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11100145 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 N TANTAU AVE CONTRACTOR:BARRON BUILDERS INC PERMIT NO: 11100145 OWNER'S NAME: CAMPUS HOLDINGS INC 415 CLYDE AVE STE 104 DATE ISSUED: 10/19/2011 OWNER'S PHONE: 4089968181 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)269-7061 ❑ LICENSED CONTRACTOR'S DECLARATION [_ r f--2) � pr / BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class f_.) Lic.N 1 1 tO 3t/3(1& 117ECH F RESIDENTIAL F_ COMMERCIAL r Contractor 0A(4K6,J LSO I LOIEK S Date i011-1 I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:Tl-OFFICE SPACE FOR A'rW0 STORY OFFICE BUILDING (commencing with Section 7000)of Division 3 of the Business&Professions ADDING I NEW LAB ON THE SECOND FLOOR. 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$30000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number:31618025.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18_ Issued b Date: Signature Date 0 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the 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 under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous 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. 1 will maintain performance of the work for which this permit is issued, compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or au razed agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 1 b 1 1 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)7T7-3228• FAX(408)777-3333• building(-kupertino.org CUPERTINO ❑NEW CONSTRUCT-ION ❑ ADDITION ALTERATION/-n ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS APN to 300 N. UTAA) Au NU 3l6 I�— d2s" OWNER NAME ��mpL(s �� PHONE �j E-MAIL bS-O� f�- �� fA7 „i-• STREET ADDRESS CITY,STATE.IIP FAX 1 CONTACT NAME` PHO E-MAIL O V41k177 ;0 STREET ADDRESS 415 6L t f A j/W U CITY,STATE• ZIP Li- fC" r 14 1 L4 veF'�so , °I6 ) ❑OwNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONIRACTORNAME G N� LICENSE NUMBER LICENSE BUS.Lly., COMPANY NAME l' �� EMAIL /"�� n 0� • Gbl� F� '/�D•�I � G1 �21,&VTW E2 STREET ADDRESS l s P i o� U U CITY,STATE ZIPS \s1 U• 1 J� A D PHONE, ' Mo 1)4 rjAj ARCHrrECT/ENGINEER NAME „` LICENSE NUMBER1� �1 V� Com* BUS.LIC p COMPANY NAME �S (GAJ , E f 1II� 2 AAe- FAX STREET ADDRESS 26�`� S 1' /_ S ¢�' CITY�.QSTATE ZIP D PHONE DESCRIPTION OF WORK 1 1 v1 41_+/►'` I,F-NP<Nf 114 F rov fo p- A —tW D S O bVkk,D Ifs(n Gyu SISTIN 61 ott L- 0Ys� F L,00 y- ? EXISTING USE PROPOSED USE CONSTR.TYPE #STO D 04(M r i1i � L USE TYPE OCC. SQ FT. VALUATION(S) EXISTG NEW FLOG A/� DEMO TOTAL L / AREA AREA / '/ AREA NETARE4 / BATHROOM KITCHEN OTHER REMODEL J REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: L1 DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT Ej YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? []NO PRY-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY:�J j /� TOTAL VALU TION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO //`�(�J� J —7 Q� By my signature below,I certify to each of the following- I am the property owner or authorized agent to act on the prpperty 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 all applicable local ordinances and state laws relating to building con ction. I authorize representatives of Cupertino to enter the above-identifil property for inspection purposes. Signature of Applicant/Agenc- Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for vER_T�ccoUNTER 07 BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 13 MAJOR EJ s►NITARY SEWER DLSTRICT ❑ ENVIRoI vixNTAL HEALTH BldgApp_201 1.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CU P E RTI N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: Q N , TAWrA O PERMIT# OWNER'S NAME: PHONE# G-sn —% 'j 3 GENERAL CONTRACTOR: JILDW BUSINESS LICENSE# TZ950 ADDRESS: u. pE A,%fL, Sgr, CITY/ZIPCODE: L'7 . !FW *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets & Millwork Cement Finishing Electrical Excavation Noy V, Fencing Flooring /Carpeting Linoleum/Wood Glass/ Glazing Heating ' abw5oA (SROLS oU Insulation Landscaping Lathing Masonry Painting/WallpaperCA1�1�E��Q 60wr- (— Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock ,C . l Q � Tile Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10300 n.tantau ave. DATE: 10/19/2011 REVIEWED BY: bobs. APN: � - —(�� BP#: O� s "VALUATION: 1$30,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK "mmercial offices ace add 1 new lab to existing lab on second floor. SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,111-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH,HOURLY Yes 0 No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY ® Yes 0 No Li Li Ll NOTE: This estimate does not include fees due to other Departments(Le Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelinina information available and are only an estimate Contact the De t or addn'1 info, FEE ITEMS (1,ee Resolution 11-053 E . 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 2 hours Plan Check,Hourly Suppl.PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 $260.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes 0 No $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'rr;z46rrt:fic3fi Irt Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planninp, Fee: $0.00 Select a Non-Residential 0 Tra-vel 1.)r,rClBuilding or Structure 0 i Stront;Motion Fee: IBSEISMICO $6.30 6.0 I hrs Inspections Bldg;Stds Commission Fee: IBCBSC $2.00 $780.00 ISTINSP 7 Inspection,Hourly SUBTOTALS: $8.30 $1,040.00 TOTAL FEE: 1 $1,048.30 Revised: 10/01/2011