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15080140CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10420 BUBB RD CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 15080140 OWNER'S NAME: HOME OF CHRIST CH CUPERTINO LLC 1460 O'BRIEN DR DATE ISSUED: 08/19/2015 OWNER'S PHONE: 4089968208 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL APPLE - BUBB 14 - T.I. (1ST FLOOR - :' S.F.) License Class,,,,r� Lic. # �� (� �� Contractor AW4, Date J3 211'3 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: $270000 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: 35720038.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITBIN 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 D S FROM LAST CALLED INSPE TI 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 by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: All shall be inspected to any roofing material being installed. If a roof is 9.18. 1 Signature Date /�f Z®/ �/ roofs prior 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) 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 25505, 25533 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: l/v� Date: /k ZG! 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 (See. 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 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE , CUPERTINCO, CA 95014-3290 '-' (409) 777-3226 d FAX (409) 777-3333 a building(2cupertino.orci CUPERTINO NEW CONSTRUCTION [_7 ADDITION [! ALTERATION / Ti [] REVISION / DEFERRED ORIGINAL PERMIT N - PROJECT ADDRESS 10420 Bubb Road, Cupertino, CA nPn CAU , OWNER NAME H CH R�✓ 1 PWif N1 - ON 6 ,_ E-MAIL STREET ADDRESS' - C) AIJn' ' �f CITY, STATE, 7_IP / i7 wry_/ i/� /. /.i�'�i� ' F.4 r 1 PHONE 650-785-16P117'W CONTACT NAME Randall Horn E-MA`IIL�(J[/Rhorn9NovoConstruction.com STREE'1'.ADDRFSS CITY, STATE, ZIP FA\ ❑ OWNER ❑ OWNER -BUILDER 11 OWNER AGENT ❑ CONTRACTOR L4T CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 791022 LICENSE TYPE B BUS. LIC ti 23891 COMPANY NAME Novo Construction E-MAIL Rhorn@Novoconstruction.com FAX STREET ADDRESS 1460 O'Brein Drive CITY, STATE. ZIP Menlo Park, CA PHON vd;,g i ARcHrrECT/ENGINEER NAME Stephanie Silkwood LICENSE NUMBER BUS. LI COMPANY NAME RMW Architecture and Interiors E-iIIAIL ssilkwood@rmw.com FAX STREET ADDRESS 40 South Market Street CITY,STATE,ZIP San Jose, CA PHONE DESCRIPTION OF WORK Furniture densification to accommodate additional work spaces. Construct (4) Private offices. Remove and replace portions of existing ceiling EXISTING USE PROPOSED USE CONSTR. TYPE ff STORIES USE TYPE OCC. SQ.FT. VALUATION ($) NEW FLOOR AREA DEMO AREA TOTAL NETAREA AREA AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA 9'OTALDECK/PORCH AREA GARAGEAREA: DETACH I ATTACH II DWELLING UNITS: ISA SECOND UNIT' ❑ YES SECOND STORY ❑YES BEINC ADDED? [3NO ADDITION? [3NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL H PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HONE? ❑ NO R' QED BY: TOTAL VALUATION' oo, Z �� C2 00 ❑NO By my signature below, l 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 1 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 construction. I authorize representatives of Cupertino to enter the above -identified property, for inspection purposes. Signature of ApplicanUAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTINGSLIP U OVER -THE COUNTER El BUILDING PLAN REVIEW New SPD or Multifamily dwellings: Apply for demolition permit for 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 ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT Submittal of Building Permit application. ❑ CNVIRONiVIENTALHEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO IRIPIP. IRRTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: 10420 Bubb Rd DATE: 08/19/2015 REVIEWED BY: PAUL IlaADDRESS: APN: 357 20 038 BP#: *VALUATION: 1$270,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingPENTAMATION 113 TI PERMIT TYPE: i USE: $1,730.24 n_. LI_.. TI7,...1... WORK Apple -Bubb 14-T.I. 1st Floor- 1880 S.F. $0.00 PME Permit Fee: SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 1,880 $2,218.84 IBTIPLNCK $1,730.24 1BTIINSP Elea It;al>. Fee: $1,730.24 n_. LI_.. TI7,...1... p- c_m;in , .4V.er mytri.w. School PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: A(hninistrative Fee: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 TOTALS: 1,880 $2,218.84 - $1,730.24 Bldg Stds Commission Fee: IBCBSC MECH; HOURLY; Yes No.' 'PLUMB, HOURLY ' - Yes ; No . ELEC, HOURLY`: Yes Mech. Plat: Check I'lwnb. Plan 10zec1k F.,Iec. Plan Check A,/ech. Per9nit Fee: plumb, Pernlit r(x: Llec:. Perwit Fee: Other taecli. hasp. Other.Plunth Insfz Other H,7ec. Ittsp. El llech. Insp. Fee: 111umb. Insp. 1`ee: Elea It;al>. Fee: $1,730.24 n_. LI_.. TI7,...1... p- c_m;in , .4V.er mytri.w. School NOTE: This estimate does not include fees due to other Departments (ie. rtunning, ruuuc rr ulna, ..—..r . •- _ ____ ___, /'nrrtn-t the Dent for addn'l info. District, etc.. These fiees are based on the pretunmuna FEE ITEMS (Fee Resolution I1-053 E . 711113) to ormuuun uvuuuute FEE u.ou -,� QTY/FEE -•.- - - - I MISC ITEMS Plan Check Fee: $2,218.84 Select a Misc Bldg /Structure or Element of a Building Suppl. PC Fee: (F)Reg. 6 OT 0.0 hrs $0.00T__= PME Plan Check: $0.00 Permit Fee: Suppl. Insp. Fee:Q Reg. () OT 0.0 hrs $1,730.24 $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: A(hninistrative Fee: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Trai-el ees: Strong Motion Fee: 1BSEISMICO $75.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $11.00 S4 $4,035.68 $0.00 :' TOTAL FEE = 10 $4,035.68 AA � Revised: uirucrcv 5 KCO engineered systems 1133 Aladdin Avenue San Leandro, CA 94577 Tel: (510) 346-4300 Fax: (510) 347-1331 Contractors Lic#120696 TEST AND BALANCE ANALYSIS REPORT Job Name: Apple Bubb 147 10420 Bubb Road Cupertino, CA ACCO Job #: 621133 Contractor: Novo Construction Engineer: acco engineered systems AIR DISTRIBUTION SYSTEM HAS BEEN COMPLETELY BALANCED AS PER REQUIREMENTS OF SPECIFICATIONS AND RESULTS OF TESTS HEREIN LISTED. Date: October 14, 2015 Technician: M. Delos Reyes Approved By: Amber Ryman ACCOengineered systems Air Balance Symbols CFM Cubic Feet Per Minute FPM Feet Per Minute Ak Free Area Factors CSD Ceiling Supply Diffuser CSG Ceiling Supply Grille CRR Ceiling Return Register EAG Exhaust Air Grille SWG Sidewall Grille EAG Exhaust Air Grille LT Light Troffer LSD Linear Slot Diffuser VAV Variable Air Volume Box AHU-1 Air Handling Unit #1 EF -1 Exhaust Fan #1 SF -1 Supply Fan #1 T -stat Thermostat D.A. Direct Acting R.A. Reverse Acting DDC Direct Digital Control N. 1. Not Installed N/L Not Listed N/A Not Accessable DNA Data Not Available FLA Full Load AMPS V Volts A Amperage PH Phase HP Horsepower BHP Brake Horsepower RPM Revolutions Per Minute SP Static Pressure TSP Total Static Pressure TES Total External Static Pressure VP Velocity Pressure OSA Outside Air RA Return Air MAT Mixed Air Temperature EAT Entering Air Temperature LAT Leaving Air Temperature AT Differential Temperature AP Differential Pressure W.C. Inches of Water Column engineered systems 1133 Aladdin Avenue San Leandro, CA 94577-4311 (510) 346-4300 • (510) 347-1331 • License # 120696 AIR OUTLET TEST REPORT DATE: 10/01/15 PAGE: 1 PROJECT Apple Bubb 147 SYSTEM No. Existing VAV Supply Air TEST APPARATUS Flowhood AREA SERVED First Floor OUTLET MANUFACTURER Titus REMARKS: BALANCE TECH: M. Delos Reyes amm ■�� ©■� ■ �a �� ■�■�■EM ■mom i • � o ■�� ��Emm REMARKS: BALANCE TECH: M. Delos Reyes engineered systems 1133 Aladdin Avenue San Leandro, CA 94577-4311 (510) 346-4300 • (510) 347-1331 • License # 120696 AIR OUTLET TEST REPORT DATE: 10/01/15 PAGE: 2 PROJECT Apple Bubb 147 SYSTEM NO. Existing VAV Supply Air TEST APPARATUS Flowhood AREA SERVED First Floor OUTLET MANUFACTURER Titus BALANCE TECH: M. De/os Reyes loll M ■ • - ■■ems �� o■v �� ��� ■mom■ ■■ �� �� ■� ■■ice■■ �■■■ ■■■�■ �� BALANCE TECH: M. De/os Reyes Gengineered systems PROJECT Apple Bubb 147 JOB # 621133 ADDRESS 10420 Bubb Road CITY Cupertino STATE CA PROJECT MGR Jose Menjivar TECHNICIAN M. Delos Reyes DATE 10/01/15 HEATING HOT WATER SYSTEM VAV 1-3 Bell & Gossett 3/4"s C UNIT TAG NUMBERVALVE / DEVICE DIFFERENTIAL GALLONS PER MINUTE .............................LOCA _ SYSTEM TION ----- -- psig- -— ft /head ------ DESIGN - ACTUAL MANUFACTURER SIZE SETTING VAV 1-3 Bell & Gossett 3/4"s C 16.0 1.6 GPM 1.5 GPM VAV 1-4 Bell & Gossett 3/4"s C 6.0 DNA 0.9 GPM VAV 1-18 Bell & Gossett 3/4"s A 1.9 0.7 GPM 0.7 GPM VAV 1-18A Bell & Gossett 3/4"s 50 9.0 DNA 1.0 GPM TOTAL 2.3 GPM 4.1 GPM NOTES: VAV 1-3,4 & 18 Bell & Gossett Circuit Setter Model RF (Black Dial w/ letter increments). VAV 1-18A Bell & Gossett Circuit Setter (Red Dial w/ numbered increments). engineered systems 1133 Aladdin Avenue, San Leandro, CA. 94577-4311 (510) 346-4300 • (510) 347-1331 • License # 120696 DATE: 10/1/2015 PAGE: 4 PROJECT Apple Bubb 147 SYSTEM NO. Existing VAV Supply Air AREA SERVED First Floor General Notes i 1) 1VAV 1-18, Not installed as shown on drawings provided. VAV serves two outlets serving Conf. Rm. 108. Additional VAV VAV 1-18A) serving Corridor 107A not shown on drawings. I 2 'VAV 1-3, Not installed as shown on drawings provided. 12"x8" SWG has two outlets, back to back. Desi n CFM shown was divided between the two outlets. I 3 'VAV 1-4, Scheduled as "Cooling Only" box w/ no reheat coil, Actually does have reheat coil piped ,to box. 1 4 'VAV 1-18A, Not installed as shown on drawings provided. Box does nota pear on drawings. ' CFM set per drawing for this area. I 5 ;VAV's are existing. (Typical). I BALANCE TECH: M. Delos Reyes CALGREEN SIGNATURE DECLARATIONS Project Name: Apple Bubb14 Tenant Improvement Project Address: 10420 Bubb Road, Cupertino, CA 95014 Project Description: Minor interior renovation to existing tenant improvement SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated Into the project plans and will be implemented Into the project In accordance with the requirements set forth In the 2013 California Green Building Standards Code as adopted by the City of Cupertino. toll W1 Date Owner's Name (Please Print) 1�+1 Design Professional's Signature Date Design Professional's Name (Please Print) A /d Signature of of License essional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone VS ,;«lam 4?6tcc0_ex- cor]r Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project Identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License essional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone V_1;P1Ia,1-e ig ticCoPJ'. Goch Email Addr ss for License Professional responsible for CalGreen compliance Page 9 of 9 CalGreen Non -Res Checklist dav revised 01/23/14