15090112CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7375 ROLLING DELL DR
CONTRACTOR: AMERICAN
PERMIT NO: 15090112
TECHNOLOGIES, INC
OWNER'S NAME: PPC SIENA LLC
25000 INDUSTRIAL BLVD
DATE ISSUED: 09/22/2015
OWNER'S PHONE: 4089961006
HAYWARD, CA 94545
PHONE NO: (510)429-5000
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL Q COMMERCIAL Q
1 `
UNITS #13 AND #14 - FIRE DAMAGE REPAIR / 360 S.F.
License Class # '
INTERIOR & 77 S.F. EXTERIOR DECK ( ON BOTH UNITS)
r/Lie.
ContractoryY ��t c rl2ebo.�� t �,ti� Date
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:
Sq. Ft Floor Area:
Valuation: $8000
t. 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
APN Number: 35933012,00
Occupancy Type:
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.
PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that 1 have read this application and state that the above information is
180 DAYS FR LED INSPECTION.
correct. I agree to comply with all city and county ordinances and state taws 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
Date:/
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. Mditionally, the applicant understands and will comply with
all non -point source egulations per the Cupertino Municipal Code, Section 9.18.
RE -ROOFS:
Signature ` --s 9-2Z- I
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
Date S—
inspection.
Signature of Applicant: Date:
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
1. 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
HAZARDOUS MATERIALS DISCLOSURE
sale (Sec.7044, Business & Professions Code)
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I, as owner of the properly, am exclusively contracting with licensed contractors to
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
construct the project (Sec.7044, Business & Professions Code),
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations:
Additionally, should I use equipment or devices which emit hazardous air
t. I have and will maintain a Certificate of Consent to self -insure for Worker's
contaminants as defined by the Bay Area Air Quality Management District I will
Compensation, as provided for by Section 3700 of the Labor Code, for the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
performance of the work for which this permit is issued.
Health&Safe ode, Sections 25505, 25533, and 25534.
r
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
Owner in ut iirized agent: .-
Section 3700 of the Labor Code, for the performance of the work for which this
. Date:
permit is issued.`
3. I certify that in the performance of the work for which this permit is issued, I shall
CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If, after making this certificate of exemption, I
for which this permit is issued (Sec. 3097, Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code, I
Lender's Name
must forthwith comply with suchprovisions or this permit shall be deemed
revoked.
Lender's Address
APPLICANT CERTIFICATION
ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is
I understand my plans shall be used as public records.
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
Licensed Professional
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
_J>F*ERT11040 (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS A p a13 3 APN #
OWNER NAME .
lodcsse EM4&&�A rora"'A
PH04 _ 1 C1 ip
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EMAIL
STREET ADDRESS 3-� o o (l d g l i V C,
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CITY, ATE, ZIP A0 6
FAX
CONTACT NAME ((ii
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PHONE
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E-MAIL
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STREET ADDRESS-16�S� v Y
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13 OWNER `t ❑ OWNER -BUILDER
❑ OWNERAGENT
❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE E
BUS. L C # '
COMPANY NAME
g ,>
FAX
�
STREET ADDRESSj_
��o CITY, STATE, ZIP
6/i l�LICENSE
HONE_
ARCHITECT/ENGINEERNAME
J
NUMBER C7AS
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/
BU . LIC #
I
CO ANY N E [�
EMAIL
ii ((JJ
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STREET ADDRESS -
e�-r ��
CITY, . TE, ZIP
L�1 c-1 L C44`
H — 3 q
70
L TION OF WORK
a
Ppl-
7
EXISTING USE PROPOSED USE CONSTR TYPE I # STORIES USE TYPE OCC.1 SQ.FT. VALUATION ($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
NDWELLING UNITS: ISA SECOND UNIT uybb bm'UmunivR u=--
BEINGADDED? []NO ADDITION? ONO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REI ryl)34� IOTA
PLANNING APPL # ❑NO PLANNING APPROVAL LETTER ETCHLER HOME? - ❑ NO
By my signature below, I certify to each the foo I e prop weer or authorized agent to act on the property owner's behalf. I ha a read this
application and the information I have ovided is t. I h read th escription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ilding co ion. I a orize a resentatives of Cupertino to enter the above -id ntified roperty for ins on purposes.
Signature of Applicant/Agent: Date: 7 1 -
SUPPLEMENTAL INFO "LIPN c2I ll
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
Dmmercial Bldgs: Provide a completed Hazardous Materials Disclosure
fb -- if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp 2011.doc revised 06/21/11
CITE' OF CUPERTINO Mo"R' FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 7375 Rollingdell Dr. DATE: 09/1712015 REVIEWED BY: PAUL
APN: 359 33 012 BP#: EVALUATION: $8,00(
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Additian.
PRIMARY Multi -Family Dwelling Buildina is PENTA ATION
USE: >3 Stories 0 Yes. G No PERMIT TYPE:
WORK Units #13 and #14 - Fire Damage Repair / 360 S.f. Interior & 77 S.f. Exterior Deck On both
SCOPE
lec/z, Plren Check1'hrrrl/i. Nan (-,'heck Iles, r`11an Check
;1-;111./1. Permit. Pee: Plumb. Perinit Fee, 1:'Czc. I'ermri Fee:
Olher,;Ve ch. Insp. Other Phvnfr Insla. Oihet• 1 zec. fn m.
ch. Insp. Fee: I'fumb. Ixs,J, 1%>e: Elee. Insp. Fee:
1GENRES
NOTE: This estimate does not include fees due to other Denartments (i.e. Planning. Public Works. Fire. Sanitary Sewer District, School
rlicfr. , nfn 1 TI.aad nrn -h, — ocf fo f'anf"rf tho vont far addn l hifn_
FEE ITEMS (Fee Resolution 1.1-053 E . 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (F) No
$0.00
1 hours
$143.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: (j) Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes E) No
$0.00
Suppl. Insp. Feer Reg. Q OT
rom
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
("onstruclion T(rx:
A(hi ini irati e Pee:
0
Work Without Permit? O Yes e No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
�L] - --- A
TraVelDt euni4ePILt.#iion Fees:
Strong- Motion Fee: IBSEISMICP
$1.04
6.0 hrs
$858.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
y r 3BTbTALs ;-
$2.04
$1,001.00
TOTAL `EE =
$1',003 04
Revised: 07/02/2015
1*1 Building Department
Al City Of Cupertino
24�7- (- 10300 Torre Avenue
Cupertino, CA 95014-3255
telephone: 4-08=777-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: 7"7S— lG c
19 a-vt lij PERMIT # ! Sb
OWNER'S NAME: PPL
PHONE # bib - jq& G� b
GENERAL CONTRACTOR: it;G,.. e�o*U
-C>+G BUSINESS LICENSE # Z(o I1
ADDRESS: ZSOdo amu-; etiI gtvA
CITY/ZIPCODE: VW", - "> 4!�
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
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Electrical
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Flooring / Carpeting
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Sheet Metal
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