12080137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10900 N,TANTAU,AYE• CONTRACTOR:,DEVCON CONSTRUCTION PERMIT NO: 12080137
INC
OWNERS-NAME; CUPERTINO TANTAU'LLC' 690-GIBRALTAR DR DATE ISSUED:08/22/2012
OWNER'S°PHONE: 4088629799 MILPITAS,CA 95035PHONE NO:(408)942-8200
❑, LICENSED CONTRACTOR'S-DECLARATION' : 3? 1
- BUILDING PERMIT INFO: BLDG ELECT' PLUMB '°
License Class 3 Lic.# �� l9 Ii
p\rA/ . MECH RESIDENTIAL . COMMERCIAL
Contractor k-�-�'VC_-�(�.1/ Date
hereby affirm ttiafI am,hcen"sed under the provision"s',ofChapter9
JORDESCRIPTION:APPLE-I ST'FLOOR-COMMERCIAL TENANT
(commen'ciug with Section 7000)of Divfswn 3 of,the Business&Professions IMPROVEMENT.
Code,and:that my license is?in full force'and effect. OF°546 SQFT TO.CHANGE(1)'LAB SPACE:INTO'(2)LAB
SPACES
hereby affirm underpenalty of perjury one ofthe following two declarations:
1'fiaveiand will maintain'a certificate of•consent,to self-insure,for'Woiker's
Compensation„as provided,for'by$ecti'on_3700.- the Labor Code,for the
p&fb(nianeerofthe w"o'rk,fortvf ch'ihis!,permifis,i'ssued.
I'liave,and,will maintain`Work,er's Compensation,lnsurance,astproyfded for by
Seeti6n6700'ofthe Labor,Code;:for the,&rfofmance of the;work for which this
permit,is issued: Sq.Ft Floor,Area; Valuation:$38800Q
APELWANT:,C ERTI FICATI ON
I certify;that l have read,thisapplicafion and state that the above information'is APN Number:31'609029:00 Occupancy Type:
correct.I,agree`to:comply witti�all city and counwordinances,and,state�laws relating
io,:bmldingconstrgetion,and.hereby�authorize representatives of this city to enter
upon the above me_mionedproperyfor(inspecttowpurposes. '(.UVe)agree to.save
ndemnity and,keepbarmless the',City<ofCupertino against,liabilities;juiigments, PERMIT EXPIRES IF WORK IS NOT STARTED
'costs,and expenses'whicli inay`accrue against said Cityin consequence of'the
grariting`of this;permii. Additionally;the appIicant,understands and.-wiII comply WITHIN X180 DAYS OF PERMIT ISSUANCE OR
with all non;Point-source regulations) the Cupertino Municipal"Cod"e,Section
180 DAYS FROMZAST CALLED,INSPECTION.
9x'18.. _
Signat e Issued y:b / //Yi���/L l Date: a
_ _
'0 OWNER-BUILDER DECLARATION'
I hereby,affi'rm:that Lim;esempffrom the Contractor-s.License Law for.,one of RE-ROOFS:
'the following two reasons; All roofsshiiV
all beiidcted:prior tdany'roofihg material being installed.If a roof is
rso
I,as;ownef theproperty,or myemployees with wages as,their'so_le;compensation; installed without'first'obtaining an inspection,I agree to remove all new materials for
will do,the,work,and the structure isnot intended4o-r:6ffered f6r.,sale'(Se"c.7044, inspection.
Business&,Professions^Code)
,I;as owner of thetproperty;am exclusivelycofitracting with.licensed contractors.to_ Signature of-Applicant:. Date:
'construct the project(5ec.7044;,Business;&;Professions Code):
,I here b affir-m under penalty of.perjury one,of the,followin three ALL RO:OF'COVERINGS TO BECLASS"A",OR BETTER
-
declarations.: P Y P_ J -Y_ _ _g_
declarations:
I have and will'mamtain a Certificate of Consent to self-msure7for,Worker's HAZARDOUS MATERIALS'DISCLOSURE
Compensation,as,provided•for by 3ection•3.700 ofthe,Labor.Coile;-for the
;performance ofthefwork•for which this permit;is issued. t have read the,hazardous materials requirements under Chapter 6.95 of the:
I have and will maintain Worker's Compensation Insurance;•as;Provided=for'liy California Health&S.afety,Code,Sections 25505,;25533;'and 25534. I will maintain
= compliance'with"tlie,•Cupertino Municipal Code;,Chapter 9 12,and the Health&_
Section 3700 of the,L&t,Code,for the perf6 riance,"ofthe work,for which this Safety Code,Section 25532(a),�should_I store or handle haaardoas�material.
rt -
permis issued: Additionally,should Luse:egoipmentor.devices which"emit hazardousiair
:1 certify tkat,inihe'performance 0f,thepwork•for which.this permit is issued)shall contaminants a"s'.defined by the Bay;;Area',-Air QoalityManagement;Distr`ic-t I_will
•not employ any°person in any manneriso.as to•bi c0rne;subjecLto.the Worker's maintain compliance with the;Cuperttno Municipal Code,Chapter 9il2:andahe
'Compensation laws-of California. If;,after.makingthis_certificate ofe-xemption,I Health&Safety+Code,Seetions,25505,25533;and 25534.
become sulijecftothe Worker's,Coin°pensation piovisions,ofthe Labor Code,I,must
forthwith comply with,such provisions or this permit shall'be,deemed-evoked. r•or a” or` /
,Date: 9/2z.hz
APPLICANT•CkRTiFICATiON CONSTRUCTION'LENDING AGENCY
certify,that.I have read this application&state4hatthe%above'idformation,is
,I
correct agree t'o-eoriiply with:allcity and county`ordinances�;andstate laws;relating Lheiebyaffirm.that there is,a;construetion lending agency°for t_he°performance of Aurk's
'to building construction,and,hereby authorize:_representatives-of,this,city to,enter for which this permit is issued(Sec.,3097;Civ C.)
upon the+above mentioned property for inspection purposes.(,We)`agree to save Lender's;Name.
indemnify and keep harmless the City of Cupertino 4gamst liabilities,judgments;
costs and expensesawhich may,accrue agamst.said.Crtym consequence of the Lepel_en's,Address.
granting of:tliiis,,permit:Additionally;,the applicant understands and will-comply
,with all non-point source regulations,pei the Cupertino;Mun'icipal Code"Section ARCHITECT'S'DECLARATION
Lunderstand+my plans shall be usedas public,records.
Signature Date
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE-,CUPERTINO, Ck95014-3255 ts
CUPtRTINO (408) 777-3228- FAX(408) 777-3333- building(akupeftino.org
N I ADDITION Al AL PERMIT4
EWCONSTRUCT ON ADD ALTERATION/ ❑ REVISION),DEFERRED,-
ORIGINAL
;I�kOJEC"t ADDRESS APN# I 1
0 0
OWNER NAME PHONE. &MAIL
STREET ADDRESS CITY STATE,ZIP FAX'
,CONTACT NAME PHO E E-MAIL
STREET ADDRESS' CITY,:STATt, Zip FAX
OWNER ❑ OWNER-BUILDER El OWNER-AGENT )!kONTRACTOR 13 CONTRACTOR AGENT El ARCHITECT El ENGINEER ❑ DEVELOPER, El TENANT
CONTRACTOWNAME eL LICENSE�NUMBER LICENSEZYPE BUS.LIC 9
_39YA
T
COMPANY NAME E-MAIL FAX
Y_ ,�nqe
DL\lcoo COY4.co!21
STREET ADDRESSpo CITY,.STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE,NUMBER BUS.LIC*
C
C
COMPANY-NAME E-MAIL 'FAX
cy STREET ADDRESS CITY;,STATE,ZIP PHONE
je CA 5-3-e F
DESCRIPTION OF WORK
�7 e-,
,
EXISTIN�USE PROPOSED USE CONSTRJ7, 4 STORIES
J�a , — j vi - I �F USE, TYPE bcc. SQ.FT. VALUATION(S)
ce
DEMO TOTAL
AREA AREA NET AREA t3
BATHROOM KITCHEN :OTHER
REMODEL AREA REMODELARFA 'REMODEL.AREA
'PORCHIAREA DECK AREA TOTAL•DECK/PORCHARE 'GARAGEAREA: UDETACH
E],ATTACH
'4 DW,ELLING�UNITS.: IS kSECOND UNIT E]YES SECONDISTORY LIYES
BEING,ADQE1)?- )RNO ADDITION? _23NO
TOTAL VALUATION:
PRE-APPLICATION ZYES IF'YES�PkO,�TDE.COP-�OF, IS�-,Tq�_BLPGA� YES. ,RECEI
V
r"n
I F Al,
PI:AT4NfNG,,AP,PL • N PLANNINGAPPROVALLETTER 00ii]EFNIOAE? NO �E g
x
0
R12
13y'my,sigrature,below-,4 certify to each,of.the�followifig_. Lamth&property.bWn-er-,6r authorizeHgen--t-to-'act on,the�proftrty owner's.,4ehalf.' I,have read'this
application and theJfiformation I have prbvidedl�is,correct. I'hav6"read,i�e'-bescripti.on,of Work,and verify'k ls�`accuraie. I agree to comply with all applicable local
6rdinari-ces;and statAaws relating to bd,ild' wAfturri representatives clCuvertino to�en'
DjX-1 I:authorize r5prese, ter the aboye-ident'fi d property for inspection purposes.
S igriature,of AppI icant/AgeDater JS e�.
SUPPLEMENTAL 10 D 'PLAN,CHECK
5140
ffl
'it f6r. N �BUILDING.-P
`New SFD orMultifdmil' Wblli�gs� ly tion'"e
10
-dkisting,lbuilding(§)� Demollii ired prior to issuance,ofbuilding,
0_1"'N", 0
NO
5
4
permit for,new building.,, �,-,,EXPRESS V
-
Commercial Bldgs: Provide a corn pl.eted'Hazardous Materials Disclosure El PUBLIC-WOW
1,01"
,form if any Hazardous Materials are b6r(gused g§,D4-t of this project.
DEPT-
Copy df,Planhi-g Approval Letter,or Meefing,with Planning prior Yo
MAJOR ❑ SANITARY
"
�AYy SEW �
,:submittal ofBuilding Permit application'.
U,4
R ENT HEAL,
B14gApp, 201.1.do'c;revi'sed,06%2,7'/II
CITY OF CUPERTINO
FEE:ESTIMATOR -BUILDINiG DIVISION
ADDRESS: 10900 N T.antau,Ave DATE: 0.8/1:3/2012 REVIEWED BY: Sean.
APNi : BP.#r � VALUATION: 1$388,000
,PERMIT TYPE:: Building Permit PLAN CHECK TYPE: Tenant Improvement:
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 113JI
WORK Tenant Improvement of 546 s 'ft to:chan e 1, .Iab s- ace into 2 labs aces.
SCOPE
TYPE-,OF FLR AREA
OCCUPANCY'TYPE CONSTR. s.0 PC.FEES PC FEE ID BP FEES BP FEE ID'
B (Tenant Improvements) 11=6;11.1-B"jV;V=B 546 $1,964.70' .IBTIPLNCK = $737.71 IBTIINSP
TOTALS:. 546` $=1,,964:70 .$737.71
1VIE HHO ��' � OU-VolRY� QIWK
ELC, R ® YdQNYMBHo
Vtech..t'ffrrr C' c:cR Mw/_Z), PlaI)
,le:f]..P'erriti? "f,,n?s%. e'crmieT er 1'ici I'.a;nzt, ( ze.
Qdxr V(ch. 'Insp, OCLE r I'l.onh Ir1sp
,1fec_/z. Insp Tcc,., l'!.tr 1. I zsp. I c,.. co:,Ih.sf,.`e:e
NOTE: This estimate doesmot include fees due,to'other Departments(he.Planning;P,ublici Works„Fire,Sanitary Sewer.District,School
District;eic:: These ees.are hased�on the relimiiza. information-available and are:onl .an,estimate. Contact the Ve 't; or addh7 in o..
FEE ITEMS(Fee'Resolution 71-053 a.' 7/1!11) FEE QTY/FEE MISC:ITEMS.
`Plan Check-Fee: $1;964,.70 Select a;Misc Bldg/:Structure
Suppl. PC:Fee: Reg. 0.OT 0 0 hrs. $0.00 Building`
or Element of 3
PME Plan Check: $0.00
Permit Fee: $737.71
Suppl:,Insp . QReg, QOT s .00
PME.Unit Fee:
PME.Permit Fee: $0.00
Conso7acrion.Tcrr:
T7
t1_CitlYltllSLt.?YdTiL't?I'f.,'R.” -
Work Without Permit? 0 Yes �. No $0;00. .
Adwa'nced.P.l'ahninV.Fee: $0.00 Select a Non-Residential. E)
'Travez DOCZlInentation 1 gees: Building or Structure 0
i
Strong IViotion"..Fee: IBSEISVIICO $81A8 S.'elect an Administrative Item
B'1dg Stds Commission'F.ee: IBCBSC `$1.6.00
r r SUBTOTA �S $2;79,9,:89 $0..00 ' T®TALFEE $2,799.$9
� Fa 1 �" .. �, tai
Revised: 07/01'/2012
SJ.Ce`��:S�Y�Fealr.�„1i.`4.._^1�..-w_'em^^ - -'�c:_ -..r, - ax.,-xt:xwar., P.ut.m.s -- '"'•'^"rS�.'-�' r�k'"`.'i ' -_ - __
'Building Department,
/ Ci ty er
Of Cu tino.
�:pz
10300 Torre Avenue
Cupertino,.CA 95:014=325.5
Telephone:408 777-3228 .F ,
C O P E RTI,N O Fax: 408-777-3333 ..
CON T1 CToR_l.S:tTBC.ONT:R-ACTOR,.LIST
JOBAD.DRESS; lzxv-1vzn. PERMIT# bl
OWNER'S NAME: ,e PHONE#1 4 o4S)r'1`l Z_, 5e�J {
GENERAL.CONTRACTOR:
. o,%1 � BUSINESS". Sel"i 3,' . ..
ADDRESS: 6ejO 67 {- C- D i' : C. CITY%ZIPCODE -lM I :'t lS
*Our municipal code.. quires alkbusinessesworking irr.ttie city to..hawe a City of C:upertino:limsiness licen'se:, I
NO BUILDING FI`NA'L OR- FINAL O.CC CC INSPECTIQN(S) WILL`BE 'SCHEDU,LED•'UNTIL THE .;
GENERAL'CONTRACTOR-ANDD ALE 'S:LTBCONTRACTORS.-.][!,AVE- OBTA-INED.A CITY'.OF C.UP.ERTIN:O
BUSINESS LICENSE:..
'1am not,using any subcontractors:
Signature Date;
Please check•applicab;le:subcontractors and,com Tete thefoll'owing.infor..matiori_; ;
p
✓' SUBC®NTI2ACI`®R, .B><TSINESS'N.AIVIE BUShhT'ESS.LICENSE
Cabinets &;millwork
`Cement'Finishing
V Electrical (,wX: ALLYL
Excavation
Flooring I Carpeting; pfes vx
Linoleum %Wood;
Glass,?V-G'lazing
.Heating, Ali
Irisulatioii.
Landscaping
Lathing:
P;ain6- /°Wallpaper'-
Paying;
Plastering.
Plumbing,,.
Roofing: _
Septic Tank .
Sheef'M6 al _
Sheet:Rock.
Tile:.
owner-/Contractor Signature'. ? ` Date