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10090159PERMIT # PROJECT ADDRESS APPLICANT OWNER z 'A APN# b o Z - e1J � RES. (INNG) (GARAGM COMM. SQ. FT. (NEB RES. REMODEL CONTACT J enx-e,,, PHONE# 7d- FAx 2 f'7 VALUATION (Cost of Project) 2 a U RBQD. PAID NOTES: CONSTRUCTION TAX (Y) SCHOOL FEES (Y) HOUSING NlInG (Y) HEART OF THE CITY (Y) (N) (N) (N) (N) ISSUED BY,��- � DATE 5��4 'DOTAL FEES rl�, --Z CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10600 N DE ANZA BLVD CONTRACTOR: DPR CONSTRUCTION INC PERMIT NO: 10090159 OWNER'S NAME: SOBRATO ORGANIZATION 1450 VETERANS BLVD DATE ISSUED: 09/16/2010 OWNER'S PHONE: 4084460700 REDWOOD CITY, CA 94063 PHONE NO: (650)474-1450 ❑ LICENSED CONTRACTOR'S DECLARATION r � r INFO: BLDG ELECT PLUMB License Class Lic. # �� BUILDING PERMIT � MECH RESIDENTIAL COMMERCIAL (�p Contractor —CAS i��l� Date P1 Ig I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: FLOOR 1 - DEMO FILE STORAGE (commencing with Section 7000) of Division 3 of the Business & Professions ROOM(I 156SQ);WALLS,FLOOR,CEILING 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: $12327 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. APN Number: 31602103,00 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally, the applicant understands and will comply with all n - oint source regulations per the Cupertino Municipal Code, Section 9.18. C SignatureDatek�� __j_�_� (( Issued by Date: ( ❑ OWNER -BUILDER DECLARATION RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspection. 1, 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, Signature of Applicant: Date: Business & Professions Code) I, 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: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self -insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I have and will maintain Worker's Compensation Insurance, as provided for by Safety Code, Section 25532(a) should 1 store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued, I shall Health & Safety Code, Sections 25505, 25533, and 25534. 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 O e ue become subject to the Worker's Compensation provisions of the Labor Code, I must Date:y i I� (� forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address 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 ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 1 0 -" DEMO UPEkT1NO PERMIT APPLICATION FORM APN# '3 1 0�_ 10 0 Date: Building Address: 6 Dc Mailing Address (if different from building address): Owner's Name: Phone: Contractor: Phone : L4 oe� Zz- Fax: D d - -7-1 h - Z9I "� Z Contractor License #: S 9q g L� ,(, Cupertino Business License #: Contact: C)e p -L— -j Phone: ��- - 3- z>- ,(r Z_ Fax: 110,? .. 6 - ZGI Residential ❑ Sq Footage Commercial Sq Footage Job Description: & t ► c,, Valuation: j c., Project Size: Express Standard ❑ Large ❑ Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee Description _Fee Group Permit Type 1DEMORES Demo -Residential Y B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM_ 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICRE Seismic Residential B Revised 01/07/09 Building Department CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: (j ST ERMIT # QD OWNER'S NAME: d / J PHONE # ,9 GENERAL CONTRACTOR: rL BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCJJ.PANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S B N—WTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature bate Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISICBiMOLITION jj VAPN:ESS: DATE: REVIEWED BY: BP#: *VALUATION: $12,327 *PERMIT TYPE: Demolition Permit PI AN CHECK TYPE: PRIMARY Commercial Building USE: PENTAMATION 1COMMLDEM PERMIT TYPE: WORK SCOPE FEE ID FLR AREA s.t. 1DEMOCOM 1,156 ,Wech. Plan Check Plumb_ Plun Check Viler_ Plan Cheek .Wuc:h Permil Fec: plumb. Permit Fae: Elec. Permir rue, Or/lei a/ech. ln.sp. Other 1"'airub Imp. El--L- Oiler Floc. lnsp_ Alech. ln.,p. hc, Philiih. hrap. TC'L glee. ln.;o, I c: NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Deptjor addn7 info. FEE ITEMS (Fee Resohrtion 09-051 E . LL 0) FEE QTY/FEE MISC ITEMS Plan Check [ c e - Suppl. PC Fe e Plum h.i1llech./Flee Plan Check. - Permit Fee: $507.00 Suppl. Insp. Feed Reg. 0 OT 0.0 hrs $0.00 Plumb.1111fech./Elec Unil Fee: Plumh.lMeeh./Elec Pernrit Fec . Construction Tax -FT Acoustical Review Fee: GVork 4'ithout .Permit? Planning Fees: Travel Documentation Fees- Strong Motion Fee: IBSEISACCO $2.59 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $510.59 $0.00J :OTALFEIE: $510.59 Revised: 9/14/2010