12070123 CITY OF CUPERTINO BUILDING, PERMIT '
BUILDING ADDRESS; :10000,TORRE AVE CONTRACTOR:,XL CONSTRUCTION PERMIT NiD:.12070123
OWNER'S NAME" TORRE,AVENUE PROPERTIES 851 BUCKEYE CT DATE ISSUED:07/17/2012
OWNER'S PHQNE; 40,89961010 MILPITAS1,CA 95035 PHONE N0:.,(408),240-6000
❑ LICENSED.CONTRACTOR'S,DECLARATION. BUILDING PERMIT INFO: BLDG' ELECT' PLUMB )
(_
License Class, Lic.4 �/
cc-�� r� f 'MECH RESIDENTIAL. ' COMMERCIAL
Contractor Cuowum Date; 71 ?.� 1 a�Z
fhereb affini thatl"a'idlicensed under
y the provisions;of Chapter 9 JOB'DESCRI'PTION-APPLE-COMMERCIAL TENANTIMP.R_OVMENT PREP'
(ciimmeocing'with Sec`tion7000)of Division3 of the Business°&Professions **SEE NOTES** LR 0 _
Code,and th_at,my license,is�in full force and effect.
hereby affirm under penalty of perjury one of:the fohowiiig two declarations:
1'have:a4Will maintaima certificate ofeonseni'io.,self-insurefor'Wotker's
Comp-ensation;,as°provided,,forbylSection 3700-of'the-L",abor'Code,for-the.
performance'of the work,for Which',this,permitis issued.
Lhave�,and`will maintain Worker's Compensation;Insurance,as,provided-for by Sq:Ft Floor Area: Valuation:$150000
Secti6n.370o ofthe:Labor:Cod",,for,t'he.performance ofthe,woik:forwhich this
permit is issued.
APN Number:36902030.00 Occupancy Type:
APPLICANT CERTIFICATION
[,certify that I'have read'this;application and state,that the above information is
correct;I agree-to,comply withrall city and.county,ordinancesand state laws relating
to liuildmg construction,and tiereby,authorize representatives of`thisscirylo enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the;above,mentioned'property-for inspection purposes!. (We)agree to;save
indemnify"and,keep:harm less the,City,'ofCupertm_o againsfliabilrties,judgments; WITHIN:180'DAYS OF PERMIT ISSUANCE OR,
costs,.and,expenses which may accrue against said City.m;consequence.of the
granting- f'this perrmt..Add.ti rally,the applicant understands and:;will comply 18O DAYS FROM,LAST CALLED INSPECTION.
with all on;point;sou eregul tionspertlie-Cupertino Municipal Code,Section
A/
9,:,18 Issued 6y: � Date:
Signa Date,
❑ OWNER-BUILDER DECLARATION RE=ROOFS:''
Ali r"oofs�shall be,inspected.prior to°any°roofing material being installed:If a roof is
1 hereby:affirm,that barn exempt from the Con tractor's,License Law for one of installed without firstobtaining an inspection;,I agree to remove,all new materials for
the followingtwo reasons: inspection.
I,;as,ownerof iherproperty,or my employees with wages as their sol"e<compensation,
will dothe work,and the-structure_isnot intended`or offered for,sale,(Sec:7044, Signature�4-Applicant: Date:
Business&"Professi-ons Code)
.1,askowner-ofthe property,:am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business:&Professions Code). ALL,ROOF COVERINGS TO-BE'CLASS"A OR BETTER
,I hereby'affirm'underpenalty ofperjury one.of the following three.
iiecfarations: HA'ZARDOUSMATERIALS:DISCLOSURE-.
lhave and will maintain a;,Certificate,of Consentdo self-insure foP Wo-rker's hhave read the;hazard ons,materials requirements under Chapter 6:95 of the
Compensation,",as.provided,for by Section 3700 of the Labor Code,for.the. California Health,&'Safety Code,Sections 25505;25533,and':25534. I will,maintain
perfoirmance of the,work for Which this permitIs issued.: compliance with the,C6pertiho Municipal,Cod'e;Chapter 9:12,and'the Health&
I have and will,Mai ntain,Worker's Compensation Insurance,as provided for-by Safety Code,:Seciion,25532(a);should I store or handle hazardous material.
:Section 3700,of the;L',ab&Code,for the,perforniance;of the work for"which this A'dditionally;should I use,equipment or devices,wh'icFi emit hazardousiair,
contaminants as defined by the Bay Area.Air Quality ManagementDistrict,will
pernir0sissued. P P H •Itainco ` Cod Secthe�Cupert!noM.iiicipal.Code,Chapter912andthe,
maintain co lance th t
I certify thdOh'the erformi mce of th"e'woek:for which this ermii°is issued;I shall ions,35505,25533,a6d'.25534.
.not employ any person many manner so,as to,become subject to the Worker's I
Compensation laws`,of California. If,after,,makmg'this certificate"ofexemption,1 or'a ori"d n
become subject to the Worker's Compensation provisions of the Lalor Code,[;must Dater
forthwiWcomply withsuch provisionsor this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT"CERTIFICATION l'hereby affirm,tharthere is a construction fending agency forthe_performance of work's
certify that I have read this application and-stateltliat the above information is for,which tliis,pe_rmit,is issued(Sec._3097,Civ,C.)
correct;_'[agree to complywith�all city and co ontyordinancesstand',state,laws relating Lender's Name
to buildirig,c'onstrucuon,and hereby authorize representatives of,this;cityto enter
upon>the�above,rnentioned property"for insp.ection,purposes,'(,We)agree to save rider's Address
indemnify and keep harmless the,City o_fCuperti-no'against"liabilities,judgments;
costs,,and'expenses=wh_h may accrue against said'City m consequence,of the
granting of:this°.ermrt Additionally,-the licant,.understands andmill,com I ARCHITECT'S DECLARATION
g g PY,r PP ,P Y -
witfi'all.non-point source regulations(perttie Cupertido,Municipal Code,Section Lunde"rstand niy plansishall'be used as public records.
9.18:
Licensed Professional
Signatuie. Date
CITY OF CUPERTINO
'FEE ESTIMATOR-BUILDING.I)IVISION
q4EW41i
DDRESS; 10000'Torre,Ave.: DATE- .07/17/2012 REVIEWED BY: A. Salvador
PN: BP#: *VALUATION: $150,000
YPE: Building Permit PLAN CHECK TYPE:
_ Tenant-improvement
PRIMARY PENTAMATION
USE Commercial Building PERMIT TYPE: ' � 1 COM
•WORK ' Tenantlm r.Ovement Pre - 'Apple"
SCOPE
i -M :. ..
qj &' ""c� Zh` ba ,�`nkaz � ' i,'`� kF.i:+ 3 aT- -s7I '�'F
Mech. P&7 Check Plumb. Plan Check Elec.,Plan Check
A,fech.Permit Fee: Plumb.Fermit Fee: Elec. Permit Fee:
Other Hoch.Insp. L1 Oiher Plumb Insp. Lj Other Elec..lnsp:
' El
Mech.lnsp,Fee: Plumb.Lnsp. Few: Elec. Insp. Fee:
NOTE:IN esdimte,,6es'not inelude fees,due to'other Deparlmenis(i:e;_,Planning;,Public.Works,Fire,,Sanitary Sewer District,School
District rete. : ,These, ees are'based oii,the prdimiMfa- in dimddbn.avdiMableand,are onl an;estimate._Contact the De t. or addn'l info.
FEE ITEMS(Fee Resolution I1-053.Eff. 7/1/1.1) FEE QTY/FEE MISCITEMS
PlansCheck Feer Hourly Only? ®Yes � No $0.00 hourPlan Check,Hourly
;Suppl. PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 $266.00 isTPLNCK
PN1E Plan.Check: $0.00 1 # Tenant Improvement Prep
Permit:Fee: $0..00 $388.00 /TIPREP
Suppl. Insp,Feer Reg. OT 0,0 lirs $0.00
PME Unif:Fee: $0.00
PME Permit.F&d- $0.00
Construction Tax:
Administrative Fee:
Work Without Permit? ®Yes (D No $0.00
Advanced Planning`Fee: $0.00 Select a Non-Residential (F)
Travel Documenaalion Fees: Building or'Structure
Strong-Motion-Fee: IBSEISMICO $31.50 Select,an Administrative.Item:
Bldg'Stds,.Commission Fee: 1B.CBSC $6.00
K
E' . SSL BTOTALS $3:7.50; $654.;00 � TOTAL FEE $691.50
evised: 07/01/2012.