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15040038I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10460 BUBB RD f CONTRACTOR DEVCON PERMIT NO: 15040038 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO XIII LLC OWNER'S PHONE: 4089742909 LICENSED CONTRACTOR'S DECLARATION License Class Lie.#_ Contractor r Date 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. 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 permit is issued. APPLICANT CERTIFICATION 1 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point sourc gulationsjper the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, I, 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date 690 GIBRALTAR DR I DATE ISSUED: 05/14/2015 MILPITAS, CA 95035 I PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL APPLE - TENANT IMPROVEMENT (30,000 SQ FT). NEW HVAC EQUIPMENT, NEW RESTROOMS, SKYLIGHTS, & LABS DEF # 2 - REAR PATIO BIKE LOCKER DETAILS/CALL'S FOR ROOF STRUTURE ISSUED 9/23/15 ie etv * -) Sq. Ft Floor Area: I Valuation: $4800000 APN Number: 35720037.00 SOccupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED DAY PERMIT ISSUANCE OR T CALLED INSPECTION. ® Date:Z�i7z Alf RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Own rF ori ed Date CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional. AL PERMIT � CONSTRUCTION PERMIT APPLICATIONzoo COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building (�cupertino.orct CUPERTIN0 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 REVISION / DEFERRED"' ORIGIN PROJECT ADDRESS 0 � , ) d MD APN 4 OWNERNAME PHONE ', I E-MAIL STREET ADD SS �y g CITY, STATE, ZIP I FAX CONTACT NAME 44 PHONE g_MIq �C I �s e STREET ADDRESS CITY, STATE, ZIP FAX l❑ OWNER ❑_ OWNER-BUEAER ❑ OV'NERAGEIST ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑'ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE 2BER LICENSETYPE BUS. LIC f COMPANY NAME E MAI FAX STRE ADDRESS CITY, STATE, ZIP PHONE tLt t? m P t C Sr� ARCHITECT/E 'GINER NAME. LICENSE NUMBER BUS. LIC n C UMP NAt SE E-MAIL W FAX STREE D 'SS. CITY TATE, ZIP PHONE DESCRIPTION OF WORK ® w® =STING USE PROPOSED USE - CONSTR. TYPE a STORIES USE TYPE I' OCC. I SQ.FT. I VALIDATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH DWELLING UNITS: IS A SECOND oNrr ❑YES SECOND STORY ❑ TES BE'"N DED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES AL VALUATION: PLANNING APPLm ❑NO PLANNING APPROVAL LETTER EICHLERHOME? _ •, �. - '- -. �- ,, "�-�„` By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th erty owner's behalf. I have read this application and the information I have provide 's correct. I have read the Description ofWork and verify it i ate. I agree to comply with all applicable Iocal ordinances and state laws relating to buildi,�' c ruction. ri esentatives of Cupertino to enter the above -Id ntified property for inspection purposes. o P Signature ofA licantlA ent: Date: PP g -.- -: SUPPLEMENTAL INFORMATION REQUIRED s' ��-> -, z ? � . CHECK IPE t0T3T7RGSLLP _ . v New SFD or Multifamily d« ellings: Apply for demolition permit for p ERNE - BUILDL�G PiNREVS£ V existingbuilding(s). Demolition permit is required prior to issuance of building P 4 ovR T1OOIJTtTER permit for new building .E*PRESS§ �- -� P 'nLTtG'EL.(ih,RE 'LEw s -z �mAwi WN _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L1DIP PUBLrc �oRlzs...- form if any Hazardous Materials are being used as part of this project. r s ' _ Copy of Planning Approval Letter or Meeting with Planning prior to�� Building Permit submittal of application. Bldgpp 2011.doc revised 46/21/11 CITY OF CUPERTINO FFF, F,.19TTMATOR RTTTT.T)TNC' 1r)1V1C1[nN 1AADDRESS: 10460 BUBB RD QTY/FEE DATE: 09/23/2015 REVIEWED BY: MELISSA $0.00 APN: 357,20 037 BP h 15040038 *VALUATION: Iso *PERMIT TYPE: Building Permit $0.00 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Civil / Religious activities in BQ zone? 0 Yes (D No PENTAMATION PERMIT TYPE: A WORK DEF # 2 - REAR PATIO BIKE LOCKER DETAILS/CALC'S FOR ROOF STRUTURE TO ADDRESS SCOPE REV # 3 - ISSUED 9/23/15 PME Unit Fee: Afech. Pian Check I ' IEsiCrt (I lec..7'lun ; `hecle ;tlech. Perri -W Fee: I I Ptumb. Permit Fee: I I Elec. Permit Fee Other :llech. Insp. ' ! Odie. Plumb Imp. L --d Oihei, E'lec. Insp. L—J ;14ech. h2q;,. Fee: 1—! Climb. Insp. Fee: E: -kc, Insp. Fee: NOTE. This estimate does not include fees due to other Departments (Le. Planning. Public Works, Fire, Sanitary Sewer District, School n..s..P..t -If- 1 rz. „'r ,. „ L-4 sb,...-I'....:.,.--1 :,..F ,. ..f:.,..... ...I.,h7., .,.-,.I nrn nr.,l„ n recti—ta !'antant tho pont far nfldn'I fslfa_ FEE ITEMS (&e Resolution I1-053 E . ZI 13, FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (E)Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -(F) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 Administrative Fee 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 Travel Doc' menlalion Fees Strong Motion Fee: $0.00 Select an Administrative Item $0.00 OT $0.00 Bldg; Stds Commission Fee: SIl�TI3�`AL:; $0.00 $0.00 Revised: u l/wzu' o ri CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 15040038 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO XIII LLC 690 GIBRALTAR DR DATE ISSUED: 05/14/2015 OWNER'S PHONE: 4089742909 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL 0 License Class APPLE - TENANT IMPROVEMENT (30,000 SQ FT). NEW Li,. # HVAC EQUIPMENT, NEW RESTROOMS, SKYLIGHTS, & Contractor _ P rye 'p m Dat -_7/_!- / LABS I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 3 - ADD BIKE LOCKERS TO REAR PATIO - ISSUED (commencing with Section 7000) of Division 3 of the Business & Professions 7/29/15 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: $4800000 of the work for which this permit is issued. rerfiormance have and will maintain Worker's Compensation Insurance, as provided for by ction 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35720037.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIItES 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 + 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 Z5 granting of this permit. Additionally, the applicant understands and will comply ssue d Date: / with all non -point source regulations per the Cupertino Municipal Code, Section -- 9.18. kr RE -ROOFS: Signature Date ?Z24 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust 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 I, 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) 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. I 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 Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 255PId 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: % $ 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 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 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 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 CONSTRUCTION PERMIT APPLICATION CONWUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO a 10300 TORRE AVENUE • CUPER 1 INO, CA 95014-3255` (408) 777-3228 • FAX (408) 777-3333 • build ino 5)_cupertino.org ❑ NEW CONSTRUCTION ❑ AMMON ❑ ALTERATION / TI lel,/REVISIO )/ DEFERRED ORIGINAL PERMIT T Kplftob& PROTECT ADDRESS to k 6 ® P✓WoW&� • N �5�- - Zo -03�' OWNER NAME nI e- PHONE ® • �� STREET ADDRESS s CITY, STATE, ZIP I FAX sp CONTACT NAME PHONE E_" - IL I AgE�� lJ �' 6 �� s191? � 1 m STREET ADDRESS I CITY, STATE, ZIP FAX ❑ owmR ❑. OWNER -BUILDER ❑ VANcRAGENr ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGRrER ❑ DEVELOPER ❑ IMNANT CONTRACTOR NAME A13 ME LICENISENU114BER Tw/1 99,00 LICENSE TYPE BUS. LIC 4 FAX COMPANYNANM E-N�AIL� s STREET ADDRESS 1�B � 4A Lel �/ CITY, STA ®ZIP PHONE a r � O V� , A tAm A N Tri- LICENSE NUMBER ARCHITECT/ENGINEER NAME AWA BUS, LIC m COMPANY NANS E-MAIL FAX STREET ADDRESS,.,�� CITY, STATE, ZIP P 0 rE UP-74-rc► Vim a dpwav e 4/ DESCRIPTION OF WORK V(.CeC)f4 _M 0 Ps�`f EXIsTINGUSE PROPOSED USE CONSTR. TYPE01L STORIES USE TYPE I OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA I\tf AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECK AREA TOTALDECKTORCHA.RBA GARAGEAREA: Ll DETACH ATTACH I m Dv1ELLII.'G UISfS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑' - T AI. VALUATION; ' `''�'' PLANZNING APPL 2 ❑ NO PLAI.NIING APPROVAL LETTER I EICHLER HOME? ❑ NO � By my signature below, I certify to each of the g: I amt perry o';mer or authorized agent to act. the pr 1-Amer's behalf. I have read this application and the information I have pro ' is c ect. I ha'e re the j2escaptisn of Work and verify rate. I aeree to comply with all applicable local ordinances and state laws relating to bu' mg co ruction. I authorize repre ryes of Cupertino to enter the above-idee�ep perty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED -_ _ T P_92Qq-Sl; .__.._ New SFD or Multifamily dNvellings: Apply for demolition permit for_27t ❑ Ot�RTHI<COUhT RT BUILD�GPLNREVIEW s x existing building(s). Demolition permit is required prior to issuance of building permit for new buildin _ �fl"10 rls�.T.znGPLU�*rR>�w� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C sral.naRD r MHM E�fl EuaLzcv�oRxs� _ form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to m x submittal of Building Permit application. B ldg-Appj 0 11. do c Bldg-App_2011.doc revised 06/21/11 7- CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10460 BUBB RD DATE: 07/29/2015 REVIEWED BY: MELISSA APN: 357 20 037 BP#: *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building Civil / Religious activities PENTAMATION 1 GENCOM USE: in BQ zone? 0 Yes No PERMIT TYPE: WORK REV # 3 - ADD BIKE LOCKERS TO REAR PATIO - ISSUED 7/29/15 SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dlstrirt. ntcl_ Thom fooc aro hacod not tho nroliminary infnrmafinn nunilahio and aro nHh) an ocfimato C'nntarf tho Dont fnr adds °I infn_ FEE ITEMS (Fee Resolution .11-033 E . 7/U13,� FEE QTY/FEE7_ MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes No $0.00 0 hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? O Yes No $0.00 Suppl. Insp. Fee:G) Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXC $0.00 _441777iniSfrWiVe FIe;': O E) Work Without Permit? O Yes (E) No $0.00 Advanced PlanningFee: $0.00 Select allon-Residential Building or Structure 0 � T7crvel I�nccn77e�r�rution I�c�es: Strong Motion Fee: $0.00 1.0 hrs $143.00 Inspections 1STINSP Inspection, Hourly Bldg Stds Commission Fee:. $0.00 SIISTOTALS $0.00 $286.00 TOTAL JEE $286.00 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 15040038 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO XIII LLC 690 GIBRALTAR DR DATE ISSUED: 05/14/2015 OWNER'S PHONE: 4089742909 MILPITAS, CA 95035 PHONE NO: (408)942-8200 Ft LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ - TENANT IMPROVEMENT (30,000 SQ FT). -33APPLE License Class Lic. #� ,� ���,,�, �,, ���0s Contractor 'ID gL C0t-/, Date /"`�"i Q`"777 ' I hereby affirm that 1 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: $4800000 performance of the work for which this permit is issued. 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 Number: 35720037 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES I NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1 so 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 N. 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 15. Date: S y granting of this permit. Additionally, the applicant understands and will comply with all non-point rce re ulations per the Cupertino Municipal Code, Section 9 18. RE-ROOFS: Signature Date 1 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: 1 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 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. I 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 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 5, , a 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent:Date• S permit is issued. rV 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 Califomia. 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 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 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 918. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-�cupertino.orq \ a�o'h� B 5� ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS O I I�^ p /•�, APN # ^'Z S� I 2-0 ,J OWNER NAME AAf ` (A/ •(- � YV�CJ�� `, P 0 0 -FE -MOA L ^d vi1 STREET ADDRESS /� ' n (•_, ^'�j��� CITY, STATE, ZIP `15 O 1 FAX CONTACT NAME �(�\ PHONE01? I I E-MAIL' of vr� C�FAX L� •l STREET ADDRESS ����YG�/ �• CITY,$ IAT ZIP _` �� ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑� CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA E JA LV' p r LICENSE NUMBER�� 1 ( `ICJ LICENS T BUS. LIC # I (D' ^ COMPANY NAME ; -GhV(�� E-MAIL cnm FAX bn ^ n , W W STREET AD RE O 1�� CTTY� TAT ZI o, cja:fM;5c5 „J J ARCHITECT/ENGINARCMTECT/ENGIN _JRNAME LICENSE NUMBER O D BUS. LIC # COMPANYNAMEi E-TQgILI�1 • �4 O IVn FAX ST ET E S TY,ST TE, ZIP ^ P O ` U DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA�TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: ND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES '� EICHLER HOME? NO4, CEIVppD $c�'ar'lp�Il�l r,ll'�f J", 'gt' T TALVALUATION: ❑ �'o-t124;'��V�i(�NhI1�t �.iIJ��IC ti'SiJ'C1� {�+ v i;�ith�} :iL"�Pnr ti.a,dVaa i'� �i VV VV By my signature below, I certify to each of the following: la the pr rty owner or authorized agent to act on the property owner's behalf. I have read this I, application and the information I have pr vide t correct. I have re t Desc ' ti of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws re tin t bui i on ion. author' a eprese t i of pertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent: Date: SUPPLEMENTAt INFORMATION REQUIRED a! k ,,r pfknv?cc%czYPwF ,t'°` tt h�RoUTuresiiP+� "4 I ar" � `_Ott OVER ',I'B�GOUNTER� z �aI {�'BUII;DIIriGPi'"AN.RE�'iEW � t"i t '3 i II New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building,; for new building.❑ r*w' r ��tr�4 1 h§i �M1�k ;� ` stip cif 34rF permit Bldgs: Provide ExPxEs5+G, y�3w;,(t+ a lld hl4 dzr4 et+' xlsY x,'" Fk�� �Q, >If�Nrillye PYnlv;tEvcEw�" a a Pe��°171 i a fixt4i r' _Commercial a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as of this part project.ay a� lL"ARGEf " f a a 4t iO��aI�EII2E > T1 J7. �r h of PlanningApproval Letter or Meetingwith Planning Prior to ;CoPY MORz�tr'YlS nj kir r �NITAItYSEWER$D[SC[iTCTy"> submittal of Building Permitapplication. 8S+rs�r� ��„,�,: T;HEALTfi4:k0 BldgApp_2011.doc revised 06/21/11 Dm CITY OF CUPERTINO F,M-,7, FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10460 BUBB RD DATE: 04/06/2015 REVIEWED BY: MELISSA PC FEE ID APN: 357 20 037 BP#: *VALUATION: 1$4,800,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAMATION 1B TI I PERMIT TYPE: WORK T.I. TO BUILD OUT INTERIOR 30 OOOS.F. INCLUDING N OFFICE AREAS LABS SCOPE LAPPLE ROOMS (ACCESSIBLE), ROOF TOP MECHANICAL & SKYLIGHTS OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 30,000 $3,408.00 IBTIPLNCK $12,101.00 IBTIINSP L•16c. fns17. L'ec: $12,101.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.o)isfractlon 7[L\: Adinini,•/rc:rtive 1'*c: ': Q Work Without Permit? Q Yes (D No $0.00 TOTALS: 30,000 $3,408.00 yasc'."71� $12,101 00 Strong Motion Fee: IBSEISMICO ,F �a:�: ��r.4 rsF€krty.+�.'L'`a. �c._at.• � �a�.w �+r��,�iu �'A, '� ;P ��,r� r'7 r �'� s +w.l •� f,p� �° "'..:4 =.,.1 r;.�tt enr r,� �?�y*�;.rrr rPS toa^ '„bv t�, ;�zr 6'� n x k a 7 f r r 1�iM` • P''� �.Sa ,4a c:,:�. .;..'.� 'u .:,, �, �v �,.�.. .��..-� ^s , y i�. ,��� � �, 7t1 aT k 1 t-' tfech. Purr (.'frock Plrrrtrh. Flub Chce/, 1-Jec. Pian (`heck Afl, cdr. Per•nrit Fee: PhIn7lr. Permil Feil: hh,c. Permit Fey c )cher llech. Inst). 0her Phi -77b (),'her L lei. Iran'. ET-t- bkch /aNp. Poe. L'htn;b. hrshr. F, v: L•16c. fns17. L'ec: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef1.' 711.1132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,408.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT FO,0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $12,101.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.o)isfractlon 7[L\: Adinini,•/rc:rtive 1'*c: ': Q Work Without Permit? Q Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure Q i 7'ral 1. l)�>ccrirrc:ralatinn I acs: Strong Motion Fee: IBSEISMICO $1,344.00 Select an Administrative Item Bldg Stds Commission Fee: JBCBSC $192.00 rf� #� SUBTOTALS r: 17 045.00 $0.00 34t �h�OTAL'FEE e. )., ifinrtv .l j.. .� , k. ,�'.'.ln i6 �.. itaL. , 4 ....m�a•Y,._ € $17,045.00 Revised: 02/14/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 15040038 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO XIII LLC 690 GIBRALTAR DR DATE ISSUED: 05/14/2015 OWNER'S PHONE: 4089742909 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL 0 APPLE License Class o s - TENANT IMPROVEMENT (30,000 SQ FT). NEW Lic. # -7- �� HVAC EQUIPMENT, NEW RESTROOMS, SKYLIGHTS, & Contractor n r [�Q� Date -7 " 1-3 — % LABS DEFERRED #1: SITE ACCESSIBILITY UPGRADES; I hereby affirm that I am licensed under the provisions of Chapter 9 INSTALL (10) EV CHARGING STATIONS; AND REMOVE (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. AND REPLACE MAIN SANITARY SEWER LINE. 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: $4800000 performance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance, as provided for by r Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35720037.00 Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 D FROM 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 fyq granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: �V f2 with all non- t source regu s per the Cupertino Municipal Code, Section 9.18. l r, Signature �v Date t RE -ROOFS: S 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 11OWNER-BUILDERDECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER will do the work, and the structure is 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 I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Cod ectior 5505, 2.55M. and 25534. Section 3700 of the Labor Code, for the performance of the work for which this I Owner permit is issued. or authorized agent: _- Date: 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 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 Lender's Address APPLICANT CERTIFICATION I certify that 1 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CONSTRUCTION PERMIT APPLIEA COMMUNITY DEVELOPMENT DEPARTMENT • BUI PA I �TOIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aPcupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI F] REVISION / DEFERRED ORIGINAL PERTAI 9 P!fOVZJ6 ��P\ pRnrt:rrADDRESS \v� �� I APNR W� STREET ADDRESS CITSTATE ZIP CONTAC PH9NE ATE, ZIP`. � �. FAX ❑ OWNER ❑. OWNER -BUILDER ❑ oWNE-RAGENT ❑ CONTRACTOR ❑ COh7RACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA -11, ^ � \ s ICENS�F \ I L1�CEN 'f?� BUS. j.�\ IC� v\ V7J COMPANY ^ MAIL FAX STREET AD(, ST\ -7 PN ` PHONE 7 -IITECT/FNGINE _ .ME LICENSE NUMBER BUS. LIC R S�D�E`W `"�'Z CITY. S PH DESCRIPTION OF WORK c EXISTING USE PROPOSED USE CONSTR.TYPE ISTORIES I USE TYPE OCC. I SQ.FT. VALUATIONS) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA '- BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE GARAGE AREA: LJDETACH ❑ ATTACH I R DI1'ELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRP -APPLICATION ❑ TES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES PLAN ING.4PPLR ❑NO PLA1,1NINGAPPROVAL LETTER EICH L£R HOME? ❑NO - 3 •�^4 �€ _.r. TOT. Com" TION: .z .s _,r By my signature below, I certify to eac e following: I erty owner or autho ' ed agent to act on the property owner's behalf. I have read this application and the information I h e provide i orrect. I have gad the ,escription ]1 f Work and verify it is accurate. I agree to comply with all applicable local ordinances and stat laws relati ,, to building c struction. I autho ' e rep `sentati �s of C p Lino to enter the above -identified property for inspection purposes. SigrlatureofAppli ndAgent: Date: SUPPL INTFORMATION REQUIRED3' v a-_.r`y`'.Y�Ai\ CHECK,SYPE�_ ;q f y �• 5 ,_,� ,_tROUTING SLIP � ; e`.c . - i- �1] OVERT) � r i�Tew SFD or Multifamilydwellings: Apply for demolition emit for PY P existing building(s). Demolition permit is required prior to issuance of bulldmg GOU7�TER h r� k� ABLEDp�GPt�NRLViE�y{' £r rte;y permit for new building. �+01, fl Exrr.Ess $ , J x Si PIAn7�rnGYLt�K REyw��t� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 7] sra�mARD�?, ❑ pt3BckoRxs _ form if any Hazardous Materials are being used as part of this project. s.10, x. t _ Copy of Planning Approval Letter or Meeting with Planning prior to �7OR £.� �es.rrRYs�RDIsrRfcr submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 ,0_1 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION r 10460 Bubb Rd DATE: 07/07/2015 REVIEWED BY: Sean IlaADDRESS: APNc BP#: *VALUATION: Iso *PERMIT TYPE:EEermit PLAN CHECK TYPE: Alteration /Addition /Repair URSIEMARY Coming Civil /Religious activities in BO zone? Yes No PENTAMATION PERMIT TYPE: 1 GENCOM i WORK Deferred Submittal #1: Site accessibility upgrades; install 1 EV charging stations; remove and SCOPE replace main sewer line. r itfec•h. Plan Cheek Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check Mech. Permit Fee: Plumb. Permit Fee: IPPERMIT Elcc. PertnitFee.• Other blech. Insp. Other Plumb Insp. 0.0 hrs $48.00 Other Elec. bsn. Li Afech. Insp. Fee: Plumb. Insp. Fee: Elec. hasp. Fee: AW L- ! his esnnlate does not includefees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary infarmadn" ava;tahl ,,,,d „moo ,,,,1„ FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (a) No $0.00 1 hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (D Reg. Cl OT 0.0 hrs $0.00 PME Plan Check: $0.00 10 # $1,090.00 Alternative Energy System 1CHRGST,4 EV Charging Station Permit Fee: Hourly Only? 0Yes Q No $0.00 Suppl. Insp. Feer Reg. 0 OT0.0 hrs $0.00 0 # Plumbing $25.00 IPCSEWER Sewer, Sanitary PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction Tax: IBCONSTAXC $0.00 Administrative Fee: ]ADMIN $45.00 0 G Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 I L I hours $286.00 Inspections ISTINSP Inspection, Hourly 0 Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: $0.00 $1,544+'TOTAL Select an Administrative Item FEE $1,685.00 Bldg Stds Commission Fee:.$0.00 $141.00 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 15040038 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO XIII LLC 690 GIBRALTAR DR DATE ISSUED: 05/14/2015 OWNER'S PHONE: 4089742909 MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �p License Class Iic. # APPLE - TENANT IMPROVEMENT (30,000 SQ FT). NEW HVAC EQUIPMENT, NEW RESTROOMS, SKYLIGHTS, & qq ff Contractor r IN 'Z�' LABS I hereby affirm that I am licensed under the provisions of Chapter 9 Revision #1: Shift locations of mechanical units AC4 and AC -5 on the roof. (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: $4800000 performance of the work for which this permit is issued. 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 permit is issued. APN Number: 35720037.00 Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM 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 p , ���/ granting of this permit. Additionally, thea licant understands and will comply Issued b �� Date Y'_ _ with all non -point source regulations er C ertino Municipal Code, Section 9.18. Signatur Date—o� ` RE -ROOFS: 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 ❑ OWNER -BUILDER DECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 structure is 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. I 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 Cuper 'no Munici al 90de Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code S 55 25533, a 2 5 4. Section 3700 of the Labor Code, for the performance of the work for which thisOwner *ctnion) permit is issued. or authorized ager7t ate: 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 Califomia. 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 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO, CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228• FAX (408) 777-3333 • building 1cuoertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI V REVISION / DEFERRED ORIGINAL PERMIT - 50 © E Bldg4pp_2011.doc revised 06/21/11 PROJECT ADDRESS ' O (� I APN ff OWNER NAMEPHS4TATE0,0 �4 -21 1 ^190 v l e - �1' t STREETADDRESS nn i QG' CA ZIP 01`5 O FAX i CONTACT NAME n n 1 vl 6� �1 P oNE GJ�, I E-MAIL `+ o (2 STREET R C)�i J �1 STAT` , ZIP FAX ❑ OWNER .❑ OWNER -BUILDER ❑ OR'NERAGENT CONTRACTOR ❑ CONTRACTOR AGENT . ❑ ARC=CT ❑ ENGINEER ❑ DEVELOPER ❑ TENS CONTRACTOR N I LICENSE NUMBER I LICENSE TYPE j _ /� I BUS. LIC # ' U (G COMPANY NAME n � �,.p� E.MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGLNFE. 'AME I n LICENSE NUMBER BUS. LIC 9 COMPANY NAMEt O S v� �� E AIv FAX �J STREET ADDliEpS S 1 ^ — r DESCRIPTION OF WORK EXISTING USE 'PROPOSED USE • CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXLSTG NEW FLOOR, .DEMO TOTAL AREA AREA AREA NETAREA ,. BATHROOM. KITCHEN. 01 REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA 1 TOTAL DECKRORCH AREA GARAGE AREA: DETACH ❑ ATTACH I ". D4YELLIIQG UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? E] NO ADDITION? [:]NO PRE -APPLICATION ❑ YESIF YES, PROVIDE COPY OF PLANNTING ADPL N, ❑ NO . PLANNT40 APPROVAL LETTER IS THE BLDG AN ❑ YES$CEIUED EICHLER HOME? ❑ NO BYrs=x�f� � t "�-' TOTAL. VALUATION: y. _ I 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 's correct. I have ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relati g bu' i g c struction. I au to enter the above -identified property for inspection purposes. !��pertino Signature of Applicant/Agent: Date: SUPPLEMENTA INFORNIATION QUIRED New SFD or Multifamily dwellings: Apply for demolition permit for O,".IR0vi TKR r�BUIL`DII�G`PLAI REi7IEW e existing building(s). Demolition permit is required prior to issuance of building for y fi}aF f permit new building, ,Cl�7tP ss� a ids Y :iI�G `�� PLANREVLESV _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure��Tu>NDATtD ��i� 32 fl ru�IaroRTc�� 3 form if any Hazardous Materials are being used as part of this project.�� 's"` fir- K 1 Copy of Planning Approval Letter or Meeting with. Planning prior to submittal of Building Permit application. �1 MA7ORr ` ��. � ���,�� ITA$Y M. ISTRY G. .�. � ',-"h. _ �. ...:_�..��,J.�•�.r_�-.:,:rs__ ����R'V;IKOIx'MEI��:9Z7iEAL,Ta��'-� . Bldg4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NU%E: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina information available and are only an estimate. Contact the De t for addn'l into. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) ADDRESS: 10460 Bubb Road DATE: 06/22/2015REVIEWED BY: Sean :Meeh. Peptrril fire: APN: BP#: �� "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: g Phtrrtb. Insp. Fee: PENTAMATION PERMIT TYPE: 1 GENCOM WORK Revision #1: Shift locations of mechanical units AC -4 and AC -5 on the roof. SCOPE Suppl. Insp. Fee:(D Reg. 0 OT NU%E: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina information available and are only an estimate. Contact the De t for addn'l into. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) Alech. Plan Check Phurrh. Plan C:%rczcic Elec Plan Check :Meeh. Peptrril fire: Plumb. Permit Fee: lsle.c. Permit Fee: Other A/ech. In'T. Other Plumb Insp. Other Elec. Insp. Li ;Tech. Iup. Fee: Phtrrtb. Insp. Fee: Elec Insp. Pee: NU%E: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina information available and are only an estimate. Contact the De t for addn'l into. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslruetion :1'ax: T -F z1dininlstrative Fee: 0 E) Work Without Permit? 0 Yes iD No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Travel Doetanenlaiion Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS.' $0.00 $286.00 :TOTAL FEE ::. $286.00 Revised: 05/07/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 15040038 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO XIII LLC 690 GIBRALTAR DR DATE ISSUED: 05/14/2015 OWNER'S PHONE: 4089742909 MILPITAS, CA 95035 PHONE NO: (408)942-8200 CONTRACTOR'S DECLARATION f d JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ -LICENSED APPLE - TENANT IMPROVEMENT (30,000 SQ FT). License Class Lic. # /fllaC-P/w)o Contractor Z�=UCCyG� Date % / �jJJ B T-7-7 0� 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: $4800000 performance of the work for which this permit is issued. 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 Number: 35720037.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMITEXPIRES + NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITH1 S O + ISSUANCE IN OR to building construction, and hereby authorize representatives of this city to enter TION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments �ate,-y costs, and expenses which may accrue against said City in consequence of the Issued granting of this permit. Additionally, the applicant understands and will comply with all non -point ice re ulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: is Signature -- Date / All roofs shall be inspected prior to any roofing material being installed. If a roof 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 I, 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. I 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 5, , ar 25534. 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 Owner or authorized agent: Date: S 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 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 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0-cupertino.org a ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS O I� f f APN # �L S� _ 2-0 J ' U OWNER NAME 1 A. n p o� • F-MA� STREET ADDRESS` n'r�—� I „O0 CITY, STATE, ZIP A O FAX CONTACT NAME (� n I��^�t �^ Y�\ pHONE I� I E-MAIL QI D�� AQ��'^� C�FAX L� , I STREET ADDRESS � 6 I �� I �r 1 /• CITY TAQ , ZI �� ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT`/ XCYONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA ', O / LICENSE NUMBER�� 1 ` LICENS T BUS. LIC # n U COMPANY NAME E-MAIL FAX U 1 • �� STREET AD RE O V , �� CITY TAT ZI P O ICj OI JJ ARCHITECT/ENGIN J LICENSE NUMBER 0 D (0 BUS. LIC # COMPANY NAME //��++ 1 , In y�/► � I FAX � �V ' �' ► I ST$JET - S TY, ST TE, ZIP ^ P O DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA�!� V O iV' 1 L/W Wv BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # E]NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECELVED BY I „ - , T TAL VALUATION: _�b0 DC7 By my signature below, I certify to each of the following: I am the pr rty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I h�video,—ISNcorrect.ave re t Desc ' ti of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws re tin tuthor' a eprese t i of pertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED` " PLANCHECKT'YPE ❑ pVER Ta�coUNrERi ❑ BUII DINGPLANREVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. CIS EXPRESS i+ -� _ ❑,PLANNIIVCPLnNitEVIEw `` Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ °z _ form if any Hazardous Materials are being used as part of this project. srANDRD PUBLICwo�ucs � LARGE . i x ❑ s �IIIE REPT } r ; r � `': _ Copy of Planning Approval Letter or Meeting with Planning prior to 'IYrAaoR rSANTTARY submittal of Building Permit application. M 3 ❑ SEWER DISTRICT ' Vyz IIt011T1YIENTAL�HEALTH - BIdgApp_2011.doc revised 06/21/11 :)m :)1,6+ CQ CITY OF CUPERTINO Iil FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: 10460 BUBB RD DATE: 04/06/2015 REVIEWED BY: MELISSA lialADDRESS: APN: 357 20 037 BP#: *VALUATION: 1$4,800,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 1BTIPLNCK PENTAMATION 1B TI PERMIT TYPE: WORK APPLE T.I. TO BUILD OUT INTERIOR 30 OOOS.F. INCLUDING N OFFICE AREAS LABS SCOPE RESTROOMS (ACCESSIBLE), ROOF TOP MECHANICAL & SKYLIGHTS OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA . s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 30,000 $3,408.00 1BTIPLNCK $12,101.00 IBTIINSP Elea. Ing). Fee: $0.00 Permit Fee: $12,101.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction "lar: TOTALS: 30,000 1 $3,408.00. ^- $12,101.00 1VIECH, HOURLY Yes;. t�.:No PLUMB;"HOURLY - Yes _ No,=. ELEC, HOURLY-; 'Yes No ,tfech. Plan Check Phuuh. Plan ('heck Elec. Plan Check ;Vech. Pernill Fee: !'lermh. Permit l'c<e: Glzc. Parzrzir Pee: Other AIech. Insp.EI-L- Other Plumb Insp. Other Elea Insp. _:Lech. 111sp. Fee: Plwiib. hisp. Fee: Elea. Ing). Fee: NULL [his estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the nrelintinary infarmatian availahlo and aro only an oetitaato_ rnstart tho Wont fnr addn'1 infn_ FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,408.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $12,101.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction "lar: Administrative; P-ee: 0 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 � 7+ Travel/�OC7.L711E?nlatlCl77 k,'C'S: F Strong Motion .Fee: IBSEISMICo $1,344.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $192.00 .. SUBTOTALS:= 17,045.00 $0.00 TOTAL FEE - $17,045.00 Revised: 02/14/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 15040038 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO XIII LLC 690 GIB TAR DR DATE ISSUED: 05/14/2015 OWNER'S PHONE: 4089742909 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESC H'TION: RESH)ENTIAL E] COMMERCIAL E] APPLE -TENANT IMPROVEMENT (30,000 SQ FT). NEW License Class_ Lic. # HVAC EQUIPMENT, NEW RESTROOMS, SKYLIGHTS, & Contractor ��13C0't,4 Date �% ?�v LABS REV # 2 REVISE/REPLACE EXTERIOR LIGHTING - I hereby affirm that I am licensed under the provisions of Chapter 9 ISSUED 7/20/15 (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 Co ensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floo Area: Valuation: $4800000 ormance of the work for which this permit is issued. 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 Numb r: 35720037.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PE IT 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 A i A ALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Date: granting of this permit. Additionally, the applicant understands and will comply J!E180 with all non-point sou regulations per the Cupertino Municipal Code, Sect' 9.18. RE-ROOFS: Signature Date--:7!—v lS" 7 All roofs shi L11 be inspected prior to any roofing material being installed. If a roof is installed without inspection. first obtaining an inspection, I agree to remove all new materials for ❑ 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 structure is 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 Jealth & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain c impliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & 5sifety 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. dditionally, 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 Cupe Munic'pal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections , 25 Section 3700 of the Labor Code, for the performance of the work for which this Owner or E uthorized agent: • Date: % 20 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 aff inn 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 Is 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 I understan 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 P ofessional 9.18. Signature Date CONSTRUCTION PERMIT APP 9 COMMUNITY DEVELOPMENT DEPARTMENT • I 10300 TORRE AVENUE • CUPERTINO, CA 9501, CUPERTINO: (408) 777-3228 • FAX (408) 777-3333 • buildin ( I I NFw(-nw.gTRTTCTTn-q n eTlilTTrilTQ 71 1 TCD a - 111 i — _ r i _ICATIO N UILDING DIVISION -3255k uoertino.ong iTT n .,( 5�� 1106) --�'gx BldgApp_2011.doc revised 06/21/11 PROJECT ADDRESS A7iN n r OWNER NAME PHONE E-MAIL WL- 1= l C . STREET ADDRESS 1 CITY, STATE, ZIP FAX CONTACTi! ( PHO _ E-MAIL c ti�:�� STREET ADDRESS CITY, STATE, ZIP FAX ❑ OR`NFR ❑. OWNER -BUILDER ❑ OV,qMR•AAG-pENT CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT ,�y❑ CONrRACTORNAME AP3, � /�.�%IPZICOLICENSE OBER LICENSETYPE BUS.LICf - - - . 1, CObfPANY NAME '\./(/fd E-MA1L j' FAX STREET ADDRESS &Ceo C��i CITY, STATE, ZIP PHONE �� 7 Lid ARCHITECTIENGINEER NAME LICENSE NUMBER -4A BUS. LIC m 1 -`(I & & (2o, COMPANY NAME E-MAIL FAX hi t� ' 5 f f rel Gr ✓! fi Ge wEd "- r . STREET ADDRESS Sri CITY STATE; ZIP PHONE �. �%1.JCS✓� DE ' 17l �e E X(2(O 14Z 1-11477 b 7f fry 6, EXISTING USE PROPOSED USE CONSTR TYPE $ STORIES USE TYPE I OCC. SQ.FT. VALUATION (S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA ._ BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATrACH D)YELLING UNITS: IS ASECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? NO ADDITION? ❑NO i PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑' r Ej\lE ' .a TOTAL VALUATION: ' PLANNINGAPPL.x LINO PLANNINGAPPROVALLEITER EICHLER HOh4E? I By my signature below, I certify to each of the following: I am the property owner or authoriz d ag on the property owner's behalf. -have read_this application and the information I have pr correct, ve rea he Description of Work and verify it is accurate. I agree to comply with all applicable local - --- ordinances and state laws relating to b ng c struc ' n. I orize representatives'of Cupertino to enter the above-iden ified pro erty for inspection purposes. SignatureofApplicant/A;ent: Date:7.4 2:, /15 SUPPLEMENTAL (FORMATION REQUIRED PLa at , = n�CHECRTP:� k� =?^ ��i20UTGSLIP „r =� ��� U� r r, --x _I�Tew SFD or Multifamily d«relIings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER THEC�OIJItTER 105s 4 �BiJIIDLM1GPi�NREVIEFVK7 r4 permit for new building.Manz t� A _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure s�DARD"��] Pz7aLTc_ wouucr� . form if any Hazardous Materials are being used as part of this project. {z 3t �❑:'LAR�� � ..� � � � ❑ �IRI;�JEP>�� -- �.>z�i � Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. oR yeses �s'�`rruzY sE�RDYs�Iuc BldgApp_2011.doc revised 06/21/11 i � CITY OF 1 CUPERTI INO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Plan ing, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) ADDRESS: 10460 BUBB RD19 DATE: 97/20/2015 REVIEWED BY: MELISSA nnri Fee: APN: 357 20 037 BP#: 15040038 *VALUATION: $0 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: g t'lunrb. hasp. hire: PENTAMATION PERMIT TYPE: 1 GENCO WORK REV#2 - REVISE/REPLACE EXTERIOR LIGHTING -ISSUED 7/20/15 SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Plan ing, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) :L9eclt. l'lart I H-tit"11 1'/runl�. 1'lun d:'hccl I:lec. Plan Check nnri Fee: pli-b. Permit Fee: Flee. 1'ermiT Fee: Other Akech. Insp. Other Plumb Irtgl.Lj Other- L.;lec. Inst. Li I'lerh. Ins'). /gee: t'lunrb. hasp. hire: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Plan ing, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/ EE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 0 hours $14Pi.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Reg. 0 OT 10.01hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (,'onstrci.ction Tax: A.61ministrative Fee: i 0 Work Without Permit? 0 Yes (E) No $0.00E) Advanced Planning Fee:• $0.00 Select allon-Residential Building or Structure, Travel 1)c cuinewalion Fees Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission .Fee: $0.00 ' { SUBTOTALS, $0.00 $14 .00 ' . TOTAL FEE $143.00 Revised: 07/02/2015 CUPERTINO TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 6--A— ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL�' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ing(cDcupertino.org aIlq I APN d 3 BP #: SU DATE: OCC LOAD LEVEL PROJECT VALUATION: $ �i60 d SITE ..... Date ......................... []APPROVED ❑ APPROVED WITH CONDITIONS - ADDRESS: I (_% p CU ❑ APPROVED WITH CONDITIONS' OWNER'S NAME: PHONE #:G >I%L LF %NG . — :15-0/v FAX #: APPROVED WITH CONDITIONS - Signature: ......................................................... MAI LING -ADDRESS (if different from site address): NL ",ef CONTRACTOR: VEUC' 9- PHONE# - IFAX#: �'C��1 _ �( Z -?2 CLQ CONTACT: PHONE #: I A173 f n FAX #: t%�.�C' — S LZ TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY B kin (1% VALUATIONCODE ❑ CHECK ❑ C ND J OF BOND: - OK max 000 [BLDBONDS] EDITION: TCO EXPIRATIKSMA DATE X MONX): C /// yZ � FEE: $2$6.00/1'110 TOTAL FEE: $ 5Zg�j [1TEMPOCC] USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT Fire Signature:.") !.. ..... ..... Date ......................... []APPROVED ❑ APPROVED WITH CONDITIONS - u is Works ❑ APPROVED ❑ APPROVED WITH CONDITIONS' Signature: ......................................................... Date:...................... t e r: APPROVED APPROVED WITH CONDITIONS - Signature: ......................................................... Date:...................... OTHER DEPARTMENT / AGENCY APPROVALS: Planning ❑ APPROVED ❑ APPROVED WITH CONDITIONS` Signature: ........................................................... Date:........................ Fire Signature:.") !.. ..... ..... Date ......................... []APPROVED ❑ APPROVED WITH CONDITIONS - u is Works ❑ APPROVED ❑ APPROVED WITH CONDITIONS' Signature: ......................................................... Date:...................... t e r: APPROVED APPROVED WITH CONDITIONS - Signature: ......................................................... Date:...................... *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount ofthe may be forfeited and the non-compliance may result in an enforcement action. Owner Contractor Signature: ....... . .......... ........................ Date:........................ Signature... . Date:./...../...�. This temporary certificate ensus that all fire protection and life safety systems have been completed, inspected, successfully tested and approved for the specific rea f h uilding specified above to provide a reasonable degree of safety to the occupants from fire and similar emergencies. /njj BuildingOfficial: ... .... .......................... .. ...el . . ........ ...................Print:...... �./.�.........................................Date:...q .{.. k..0..: ....... DEPARTMENT ACTION: Afte det on, copies to: 1) applicant, 2) permit file TempOccForm 2013.doc revised 717114 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10460 BUBB RD CONTRACTOR: DEVCON PERMIT NO: 15040038 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO XIII LLC 690 GIBRALTAR DR DATE ISSUED: 05/14/2015 OWNER'S PHONE: 4089742909 MILPITAS, CA 95035 PHONE NO: (408)942-8200 Ft LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ - TENANT IMPROVEMENT (30,000 SQ FT). -33APPLE License Class Lic. #� ,� ���,,�, �,, ���0s Contractor 'ID gL C0t-/, Date /"`�"i Q`"777 ' I hereby affirm that 1 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: $4800000 performance of the work for which this permit is issued. 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 Number: 35720037 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES I NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1 so 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 N. 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 15. Date: S y granting of this permit. Additionally, the applicant understands and will comply with all non-point rce re ulations per the Cupertino Municipal Code, Section 9 18. RE-ROOFS: Signature Date 1 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: 1 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 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. I 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 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 5, , a 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent:Date• S permit is issued. rV 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 Califomia. 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 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 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 918. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-�cupertino.orq \ a�o'h� B 5� ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS O I I�^ p /•�, APN # ^'Z S� I 2-0 ,J OWNER NAME AAf ` (A/ •(- � YV�CJ�� `, P 0 0 -FE -MOA L ^d vi1 STREET ADDRESS /� ' n (•_, ^'�j��� CITY, STATE, ZIP `15 O 1 FAX CONTACT NAME �(�\ PHONE01? I I E-MAIL' of vr� C�FAX L� •l STREET ADDRESS ����YG�/ �• CITY,$ IAT ZIP _` �� ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑� CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA E JA LV' p r LICENSE NUMBER�� 1 ( `ICJ LICENS T BUS. LIC # I (D' ^ COMPANY NAME ; -GhV(�� E-MAIL cnm FAX bn ^ n , W W STREET AD RE O 1�� CTTY� TAT ZI o, cja:fM;5c5 „J J ARCHITECT/ENGINARCMTECT/ENGIN _JRNAME LICENSE NUMBER O D BUS. LIC # COMPANYNAMEi E-TQgILI�1 • �4 O IVn FAX ST ET E S TY,ST TE, ZIP ^ P O ` U DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA�TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: ND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES '� EICHLER HOME? NO4, CEIVppD $c�'ar'lp�Il�l r,ll'�f J", 'gt' T TALVALUATION: ❑ �'o-t124;'��V�i(�NhI1�t �.iIJ��IC ti'SiJ'C1� {�+ v i;�ith�} :iL"�Pnr ti.a,dVaa i'� �i VV VV By my signature below, I certify to each of the following: la the pr rty owner or authorized agent to act on the property owner's behalf. I have read this I, application and the information I have pr vide t correct. I have re t Desc ' ti of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws re tin t bui i on ion. author' a eprese t i of pertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent: Date: SUPPLEMENTAt INFORMATION REQUIRED a! k ,,r pfknv?cc%czYPwF ,t'°` tt h�RoUTuresiiP+� "4 I ar" � `_Ott OVER ',I'B�GOUNTER� z �aI {�'BUII;DIIriGPi'"AN.RE�'iEW � t"i t '3 i II New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building,; for new building.❑ r*w' r ��tr�4 1 h§i �M1�k ;� ` stip cif 34rF permit Bldgs: Provide ExPxEs5+G, y�3w;,(t+ a lld hl4 dzr4 et+' xlsY x,'" Fk�� �Q, >If�Nrillye PYnlv;tEvcEw�" a a Pe��°171 i a fixt4i r' _Commercial a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as of this part project.ay a� lL"ARGEf " f a a 4t iO��aI�EII2E > T1 J7. �r h of PlanningApproval Letter or Meetingwith Planning Prior to ;CoPY MORz�tr'YlS nj kir r �NITAItYSEWER$D[SC[iTCTy"> submittal of Building Permitapplication. 8S+rs�r� ��„,�,: T;HEALTfi4:k0 BldgApp_2011.doc revised 06/21/11 Dm CITY OF CUPERTINO F,M-,7, FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10460 BUBB RD DATE: 04/06/2015 REVIEWED BY: MELISSA PC FEE ID APN: 357 20 037 BP#: *VALUATION: 1$4,800,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAMATION 1B TI I PERMIT TYPE: WORK T.I. TO BUILD OUT INTERIOR 30 OOOS.F. INCLUDING N OFFICE AREAS LABS SCOPE LAPPLE ROOMS (ACCESSIBLE), ROOF TOP MECHANICAL & SKYLIGHTS OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 30,000 $3,408.00 IBTIPLNCK $12,101.00 IBTIINSP L•16c. fns17. L'ec: $12,101.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.o)isfractlon 7[L\: Adinini,•/rc:rtive 1'*c: ': Q Work Without Permit? Q Yes (D No $0.00 TOTALS: 30,000 $3,408.00 yasc'."71� $12,101 00 Strong Motion Fee: IBSEISMICO ,F �a:�: ��r.4 rsF€krty.+�.'L'`a. �c._at.• � �a�.w �+r��,�iu �'A, '� ;P ��,r� r'7 r �'� s +w.l •� f,p� �° "'..:4 =.,.1 r;.�tt enr r,� �?�y*�;.rrr rPS toa^ '„bv t�, ;�zr 6'� n x k a 7 f r r 1�iM` • P''� �.Sa ,4a c:,:�. .;..'.� 'u .:,, �, �v �,.�.. .��..-� ^s , y i�. ,��� � �, 7t1 aT k 1 t-' tfech. Purr (.'frock Plrrrtrh. Flub Chce/, 1-Jec. Pian (`heck Afl, cdr. Per•nrit Fee: PhIn7lr. Permil Feil: hh,c. Permit Fey c )cher llech. Inst). 0her Phi -77b (),'her L lei. Iran'. ET-t- bkch /aNp. Poe. L'htn;b. hrshr. F, v: L•16c. fns17. L'ec: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef1.' 711.1132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,408.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT FO,0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $12,101.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.o)isfractlon 7[L\: Adinini,•/rc:rtive 1'*c: ': Q Work Without Permit? Q Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure Q i 7'ral 1. l)�>ccrirrc:ralatinn I acs: Strong Motion Fee: IBSEISMICO $1,344.00 Select an Administrative Item Bldg Stds Commission Fee: JBCBSC $192.00 rf� #� SUBTOTALS r: 17 045.00 $0.00 34t �h�OTAL'FEE e. )., ifinrtv .l j.. .� , k. ,�'.'.ln i6 �.. itaL. , 4 ....m�a•Y,._ € $17,045.00 Revised: 02/14/2015