building
Bung or Structure.
0
A
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICO
$0.50
Select an Administrative Item
B1dQ Stds Commission Fee: 1BCBSC
$1.00
row SUBTOTALS:
$133.50
$45.00
TOTAL FEE: $178:50
Revised: 04/01 /2013
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
V/
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: lC'C -'
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OWNER'S NAME:�'A-,,,,:s;
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PHONE # '7
GENERAL CONTRACTOR:
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BUSNESS LICENSE #/z,-,; `
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ADDRESS:
CLTY/ZLPCODE:=�:,�'r ��/.z�
'Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND -ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
..
wner / Contractor Signature Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
— 4
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
i
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
i
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock_
Tile
..
wner / Contractor Signature Date