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15090026CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10627 BANDLEY DR CONTRACTOR: TECHNICAL BUILDERS PERMIT NO: 15090026 INC OWNER'S NAME: SI 30 LLC 12881 HEMLOCK AVE I DATE ISSUED: 09/0312015 1 OWNER'S PHONE: 4087806489 1 SAN JOSE, CA 95128 1 PHONE NO: (408)554-1011 ❑ LICENSED CONTRACTOR'S DECLARATION License Class+ P ji Lie. Contractor Date ! (v 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: 1. 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 er£orman'e of fie work for which this permit is issued. have and will mainlain 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. 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 aDkKeC11,,a,,nle,,, the City of Cupertino against liabilities, judgments, costs, and exch may accrue against said City in consequence of the granting of tAdditionally+ pplicant understands and will comply with all non-poinulations �r he pertino Municipal Code, Section 9.18. Signature Date—v- ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of 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 sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 tire, 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. Date JOB DESCRIPTION: RESIDENTIAL ❑ APPLE TI IN LAUNDRY ROOM (340 SQ FT). Sq. Ft Floor Area: APN Number: 32610047.00 COMMERCIAL ❑ Valuation: $65000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: t -3 -/ -5 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: GTKWIT6Z115iKUr/DIt7.1001 113 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. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the health & Safety Code, Section 25532(a) 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: -0in •1,64 ZIAEDate: / J CONSTRUC'T'ION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records, Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPER71N0 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ALTER-ATION / TI ❑ REVISION /DEFERRED I✓✓ ORIGINAL PERMIT # PROJECT ADDRESS p r! � �A -. APN# OWNER NAME ` 1 OD f � � Y � ^ tl � Q E-MAIL STREET ADDR SJn a. /111-" G� Ll'hY CIiY, STATE, ZIP ( 1 CONTACT NAME PHO p E-MAIL ` STREET ADDRESS e CITY, STATE, ZIP�L ' 600, e A TS FAX '4101-3-72'(o560 11 OWNER ElOWNEOWNER-BUILDER ❑ OA% RAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGWMP ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMETe,c.�► C LICENSENUMBERW,8gIl l�pp[] LICENSE TYPR BUS. LIC # COMPANY NAME "d]a�Q, tiY►C�i �V E-MAIL '�Pov.c +av+o L.Nt '��+�4. FAX STREETAllDRESS CITY STATE ,IZIP C PRONE�P��1-� yk ��Q AItCH[TEC77ENGMEERNAME LICENSENIJM$ER --- —� BUS. LIC 4 --�— COMPANY NAMEi -- AA y rte► E-MAIL �dnOly� �S`�o_ .1/s• PAX S'I'REET ADDRESS©� AkA I5CL CI, STATE, IP _ '�Q.1i`'�l�l►% —[ `� DESCRIPTION OF WORK EXISTING USE PROPOSED USE CO 'STK T1'PG # STpRIGS 1 f C USE TYPE OCC. SQ.FT. VALUATION ($) EX[STG AREA D NEW FLOOR AREA DEMO AREA TOTAL NET AREA7-1 f ` ! BATHROOM KITCHEN OTHBR REMODEL AREA REMODEL AREA REMODEL AREA PORCE AREA DECK. ARBA TOTAL DECMORCH AREA GARAGE AREA: DETACH ❑ ATTACH # T)WLLLM UMTS; 1S A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ©YES IFYES, PROVIDE COPY OF PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLERHOiME? ❑NO RECEIVE Y _- _�Air - "TOTAL V LUATION: _ Ojr no By my signature below, I certify to each of following: I am the properly owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have pr ide. is correct have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu' ing nstruc n. authorize representatives of Cupertino to enter the above -i nt' ied property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INTO ATION REQUIRED h OVER TBE -CO ETER — W BiII%bING PLAN REVIEW r New SPD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance ofbuilding pennit for new building. D EIPREA SS ' PLANivINGPLANREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAhID"AR7l ❑ PUBLIC SIORRS form if any Hazardous Materials are being used as part of this project. -_ ns� ❑ LaRrE ''FIItEAEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ' t ❑ submittal of Building Permit application. MAJOR L -$ANTTARY SER'E[tDISSRICT z , - - - ❑:':ENyIROI�TMENTAIiiEA1TH �-- BldgApp.2011,doc revised 06/21111 lrrl�.�-�'. CITY OF CUPERTINO 1I FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10627 BANDLEY DRIVE DATE: 09103/2016 REVIEWED BY: SEAN PC FEE Hl APN: BP#: *VALUATION: $65,000 xPERMITTYPE: Building Permit PLAN CHECKTYPE: Tenant Improvement PRIMARY USE: Commercial Building $656.36 PENTAMATION PERMIT TYPE: 1 B T� WORK APPLE TI IN LAUNDRY ROOM 340 SQ FT). SCOPE OCCUPANCY TYPE: TYPE . CONSTR. .fFLR AREA s. PC FEES PC FEE Hl BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 340 $2,102.26 IBTIPLNCK $656.36 IBTIINSP L1,ec. Imp, P'ee: $656.36. Supp!. Insp. Fee:Q Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 construction Tay: Administrative Fee_ 0 Work Without Permit? 0 Yes i@ No $0.00 TOTALS: 340 $2,102.26 Travel Documentation Yees: $656.36 Strong Motion Fee: IBSEISMICO MECH, HOURLY 0 Yes. 0. No PLUMB, HOURLY Yes ` No ELEC, HQURLY ` ,® "Yes No lfech, Plan Check Phu nb. Plan (heeh 1,7erc. Plan Check :i�tectr. Perwii Fee: Plumb, Permrl Fee: 57ee. Permit Pee: Other' hlech. lntp.LI 0111er PIKITlr Insp.0 Ulher lsk;(.,_ Imp, ET 14kech. Insp]. 1`C'L': 1'111211b, laq). Pee: L1,ec. Imp, P'ee: NOTE: This estimate noes not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . Z/ 3,� FEE QTY/FEE MISC ITEMS Platz Check Fee: $2,102,26 Select a Misc Bldg/Structure or Element of a Building i Suppl. PC Fee: Q Reg. 0 OT p,Q his $0.00 PME Plan Check: $0.00 Permit Fee: $656.36. Supp!. Insp. Fee:Q Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 construction Tay: Administrative Fee_ 0 Work Without Permit? 0 Yes i@ No $0.00 Advanced Planning Fee: $0,00 Select a Non -Residential 0 Building or Structure 0 Travel Documentation Yees: Strong Motion Fee: IBSEISMICO $18.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS '° $2,779.$2 $0.00 TOTAL FEE: $2,779.82 Revised: 07/02/2015