10120041CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10201 TORRE AVE
CONTRACTOR: DPR CONSTRUCTION INC
PERMIT NO: 10120041
OWNER'S NAME: CORNISH & CAREY COMMERCIAL
1450 VETERANS BLVD
DATE ISSUED: 12/07/2010
OWNER'S PHONE: 4089828466
REDWOOD CITY, CA 94063
PHONE NO: (650)474-1450
❑ LICENSED CONTRACTOR'S DECLARATION
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License Class F) Lic. # l_ I 10L( fO
BUILDING PERMIT INFO: BLDG ELECT PLUMB
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MECH RESIDENTIAL COMMERCIAL
D��Ns�2 ��0, } �
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: 3 FLOORS- COMM'L DEMO OF INTERIOR WALLS &
(commencing with Section 7000) of Division 3 of the Business & Professions
FINISHES
@EXISTING 3 STORY BUILDING- (89335SQFT)
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $100000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 36941005.00
Occupancy Type:
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
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 's pemut. Additionally, the applicant understands and will comply
'
180 DAYS FROM LAST CALLED INSPECTION.
with all n -p t source rTlations per the Cupertino Municipal Code, Section
9.18.
Signatu Date 17, I-q-110
Issued bye/ Date:`�Y�
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. Ifa roofis
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.
wil I 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
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I 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
I 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 1 use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District 1 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
Hea 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
Owe r uth en
Date:IL*a
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
1 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
DEMOLITION
FM-1
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10201 Torre Ave.
DATE: 12/07/2010
REVIEWED BY: gs
APN:
BP#:
`VALUATION: j$100,000
*PERMIT TYPE: Demolition Permit
PL Y C 11F('K 7TPE.
PRIMARY Commercial Building
USE:
PENTAMATION 1COMMLDEM
PERMIT TYPE:
WORK
SCOPE
FEE ID FLR AREA
s.f.
1DEMOCOM 89,335
Mee& Plan Check I Elev. Plan Check
;b1'c.1r::h. permit Fc,r h. Permit Fee: Ref'. Permit hr4'
l)tlfe ,Wvc h. Imp, Or: ;,f. Plamb Insp. Oihef• Elec. Insp. Li
,Vcclr. Irts1). F'�•rt': l'Irv+ill. fi,.:. r ;:; f,Yrc. I+7�p, F�•;�
NnTF- These fees are ha.ced an /he nreliminary infarmalinn availahly and are nnly an aclimala t`awaiv tha nant far addn'1 info
FEE ITEMS (Fee Resolution 09-051 Eff. 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Cheek Fee:
Suppl. PCFee
Plu nh.!;1rcclt.;Elec: Plan Chcc:><:
Permit Fee:
$7,844.00
Suppl. Insp. Fee{0 Reg. 0 OT
0.0
hrs
$0.00
f'lumb.l:�Ic'rrh./T l�'c Unit
P(umfr.;':11ech.%Lsler' Pei-niii
(-,()I Isti -tic IiW7 l ct.,-
A(_--oustival Rci;. ..
IVor•k 4`ithout .M,),rnit?
Planrririg ruc,v:
I
Tr cnw'el Docrurrti�ntutinn
Stroniz Motion Fee: IBSEISMICO
$21.00
Select an Administrative Item
Bldj; Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$7,869.00
$0.00 TOTAL FEE:
1 $7,869.00
Revised: 12/07/2010