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15010126CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10900 N TANTAU AVE
CONTRACTOR: DEVCON
PERMIT NO: 15010126
CONSTRUCTION INC
OWNER'S NAME: CUPERTINO TANTAU LLC
690 GIBRALTAR DR
DATE ISSUED: 01/23/2015
OWNER'S PHONE: 4084990223
MILPITAS, CA 95035
PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
APPLE TENANT IMPROVEMENT (FIRST FLOOR) (10240 SQ
License Class 6�1 L'1 L Lic. # �j &%, % (p ,�5
FT).
Contractor Date 2
I hereby affirm that I am licensed under the rovisions 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: $150000
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: 31609029.00
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. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS-0f PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned for inspection (We) agree to save
180 DAYS FRO AI LMT CALLED INSPECTION.
property purposes.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
s
costs, and expenses which may accrue against said City in consequence of the
1
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date: �. 1 �':-"
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature_ Date 1 23 Irj
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.
❑ 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)
t, 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(x) 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 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 1
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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sect' s O5, 25533, ai 34.
t 2-3115
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 in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, [
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. 1 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
l 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 • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.orq
NEW CONSTRUCTION ❑ ADDITION lbJ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 0
PROJECT D DRESS0
ALL-
APN H // T D
OYR NAME
�<NU �—�J • /F7J� `
C3&,—o
PHONE LLr�Gt •� J . d Z��
E-MAIL ��DO
STREV AD RESS CITY, STATE, ZIP FAX
CONTACT NAME PHONE -MAIL
>✓ MdDRE" YOB' �•D�
STREET ADDRESS
// ✓ / o
CITY, ST!% ZIP
r✓a G119
FAX
❑ OWNER. ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CO T1 G CONS7R u C7�b
LICENSEfe / �'{
((%% /
LICENSE TYPE
BUS. LIC k
CQ PANYNAy�% dA C) C ���
�1
E-MAIL
FAX
STREET ADDRESS
/!L71tA bA.
CITY, STATE, ZIP
CIA- 7S83
P140
.Z427- .Z5S
ARC . rECT/ENGJT,N'EER N M
LICENSE NUMBER
BUS LIC k
L1
NAME
COMP4 NAM S C /Y
E-MAIL
k11^ X
u� S
FAX
/
.
' -6S-l' V
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR
TYPE
k STO S
,r - a-
1
/
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
KITCHEN
OTHER
'.. REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
''. # DWELLING UNITS:
IS A SECOND UNIT C3 YES
SECOND STORY []YES_
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY -
, TOTAL VALV„A;pl, u:
PLANNING APPL AI ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
,
By my signature below, I certify to each of the following: 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 provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with al I applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified roperty for inspection purposes.
Signature of Applicant/Agent: °°'�~ Date:/Z� �5
SUPPLEMENTAL fNFORMATION
+ , PLAN CHECKTYPE
RpC]TIIVG SLI .
Q,�iR T1 E -q 'TER
"
BIJILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demo rtlon permit for
existing building(s). Demolition permit is required prior to issuance of building°
permit for new building.
,:. ,.
©' Ex REss
❑"PI ANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Q STANDARD '
1 ° PTIBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
ET
LARGEFIRE
DEPT„
�rSANITARY
Copy of Planning Approval Letter or Meeting with Planning prior to
`,S,
submittal of Building Permit application.
srwERDIsxRICT
CD> ENVYRQNMENTAL HEALTH
BIdg,4pp_2011.doe revised 06/21/11
v -f
CITY OF CUPERTINO
FM_71 FEE ESTIMATOR -BUILDING DIVISION
ADDRESS: 10900 n tantau-ave
TYPE OF
CONSTR.
DATE: 01/22/2015
REVIEWED BY: Mendez
APN:
BP#: It 5VO
`VALUATION: 1$150,000
`"PERMIT TYPE: Building Permit
II-B,III-B,IV,V-B
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
Commercial Building
USE:
IBTIPLNCK
PENTAMATION
PERMIT TYPE: 1 B TI
WORK
comm ti 10240 sq ft
$0.00
SCOPE
Lj
-L-
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
ss.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
10,240
$2,719.06
IBTIPLNCK
$6,679.05
1BTIINSP
hrs
$0.00
PME Plan Check:
Lj
-L-
EJ
Permit Fee:
$6,679.05
SuppL Insp. Fee:Q Reg.
Q OT
F0,0Thrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
10,240
$2,719.06
$0.00
$6,679.05
MECH, HOURLY
0 Yes
0 No `'
PLUMB, HOURLY
® Yes
Q
No
ELEC, HOURLY
® Yes
0 No
Swimming Pool
Vinyl -Lined
i
Suppl. PC Fee: 0 Reg. 0 OT
FO.0
hrs
$0.00
PME Plan Check:
Lj
-L-
EJ
Permit Fee:
$6,679.05
SuppL Insp. Fee:Q Reg.
Q OT
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Can tact the Dent for addn'l info.
FEE ITEMS (Fee Resolulion 11-053 Eft. T'11'13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,719.06
:1 s.f.
$0.00
Swimming Pool
Vinyl -Lined
i
Suppl. PC Fee: 0 Reg. 0 OT
FO.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$6,679.05
SuppL Insp. Fee:Q Reg.
Q OT
F0,0Thrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
Strom Motion Fee:
IBSEISNIICO
$42.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$6.00
SUBTOTALS:
$9,446.11
$0.00
TOTAL FEE:
$9,446.11
Revised: 01/06/2015
CUPERTINO
CONTRACTOR TOR / SIBC®ia1'I'RACTOIB LIST
Building Department
City Of Cupertino
10300 Torre Avenin
Cupertino, CA 95014-3255
Telephone: 408-777-3223
Fax: 408-777-3333
JOB ADDRESS:__0-cl-2 V'I2�,i�,-
OWNER'S NAME: I C',� �.._
_ _
€,ENIEIRALCONTRAC'T R� F, ��,v1
--
PERIMIT-4 t S°1612 -
j"HONE rt Lf1L° `I `7 Z � 2 00
BUSINESSLICEN-SE# --
Ant RESS: (Qcl b
BUSINESS LICENSE #
CITYIZIPCOUE: l4 I 1 9s ?Y5
*Out- municipal code requires all hosinesses working in the city to h,rve a City of Cupertino business license.
NO BUILDING FINAL OR FINAL. OCCURkNCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL: SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I ant not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following iinfor ri ation:
V
SUBCONTRACTOR
BUSINESS NAME � —
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
V
Electrical
'
Excavation
Fencing
Flooring I Carpeting
Linoleum / Wood
Glass / Glazing
Heating
JnWlation
Landscaping
Lathing
Masonry
v/
Painting! Wallpaper
--
.
Paving
Plastering
Plumbing
Roofing
_ _ Y
Septic Tank
Sheet Metal
yr j k60/ Me
V
c_k_,__.___._
S11eeC RoCI<
(�i J^2 LI� l�✓L%L��t
Tile
T _�.. -- ---------- 5 ZG /5
OWDer / Contractor Signature Date
CUPERTINO
TEMPORARY CERTIFICATE OF OCCUPANCY FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 a FAX (408) 777-3333 • building@cuper ino.orq
APM'l / U Z
b
Y
DATE. Q �s,
Zp
VALLUPOJATION: $ (� D1 Q O v
SITE
ADDRESS:
OWNER'S NAME:
/2 �/7 G
PHONE #:
FEE' $286.00/m0
FAX #:
MAILING ADDRESS (if different from site ddress):00
�
CONTRACTOR: �_,c
'Dew erYl co-eis�tlolm
PHONE* O& cf Z 2 on
FAX#: 06'2&2 23C12-
3yzCONTACT:
CONTACT:
/CG
(,Z/ I nV d tt Z2i
PHONE #:
FAX #:
TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION
BOND TYPE: ❑ SURETY BOND
AMOUNT (1% VALUATIONS6� U �' DSONDSJ
CODE
El' CHECK El CASH BOND
OF BOND: SK min -10K max
EDITION:
TCO EXPIRATION
g /S
FEE' $286.00/m0
TOTAL FEE: $ S �'Z [1TEMPOCCJ
DATE (6 MONTHS MAX):
USE
TYPE OF
CONSTR
FLOOR
AREA
OCC
LOAD
LEVEL
COMMENT
>e�S 12y 132-21
iia
❑ APPROVED WITH CONDITIONS"
Signature:...................................................... Date:......................
other
❑ APPROVED
❑ APPROVED WITH CONDITIONS"
Signature:......................................................... Date:......................
OTHER DEPW1106T I AGENCY APPROVALS: /
annrng .../ / .......... Date:
Sinature; ...........................................
L15...APPROVED
❑ APPROVED WITH CONDITIONS"
Fire
r nature; ...... . .. .................... Date:.......
/ 5 ❑ APPROVED
.........
❑ APPROVED WITH CONDITIONS'
'Public Works
❑ APPROVED
❑ APPROVED WITH CONDITIONS"
Signature:...................................................... Date:......................
other
❑ APPROVED
❑ APPROVED WITH CONDITIONS"
Signature:......................................................... Date:......................
*CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property
stating the list of items required to be completed for each individual Department before final occupancy
can be granted. Include approximate completion dates for each Item.
The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or
buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration
date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non-compliance
may result in an enforcement a ion.
Owner Contractor
f/
S
SianatWSAMMt.IU.Ikd.V Date:�.Signature:.................................. Date: ...
This temporary certificate a ures tha I fi rote�on and life safety systems have been completed, inspected, successfully tested and
-rproved for the specific it e f the ui g eafied above to provide a reasonable degree of safety to the occupants from fire and
.milar emergencies,
BuildingOfficial:.. . . ............ Print: AllP ........... Date:..6 .....� 4 .........
DEPARTMENT ACTION: After d rminafio?V copies to: 1) applicant, 2) permit file
TempOccForm_2013. doc revised 717114
