13110183 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10200 S DE ANZA BLVD CONTRACTOR:CUPERTINO ELECTRIC PERMIT NO:13110183
INC
OWNER'S NAME: SEAGATE TECHNOLOGY LLC 1132 N 7TH ST DATE ISSUED:11/27/2013
OWNER'S PHONE: 4086581001 SAN JOSE,CA 95112 PHONE NO:(408)991-1000
0 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALD
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License Classto U Lie.# L\
ADD(1)DATA RECEPTACLE 20 AMP
Contractor( X, Date��i��&
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
performance of the work for which this permit is issued,, Sq.Ft Floor Area: Valuation:$2400
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 Nu I mber:36901035.00 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 OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes, (We)agree to save 180 DAYS LAST CALLED 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 Issued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source re tions per the Cupertino Municipal Code,Section
9,18.
RE-ROOFS:
Signature Date 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)
1,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. 1 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(a)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 I
performance of the work for which this permit is issued, will maintain compliance with the Cu ti Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' 5 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agent:. -Date&ZL5
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 CONSTRUCTION LENDING AGENCY
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 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
APPLICANTCERTIFICATION 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 I 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
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10.200 s de anza blvd DATE: 11/27/2013 REVIEWED BY: Mendez
APN: BP#: VALUATION: $2,400 r�
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY g PERMIT TYPPENTAM E:
USE: Commercial Building 10EAP10
WORK I add 1 data receptacle 20 am
SCOPE
.�wilt Plan C hecA, llhut h. 1'lcrrr Check
Elec.Plan Check 0.0 hrs $0.40
Me r_.11ennit plr mh. l'c rmit Fee: Elec.Permit Fee: 1EPERMIT
otber;Xpeck True. C)11rer F'lwnb/?a p. L1
Other Elec.Insp. 1 0.4 1 hrs $47.00
Ale,A Msp,F'ec: I'Twnb h3-T,r''c e; Islec.Insp, Fee:
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
Distrlet,etc .
Thesefees are based on the CaLintina information available and are onl an estimate. Contact the De t or addn 7 info.
FEE ITEMS(Fee Resolution 11-053 Eff 71111jj FEE QTYIFEE MISC ITEMS
Plan Check Fee: $0.00 1 # Electrical
Suppl.PC Fee: Reg. OT 0.0 hrs $0.00 $47.00 1BREMRECEP Recep/SwitchlOutlets
PME Plan Check: $0.00 = amps Electrical
Permit Fee: $0.00 $47.00 11311 ECzoo Services
Suppl. Insp.Feer Reg. C)OT p;Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
C'onstruclion Tax.,
Administrative Fee: 1ADMIN $44.00 0
Work Without Permit? 0 Yes 0 No $0,00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $47.00 1
Building or Structure
i
Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
`SUIRt )TALE: $139.501 $94.00TOTAL
Revised: 10/01/2013