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12090044MY OF C>L ? ERTff O BUIDLWNG ? ERMffT BUILDING ADDRESS: 10201 TORRE AVE CONTRACTOR: DPR CONSTRUCTION, A PERMIT NO: 12090044 GENERAL OWNER'S NAME: I & G DIRECT REAL ESTATE 21 LP 1450 VETERANS BLVD DATE ISSUED: 09/06/2012 OWNER'S PHONE: 4089828433 REDWOOD CITY, CA 94063 PHONE NO: (650)474-1450 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COA�IMERCIAL0 License Class Lic. #9� 7 � � LAIC 126- 3RD FLOOR COMM 'd'.1425 SQ FT- CONVERT T n ! s �4 Contractor ��6� t��'�"n y Date � � EXISTING SPACE INTO 2 SMALL LADS 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 Sq. Ft Floor Area: Valuation: $121396 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 APN Number: 36941005.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES ES jai WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN �� Ili® �� ®� �� ISSUANCE ®� 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 DAA' I[8®lei[ LAST CALLED I INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the �! y, granting of this permit. Additionally, the applicant understands and will comply G /y '(.�� IID e Issued by: iQ with all no oint source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. '5(6 Signa a Date— All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 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 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) 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 1 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 U performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 255 , and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent:CC�Date: 1 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 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 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building cupertino.org vCA ❑ NEW CONSTRUCTION ❑ ADDITION X❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRES1 10201 Torre Ave APN # to Gi I Do S &C RiverRock Newmark PHON 408.982.8433 E-MAIL dnovak@riverrockreg.com OWNERNAMEg2804 STREET ADDR Mission College Blvd, Suite 120 TY, STATE, zIP Santa Clara, CA 95054 FAX CONTACT NAME Eric Flores PHONE 650-421-3817 E -MAI erlcf@dpr.com STREET ADDRESS 10201 Torre Ave CITY, STATE, Cupertino, CA 95014 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT X CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA Eric Flores LICENSENU953749 LICENSE TYPE B BUS. LIC# COMPANY NAME DPR Construction E-MAjericf@dpr.com FAX STREET ADDRES 1510 S Winchester Blvd ICIISan Jose CA 95128 PHONE 650-421-3817 ARCHITECT/ENGINEE Roy Milltar LICENSENUMBER 65165 BUS. LIC# COMPANY NAME Interior Archiects IA F -MA, r.militar@interiorarchitects.com FAX STREET ADDRESS 350 California St #1500 CITY, STATE, San Francisco, CA 94104 PHo 415-296-5378 DESCRIPTIONOFWORK Create two small labs, installing walls and doors, and expand existing lab by installing new demising wall and relocating existing door. :-3� -f(CMa'L -V Cuhve, - tFyisAi n q sp.<re I n,�b 2 srnp L( L -#-i5. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR/ AREA I// L. DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH I ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING -ADDED? []NO ADDITION! []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER THE BLDG AN ❑ YES EICHLER HOME' ❑ NO RECE E BY: TOTAL VALUATION: -1, V (A lo 3 IFCo By my signature below, 1 certify to each of the following: � I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I ha v p d is correct I have read the Description of Work and verify it is accurate. 1 a ee to comply with all applicable local ordinances and state laws relating Lincperty for inspection purposes. uie=�tt esentatives of Cupertino to enter the above; Iden fledr(?,— 11 pto Signature of Applicant/Agent: i Date: SUPPLEMENTVAL"WFORMATI UIRED PLAN CHECK TYPE ROUTING SLIP I-�� OVER-THE-COUNTER -0 nUILDING PLAN REVIEW —New SFD or Multifamily dwellings: Apply f� de olition permit for existing building(s). Demolition permit is required or to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_20/ 1.doc revised 06/2//11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10201 TORRE AVE DATE: 09/06/2012 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: 1$121,396 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: I PERMIT TYPE: WORK LAB 126 COMM. T.I CONVERT EXISTING SPACE INTO 2 SMALL LAB SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE RD B (Tenant Improvements) II-B,111-B,IV,V-B 0 $0.00 Other Elec. Insp. C $0.00 Phtrnb. Insp. Fee: Elec. Insp. Fee: Permit Fee: Hourly Only? 0 Yes Q No Suppl. Insp. Feer Reg. 8 OT 0 0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $0.00 Const-riction Tax: Administrative Fee: $0.00 TOTALS: 0 $0.00 Work Without Permit? Yes (F) No $0.00 $0.00 MECH, HOURLY O Yes (F) No PLUMB, HOURLY o Yes Q No ELEC, HOURLY C) Yes O No Xfeeh. Plan ('heck Phunb. Plun Cheek Elec. Plan Check Xfech. Perini! Fee: Plumb. Permit Fee: Elec. Permit Fee: Other rllech. Insp.Li Other Plumb Insp. Other Elec. Insp. C .1k,ch. fnsp. Fee: Phtrnb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt of.- ) Thoco foocan, hacod nn tho nroliminary infnrmatinn availahlo and aro nnhy an octimato_ rnn tort tho Dont fnr addn'l in fn_ FEE ITEMS (Fee Resolution 11-053 E17.' 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes O No $0.00 $0.00 L_ `J hours Plan Check, Hourly $266.00 1STPLNCK Suppl. PC Fee: O Reg. O OT L0j hrs PME Plan Check: $0.00 $0.00 Permit Fee: Hourly Only? 0 Yes Q No Suppl. Insp. Feer Reg. 8 OT 0 0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $0.00 Const-riction Tax: Administrative Fee: $0.00 0 Work Without Permit? Yes (F) No Advanced .Planning Fee: $0.00 0 hours Inspections $665.00 ISTINSP Inspection, Hourly 0 Travel Doct.rtrientu�ion Fees: Strong Motion Fee: IBSEISMICO $25.49 $5.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC SUBTOTALS: $30.49 $931.00 TOTAL FEE: $961.49 Revised: 07/0112012