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13110069CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: JA9'WTANTAU AVE OWNER'S NAME: TANTAU PROPERTIES LLC CONTRACTOR;^TSD'- i 0 PERMIT NO: 13110069 DATE ISSUED: 11/12/2013 I OWNER'S PHONE: 4087834613 ( , fu... IA"e—, I PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 70 Is :7 2 8 Contractor 4 P% ,Qu r vE /0 l.Jc . Date / / 2-1 / 1 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. JOB DESCRH'TION: RESIDENTIAL COMMERCIAL APPLE- T.I PREP MINOR INTERIOR DEMOLITION TO INCLUDE REMOVAL OF SOME EXISTING NON-BEARING INTERIOR WALLS 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: I have and will maintain Worker's Compensation Insurance, as provided for by Jection 3700 of the Labor Code, for the performance of the work for which this APN Number: 31609028.00 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�7�'— �� — Dates i Z ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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 Valuation: $75000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN J§O DAYS OF PERMIT ISSUANCE OR 180 DAY OM LAST CALLED INSPECTION. Issued by: Date: 1112- 13, 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(x) 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 agent- t-- Date: / 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 CONSTRUCTION LENDING AGENCY 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 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. Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, SanitarySewer Destrtct, a 00 d h 1' ' in-rmation available and are on[ an estimate. Contact the Dept or addn 7 info. mstrtct, etal. These Lees are base on t e re tmtna FEE ITEMS (Fee Resolution 11-053 ETt.' 7:'1113) ADDRESS: 10710 n tantau Plumb- Plan Checl DATE: 11/12/2013 REVIEWED BY: MENDEZ Plumh. Permit Fee: APN: BP#: / OL�J $75,000 1PERMIT TYPE: Building Permit He(h, hasp. Faze: ----r'VALUATION: PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building hrs $0.00 PENTAMATION 1TIPREP PERMIT TYPE: WORK apple t.i prep minor interior demolition to include removal of some existing non-bearing interior walls SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, SanitarySewer Destrtct, a 00 d h 1' ' in-rmation available and are on[ an estimate. Contact the Dept or addn 7 info. mstrtct, etal. These Lees are base on t e re tmtna FEE ITEMS (Fee Resolution 11-053 ETt.' 7:'1113) Ivteeh. Plan Check Plumb- Plan Checl ; /ec. Plan Check "Mch. Permit Fee: Plumh. Permit Fee: I Elec. Permit Fee: Other Mech. Insp other Plumb Irssp E3--L- Mier Elec. Insp. He(h, hasp. Faze: �hnrh [,-w. If, :,, r( Insp. Fcc hrs $0.00 Sh l NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, SanitarySewer Destrtct, a 00 d h 1' ' in-rmation available and are on[ an estimate. Contact the Dept or addn 7 info. mstrtct, etal. These Lees are base on t e re tmtna FEE ITEMS (Fee Resolution 11-053 ETt.' 7:'1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $405.00 Tenant Improvement Prep 1TIPREP Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax. Adininistrative Fee: E) Work Without Permit? Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 Strong Motion Fee: 1BSEISMICO $15.75 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $18.75 $405.001_TOTAL FEE: 1 $423.75 Revised: 10/01/2013 CUPERTINO GRF1 ri Program City of Cupertino Public works Department Environmental Programs Division 10300 Torre Ave Cupertino, CA 95014 (408) 777-3354 Construction and Demolition Recycling Diversion Requirements and Instructions Covered projects, or all construction, demolition and renovation projects that are 3,000 square feet or more are required to complete a Waste Management Plan for the City of Cupertino demonstrating that 60% of the material generated is recycled, in compliance with ordinance CMC 16.72.050. At the conclusion of the project a Construction Recycling Report must be filed with the Public Works Department/Environmental Division showing the tons recycled and disposed by material type. Use tonnage information from weight tags provided by facilities to quantify total estimated waste and percentages for materials. Weight Tags of all material recycled and disposed must be submitted with the final report in order to receive a Final Building Inspection. Recology is the only debris bin service provider franchised to do business in Cupertino. Debris from a project 3,000 square feet or more in Cupertino can be collected and disposed by using: Please check all that apply: ❑ lam not using a Recology debris bin, however, the project is less than 3,000 s.f., e.g. buildings, patios, sidewalks, driveways. I will use a Recology debris bin. By Agreement with the City, Recology will prepare my required Waste Management Plan & Recycling Report. Contact Recology: (408) 725-4020. ❑ I am not using a Recology debris bin. I will provide the following submittals to the City's Public Works Department, showing that I have recycled at least 60% of all construction demolition material: Ask for the Construction & Demolition Recycling Packet from the Building Department and complete the following: ✓ Submit a Construction and Demolition Waste Management Plan with your building permit application. No fee for this plan. Forms are available at the Building/Public Works counter and online at www.cupertino.org/environmental. Report the tonnage recycled and disposed, by material type. Recycling facilities must be selected from the City's approved list of Recycling Resources. ✓ Submit a Construction Recycling Report form. The report is required before the Building Department will schedule a final inspection. The report form is available at the Building/Public Works Counter and online ww►►-.cupertino.org/environmental. Signature: Dater /I/�z� Name: (printed)^,/JLv1,y /?9o,-i-,rpo,i Eizd Title: 1%Q ,-TFC--Z /�l,•�„r e� � Phone: 6.cn - Sa.z — o-rgz- Project Address: 10-:;r/ o N. 7.9iv-�.9tj ,e4axt ulpE27i�/ c 9.SoIY This form to remain in the project's building permit file for the duration of the project. Revised 317112 1