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14010167 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10200 S DE ANZA BLVD CONTRACTOR:VULCAN PERMIT NO: 14010167 CONSTRUCTION INC OWNER'S NAME: SEAGATE TECHNOLOGY LLC 346 MATHEW ST DATE ISSUED:01/30/2014 OWNER'S PHONE: 8314395457 SANTA CLARA,CA 95050 PHONE NO:(408)499-6039 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION:RESIDENTIAL COMMERCIAL❑ ❑ T. I PREP-FOR LOADING DOCK License Classy J_ Lic.# ��,�71 Contractor 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. 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:$6500 1 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:36901035.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating �/ITIIIN 18 SOF PERMIT ISSUANCE OR 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 DAYS OM LAST CALLED 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 granting of this pe it. dditionally,the applicant understands and will comply Issued by: Date: with all non-po'ou lations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature I l 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) 1,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. 1 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 I use equl'pn3#nt or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the 7AW Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t C e o u icipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S ion 55 3,an 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age t: Date: permit is issued. f .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 COl4STRUCTION 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 1 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, ARCHITECT'S DECLARATION 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ` O' 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 O 1 CUPERTINO (408)777-3228• FAX(408)777-3333•building okupertino.org '� ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT N PROJECT ADDRESS AIN N /O K OWNER NAME 1 PHONE E-MAIL STWT ADDRP.S CITY,STAZIP FAX Sy K CO C AME f P ErMAIL STREET ADDRESS CITY,S TE,ZIP FAX C� ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO T CT R NAME f I LICENSE NUMBER LICENSE E BUS.LIC N �yr+ f >y COMP Y N r ErMA1L FAX fou 71/ dJ l9 C STREET ADDRESS - CIT ,STAT ,ZIP ` PHO ICSr ARCH /E INFER NAME LICENSE NUMBER BUS.LIC N COMPANY I EMAIL FAX STREW ADDR& CIT� STATE,Z �/ PHONE tc, • .� Gn„ � r DESCRIPTION OF WO I,';, EXISTING USE PROPOSED USE CONSTR-TYPE N STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: U DETACH []ATTACH N DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? FIND ADDITION? ❑NO PRE-APPLICATION E]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTALVALU_ATIO1��r' PLANNING APPL N []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �r••— By my signature below,I certify to each of the f (lowing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have ide6�r L I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ui irlg c on. ize representatives of Cupertino to enter the above-identified pro for inspection purposes. Signature of Applicant/Agent: ��"' Date: SUPPLEMENT4 INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior 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 ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10200 s de anza blvd DATE: 01/30/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$6,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1TIPRE WORK T. I Pre - for loading dock SCOPE Meeh. Permit Fee: Pllwdk, Perrr:il 1,ee. Flec•. Permit Fee: Other titec•h.Insp. Other Plumb Insp Oilrer Elee.Insp. Mech.Insp. Pee: E Plumb. Insp, Fee., Elco.Insp.Feer. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the erelimina information available and are onlE an estimate- Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Tenant Improvement Prep Supp/. PC Fee: Reg. Q OT 0.0 hrs $0.00 $405.00 ITIPREP PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constmetion Tax. ,ldtninistratt•ve Fee: 0 Work Without Permit? 0 Yes (F) No $0.00 E) Advanced Planning_Fee $0.00 Select a Non-Residential e) Trawl Documental ori FC(IS: Building or Structure 0 Strong,Motion_Fee: IBSEISMICO $1.37 Select an Administrative Item $idQStds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.37 $405.00 TOTAL FEE: $407.37 Revised: 01/15/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS:Aa-122 ff4ld PERMIT# OWNER'S NAME: PHONE# — GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: TZ42 Ak44LQ&jCITY/ZIPCODE: Sr" *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. _ I am not using any subcontractors: 7 ignature _ Date 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 Septi ank St et Metal ,l heet Rock Tile Owner/Contractor Signature Date