12070181 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100 N TANTAU AVE CONTRACTOR:NOVO CONSTRUCTION PERMIT NO: 12070181
OWNER'S NAME: ROCKTINO FEE LLC 4025 BOHANNON DR DATE ISSUED:403/2012
OWNER'S PHONE: 4.159994505 MENLO PARK,CA .94025 PHONE NO:(650)701-1500
❑ LICENSED'CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
"License Class Lic:# 71»'2 2 COMMERCIAL INTERIOR,DEMO,NON,-STRUCTURAL
gyp' r APPLE
Contractor. /�hi&> G&j-ire.)CM4�S Date
I hereby affirm that Lam 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
'I have andiwill maintain a certificate.of consent to self-insure for'Worker's
Compensation,:as provided for by Section 3700 of the Labor Code„forthe
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$100000
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:3'1619061.10100 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify tliaf1 have read this application and_state that the above information,is PERMIT.EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws:relating WITHIN 180.DAYS OF PERMIT ISSUANCE OR
to building construction,and herebyautho'rize representatives of this city to enter
upon the above,mentioned;proobhy'for inspection purposes. (We)agree to save 180 DAYS'FROM LAST CALLED INSPECTION.
indemnifyand keep harmless the City of Cupertino against liabilities,judgments,
costs,andexpenses whidi may accrue against said City inconsequence"of the >
granting of this permit. Additionally,the applicant-understands and will comply Issued by: �/✓ �z`li Date: 'J ��
with all non;point'source regulations perthe Cupertino Municipal Code,Section
9.18.
'�,� � RE-ROOFS:
Signature Date 9/yiz_ All roofs shal l.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.
❑ OWNER-BUILDER DECLARATION
Signature of.Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the'followng twoxeasons: ALL ROOF COVERINGS TOBE 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'.imended or offered for sale(Sec.7.044,
Business&Professions Code)
J,,as ownerof the property,am exclusively contracting widi.licensedcontractors 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
1 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;rSeetion.25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to selfinsure,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 I
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 25505,25533,and15534.
Section 3700 of.the Labor Code,for the performance'of the work for which this
Owner or authorized agent: __ Date:..
'Permit is^issued.
I certify that in the performance of the'work for which this permit is issued,I shall
not-employ any'person inanymanner 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 1 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
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 constructi6ii,,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 harinless the City of Cupertino,against.liabilities,judgments,
costs;and-expenses wliich may accrue against said City in consequence of the I understand my plans shall be used m public records.
granting ofthis permit..Additionally,the applicant understands and'will comply
with all non-point source regulations per the Cupertino Muni cipal'Code,Section Licensed Professional
9.C8:
Signature Date
CITY OF,.CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
[I'llTADDRESS: 1.0100 N Tantau DATE: 07/24'/2012 REVIEWEDBY:
PN: 3�,� —1�.-0 6 / BP#: 'VALUATION: $100,000
'xPERMIT TYPE: Demolifion Permit I'i_4,--''C171'CK I YPL:
PRIMARY mPENT-AMATION
Comercial Building1 COMMLDEM
USE: PERMIT TYPE: �
WORK interiordemo non-structural commercial
SCOPE.
FEE ID FLR._AREA
_. s.f:
1DEMOCOM 35.;679
tae - 7
if
fuB R' tea -
XkcJi.Plan Check 'i7ti71?: Plug!Cl,ct'-lf I.iuc. Plat,("heck
'erwilFce, F'hnY%;. ?errr,:. r'i"c! facZ�. Perrni'I' e.
0111,'r P:9ei�{,.,InsP. :)llrer'I'r.T,7z i'Insp. �)7 rtT I:;'ier:':.arsn.. Lj
1tech.In:y).Pc:e: I'iunih. hr?'pJ,_eec: {..lec.Insp. Fco:
NOTE: This estimaterdoeswoi inchide'fees',due to,oiher>Departments(i.e..Pl_anning,PubliciWorks,Fire_,Sanitary Sewer District,.school
District,etc. . These:'Cesare based on;ihe, relimina. in ormation availiible dnd:are'onl,an esiimate. Contactihe De t_ or addn'l in o.
FEE ITEMS fFee Resolution I4-053.Eff'7/I%1.1) FEE, QTY%FEE MISC ITEMS
Plan! Cht ek.F°e
S'zipi7l,.P.C:I''ee
Permit Fee:- $3,460.00
Suppl. Insp. Feed_Reg.. C) oT 07 hrs. $0.60
�hs7nh,.,-t:Iectz: L-1ec
Phrrri6..'f1�leclr,iFac�c:Pera•7�7i.1 1:`�Cet:
C'onstrr.rc;ti��n I,�cPa; ,
1
'Idinirlistrative Fee:
Aduuneed phlnr7irjg lees
StrongM'ofion:Fee: IBSEISMICO Select an Administrative Item
Bld,ii,StdsCommission Fee: 1BCBSC' $4.00
� ..r,�3 SIIBTOT�LS"' $3,485..0.0 $0.00 _ TOTALFE`E' $3',485.00
. . ,a.
,Revised: 07/01/2012