13040019CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10200 N TANTAU AVE CONTRACTOR: BARRON BUILDERS INC PERMIT NO: 13040019
OWNER'S NAME: ROCKTINO FEE LLC 1415 CLYDE AVE STE 104 1 DATE ISSUED: 64/62/2013
OWNER'S PHONE: 4089961010 I MOUNTAIN VIEW, CA 94043 I PHONE NO: (650) 269-7061
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # gg
Contractor a se>6{ C F° 1 Date 2-113
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.
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. 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.
Signature Date 1211
❑ 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'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.
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.
JOB DESCRIPTION: RESIDENTIAL
INSTALL (N) DOOR WITH GLAZING SYSTEM AT
HALLWAY
AND INSTALL (N) CARD READING SYSTEM FOR ACCESS
ONE EXIT SIGN
Sq. Ft Floor Area: I Valuation: $6000
APN Number: 31619061.10200 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FIMM L T CALLED INSPECTION.
do_. Date:
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 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, 2553 , and 25534.
Owner or authorized agent: Date: z" 1113
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Date
CITY OF CUPERTINO
FFF, F, TMMATOR - BUILDING DIVISION
191
ADDRESS: 10200 N TANTAU AVE
DATE: 04/02/2013
REVIEWED BY: MELISSA
APN: 316 19 061.10200
BP#: 3 V L . �
*VALUATION: $6,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
g
PENTAMATION 1GENCOM
PERMIT TYPE: A
USE:
WORK
INSTALL N DOOR WITH GLAZING SYSTEM AT HALLWAY AND INSTALL N CARD READING
SCOPE I
SYSTEM FOR ACCESS & ONE EXIT SIGN
kfech. Plrna Check
Pluaib. Plan Cheek
Elec, Plttn Cherc/r
liIic1c:lt. Permit Fee:
Phrrnb. Permit Fee:
Elec. Pc onh Fee:
Other Alech. Insp.
Other Ph+mb Insp.
Cher Elec. Insp. Lj
Heck h1sp. T ce:
Phtnrh. hasp. Tee:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, fire, Sanitary Sewer Astrrcy .knout
TI b d n the relinrina information available and are onl an estimate. Contact the Dept or addn'l in o:
Drstrrct, etc Z. rese ees are ase o
FEE ITEMS (Fee Resolution 11-053 Ef . 7/f 1112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
1 hours
$133.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: Q Reg. Q OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 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
Constrltcllon Tay':
A,4111irlistrative Fee:
Work Without Permit? 0 Yes Q No
$0.00
Advanced Plannin& Fee:
$0.00
Select a Non -Residential '
Building or Structure 0
Trm,el Docim7entotiou Tees:
Strong Motion Fee: IBSEISMICO
$1.26
2.0 hrs
$266.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.26
$399.00
TOTAL FEE:
$401.26
Revised: 04/01 /2013