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13120080vl CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10200 S DE ANZA BLVD CONTRACTOR: VULCAN PERMIT NO: 13120080 CONSTRUCTION INC OWNER'S NAME: SEAGATE TECHNOLOGY: LLC 346 MATHEW ST DATE ISSUED: 12/10/2013 OWNE PHONE: 4086581602 SANTA CLARA, CA 95050 PHONE NO: (408) 499-6039 CONTRACTORS DECLARATION JOB DESCRIPTION: RESIDENTUL E] COMMERCIAL /LICCEENNSED �/ T.I. FOR SEAGATE (400 S.F.) TO INSTALL (N) PARTITION WALL TO License Class 1J Lic. # SEPARATE OFFICE SUPPLY ROOM FROM (N) CATERING SUPPLY ROOM Contractor V L CAI -1 .,_�Date Z (' O ?> WITH ELECTRICAL (NO FOOD PREP IN T.I. AREA) 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: 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: $10000 performance of the work for which this permit is issued. j_bx.d 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 1 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 WITIIIIV 180 DAYS OF PERMIT ISSUANCE OR building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D LLED 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 b • Date: P Q granting of this permit. Additionally, the applicant understands and will co y e with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date ( RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l 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 I, as owner of the property, or my employees with wages. as their sole compensation, will do the work, and the structureis not intended or offered for sale (Sec.7044, Business & Professions Code) I, 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. [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 II performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this le 11 p -.3 Owner or authorized a ert&' --� � Date: r 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, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must l 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. 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 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 1 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 {CUPERTINOt � LL�EW CONSTRUCTION D� CONSTRUCTION PERMIT APPLICATION O" B COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 ^ building a--)cupertino.ora \� ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS . O APN #� I S 3 _ Q 2 ✓� OWNERN'AA2E3 PHOl�go 6 J STREET ADDRESS CITY, STATE,, ZIP ^ ^ FAX 5 �2 4tjZA /d z.p / CONTACT NAMEPHONE E-MAIL. 6 Hi C cv (0, J ", e M C c -4 ,r n Q qzt ( ® CC?N Tt1 .; N '/-I< c� STREET ADDRESS CITY, STATE, ZIP FAX 5 l' 9 So ❑ OWNER ❑ OWNER -BUILDER ❑ OWNTERAGENT 9-r.0N` R.4CTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEj? ' C n �j W LICENSE NUMBER Z LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL J> Alk C L -L L C FAX LC.. C A+J rDS ? Z A., C r n /,)S ) C.T a i tJ C G a /— STREET ADDRESS CITY, STATE, ZIP PHONE 3tk /►�, i C � d c� ARCHITECT/ENGINEERNAME / LICENSE NUMBER (` Rus. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK e - EXISTING USE PROPOSED USE CONSTR. TYPE f STORIES USE TYPE OCC. SQ,FI'. VALUATION (5) ExlsrG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA bi CY. t S T3 cf0 U (6,000 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH *DWELLING UNITS: IS ASECOND UNIT ❑YES SECONDSTORY E] YES BEING ADDED? NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESREGENED $Y'S��U.:� TOTAL VF�LUATION: PLANNING APPL * NO PLANNING APPROVAL LETTER EICHLER HOME? NO .K, n, `� a^i k 'n 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. 1 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 building constructicaL I authorize representatives of Cupertino to enter the above-iden fied property for inspection purposes. Signature of Applicant/Agent: Date: © l SUPPLEMENTAL INFORMATION kEQUIRED PLAI�,C IiFCIC 3]P,E, ,.., RG[TfI S IPYa New SFD or Multifamily dwellings: Apply for demolition permit for � k: AN _ � existing building(s). Demolition permit is required prior to issuance of building AVER TFIE COAI�TER ,�- £ s n ? f ice- s�fl BUILDIrGPLAN REVIEW c � xs n permit for new building. t EaPREss, tr ❑ rIA�,>`ucFLANREvtExt{ zh x}s x Bld;s: Provide a completed Hazardous Materials Disclosure0 rsTAr.DnRDd k 3 . ❑PUBLrCt�oRxs ,,. _Commercial form if any Hazardous Materials are being used as part of this project. t�r � x�x r ❑ �', L�ARCEs '� r� � FIRE DEPTs �� _ Copy of Planning Approval Letter orMeeting with Planning prior to -� I14J.JOI�t�'z 3' '" a yO:�;SiTARY SER ER DISTRICT X , . submittal of Building Permit application. gE.ENVIRONIIIENTAliHEALTH BldgApp_2011.doc revised 06/11/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10200 S DE ANZA BLVD DATE: 12/10/2013 REVIEWED BY: MELISSA APN: 369 01 035 131"M � *VALUATION: 1$10,000 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1B T) USE: PERMIT TYPE: WORK T.I. FOR SEAGATE 400 S.F.) TO INSTALL (N) PARI -1 -1 -ION WALL TO SEPARATE OFFICE SUPPLY SCOPE ROOM FROM (N) CATERING SUPPLY ROOM WITH ELECTRICAL (NO FOOD PREP IN T.I. AREA) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) I-A,I B 400 $3,061.68 1BTIPLNCK $956.55 1BTIINSP Me. Insp. Fee: PME Plan Check: $0.00 Permit Fee: $956.55 Suppl. Insp. Fee:Q Reg. © OT ro.0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 400 $3,061.68 Construction Tcrr: $956.55 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY Yes Q No ELEC, HOURLY 0 Yes Q No Mech. Plan,Check Phan6, Mori Check Elec..Plan Check: Xhl ch. Permit Fee: Phan& Permit Fee: Elec, Permit Fee: Other Alech. Insp. Other Plumb Insp. Other Elec°. Insp. L] Alech. Insp.-Fee: Phtnib. lush Fee: Me. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, dire, Sanitary Sewer District, School Dictrirt_ ate ) Thaca fooe Ora haeod nn tho nroliminary infarmadnn avaitahto and Ora mtiv nn oc&mato_ Contort the Dent far addn 11 info_ FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,061.68 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT F0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $956.55 Suppl. Insp. Fee:Q Reg. © OT ro.0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tcrr: Administrative .Feu: L Select a Non -Residential Building or Structure 0 E) E) Work Without Permit? 0 Yes 4 No Advanced PlanningFee: $0.00 $0.00 Travel Documentation 1*'ces: Strome Motion Fee: IBSEISMICO $2.10 Select an Administrative Item Bldp, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $4,021.33 $0.00 TOTAL FEE: $4,021.331 Revised: 10/01/2013 CUf'E HT NOO BuRding (Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 *Our municipal code requires all businesses working in the city to have a City of Cupertino (business Qicense. NO BUILDING ]FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITE' OF CU P1ERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature 1lDlease check appl6caWe subcontractors anal complete the following infformatuon: (Date c� Owun / Contractor Signatanu-e (Date 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 Septic Tank Sheet Metal Sheet Rock Tile Owun / Contractor Signatanu-e (Date