14120060CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100 N TANTAU AVE
CONTRACTOR: NOVO CONSTRUCTION
PERMIT NO: 14120060
OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC
1460 O'BRIEN DR
DATE ISSUED: 05/12/2015
OWNER'S PHONE: 4087834731
MENLO PARK, CA 94025
PHONE NO: (650)701-1500
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
ADDITION OF (2) NEW SNORKELS AND NEW
LicenseClass__Lic. # (] r��
REPLACEMENT
Contractor �/o .ttf,+h fa S
(,DSS y' Date
ROOFTOP EXHAUST FAN. NEW FLOOR -SUPPORTED
COMPRESSED GAS STORAGE TANKS WITH ASSOCIATED
1 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.
1 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: $15000
performance of the work for which this permit is issued.
1 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: 3161906 1. 10 100
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. 1 agree to comply with all city and county ordinances and state laws relating
WITIIIN 180 ERM SSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection putyoses. (We) agree to save
180. R .M.�,. �L _m INS PEC N.
indemnify d keep harmless the Cityof Cupertino against liabilities, judgments,
,.W. .. m
costs, and expenses which may accrue against said Ci in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
f.
Signature Date j
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:
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
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (See. 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).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
1 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 1 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 1
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, 33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
���� s
Owner or authorized agent: Date: J ��
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, 1 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. 1 agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
ARCH ITECT'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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100 N TANTAU AVE
CONTRACTOR: NOVO CONSTRUCTION
PERMIT NO: 14120060
OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC
1460 O'BR1EN DR
DATE ISSUED: 05/12/2015
OWNER'S PHONE: 4087834731
MENLO PARK, CA 94025
PHONE NO: (650)701-1500
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
ADDITION OF (2) NEW SNORKELS AND NEW
License Class Lic. # set I o
REPLACEMENT ROOFTOP EXHAUST FAN. NEW FLOOR-
LOOR-
. Date,.
Contractor
Convactor_
SUPPORTED COMPRESSED GAS STORAGE TANKS WITH
,
ASSOCIATED
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
REVISION #1 - PLAN TO INCLUDE SUPPLY AND EXHAUST
Code and that my license is in full force and effect.
PIPING FOR NEW EQUIPMENT. ISSUED 7-9-15
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: $15000
performance of the work for which this permit is issued.
1 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: 31619061.10100
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that 1 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
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 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
Date: .I
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
Signature g Date
,d"
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 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
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
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. 1 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
1 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
p � y
I have and will maintain Worker's Compensation Insurance, as provided for b
Section 3700 of the Labor Code, for the of the work for which this
Safety r5 a d 25534.
the Health &Safe Code, Se OIIJ 5505, 2 5 �� �
w" a
performance
r X02"� „,
� u
Owner or authorized agent. Date:
permit is issued.
1 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, 1
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
..:....
%-ll 1 V1` %-UiJUAN 111\V
FEE ESTIMATOR - BUILDING DIVISION
FLR AREA
s.f.
PC FEES
ADDRESS: DATE: REVIEWED BY: '
BP FEES
APN: BP#: �Q
'VALUATION: 1$15,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Alteration / Addition / Repair
PRIMARY Commercial Building
$0.00
$0.00
PENTAMATION 1BOFF
USE:
PERMIT TYPE:
WORK
Addition of 2 new snorkels and new replacement rooftop exhaust fan. New floor -supported
SCOPE
compressed gas storage tanks with associated oxygen sensors.
Add electrical receptacles.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Offices)
II-B,111-B,IV,V-B
0
$0.00
0.0
$0.00
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Supp/. Insp. Fee:Q Reg. Q OT
1 Q.Q
hrs
$0.00
Ll
$0.00
PME Permit Fee:
$0.00
TOTALS:
0
$0.00
$0.00
MECH, HOURLY
0 Yes
0 No
PLUMB, HOURLY
0 Yes
0 No
ELEC, HOURLY
0Yes
Q No
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Supp/. Insp. Fee:Q Reg. Q OT
1 Q.Q
hrs
$0.00
Ll
$0.00
PME Permit Fee:
$0.00
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'l info.
FEE ITEMS (Fee Resolution II -053 Ef: T'V13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? ® Yes Q No
$0.00
hours Plan Check, Hourly
$286.00 ISTPLNCK
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Supp/. Insp. Fee:Q Reg. Q OT
1 Q.Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
G
Work Without Permit? 0 Yes) No
$0:00
Advanced Planning Fee:
$0.00
I I hours Inspections
$286.00 ISTINSP Inspection, Hourly
0
0
Strom Motion Fee: IBSEISMCO
$4.20
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTAM
1 $5.20
$572.00
TOTAL FEE;
$577.20
Revised: 10/01/2014
CITY OF CUPERTINO IJ+ld,006
Fm -ft, FEE ESTIMATOR - BUILDING DIVISION
„
ADDRESS: 10100 N Tall Ave
DATE: 06/23/2015
REVIEWED BY: Paul
APN: 316 19 061
BP#:
*VALUATION: Iso
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
Suppl. PC Fee: 0 Reg. 0 OT
PENTAMATION
PERMIT TYPE: A
WORK
Revision #1 - Plan to include supply and exhaust piping for new equipment
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc). These fees are haled an the nreliminary information availahle and are onlv an estimate- Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
F0.0Thrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
'/'n
Pcc:
0
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
Strong Motion Fee:
$0.00
F1 #
$859.00
Revisions
IREVCOMTI Tenant Improvement
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$859.00
T0TAL FEE:
$859.00
Revised: 05/07/2015