13010048CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100 N TANTAU AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 13010048
OWNER'S NAME: ROCKTINO FEE LLC
851 BUCKEYE CT
DATE ISSUED: 01/08/2013
OWNER'S PHONE: 4088624397
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #-%
1_ --1�
APPLE- T.I PREP ON 1ST AND 2ND FLOOR 61,683 SQ FT
i
/� f
INTERIOR DEMO
Contractor 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.
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $350000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31619061.10100
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITIIIN 180 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 FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
said City in consequence of the
/ar!�3
costs„and expenses which may accrue against
Issued by: %a� l Date:
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. �'�
f j /
RE -ROOFS:
being installed. If a roof is
Signature Date
All roofs shall be inspected prior to any roofing material
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I:am exempt from the Contractor's License Law for one of
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 read 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(a) 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
of the work for which this permit is issued,
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance
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
the Health &Safety Code, Sections 25505, 25533, and 25534.
° I %.3
Owner or authorized agent: Dater_
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
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: 10100 N Tantau
DATE: 01/08/2013
REVIEWED BY: mendez
APN:
VALUATION: $350,000
`,PERMIT TYPE: Building Permit
EBP#:
PLAN CHECKTYPE:
Tenant Improvement
PRIMARY
USE: Commercial Building
PENTAMATION 1TIPREP
PERMIT TYPE: i
WORK
Apple- .1 Prep on 1st and 2nd floor 61,683 sq ft interio Demo
SCOPE
ICE
7Xtedi.Planheck
Per�mil Fee:
Other Vkch, Insp,
111ech. brsp. Fee:
P/rrnrb, Plcm Check
Phnnb. Permit Fee:
Other Plrmtb Insp.
Plumb. hrsp. Fee:
Elec. Plan Checlr
Elec. Per»Pit Fee:
Other Elec. Insp.
Elec. Insp. Fee:
Rrhnol
NOTE: This estimate does not include fees clue to other Departments (i.e. Planning, Public Yrurna, Pore, �u•«+u,y �•�••
.. m-Lii —1,, —, ava"intn_ Contact the Dent for addn'l into.
District, eta). Theseees are based on the reaminar
FEE ITEMS (Fee Resolution 11-053 E ff. 711112)
in urnuuaun uv4anuuso
FEE
•.•••• •••�
QTY/FEE
�••• •••• - ••.._.___. ___.__-
MISC ITEMS
Plan Check Fee:
$0.00
L_' J # Tenant Improvement Prep
$388.00 ITIPREP
Suppl. PC Feb: G Reg.. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
T=
C'onsirrrction Tox.
,4(111111)lStpative Fee:
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
77=
Trcwel Docannentation Fees:
Strong Motion Fee: IBSEISMICO
$73.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$14.00
SUBTOTALS:
$87.50
$388.00 TOTAL FEE:
$475.50
Revised: 10/0-1/2012-