15090024I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10161 BUBB RD I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 15090024
OWNER'S NAME: DEVCON/BUBB RD INVESTORS
OWNER'S PHONE: 5104418424
❑ LICENSED CONTRACTOR'S DECLARATION
License ClassypI7 Lic. # -7 �Oa—)
Contractor NOVO L,tJnS�f t)C.�►OnDate "1 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:
t. 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.
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 reg'ul`a'tiions, per the Cupertino Municipal Code, Section 9.18.
Signature , '.iJYh+h1 Date l /3/ 15
❑ 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.
s. 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.
Date
1460 O'BRIEN DR I DATE ISSUED: 09/03/2015
MENLO PARK, CA 94025 ( PHONE NO: (650)701 -1500
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
ADD (1) DISTRIBUTION PANEL TO SUPPLY NEW OFFICE
SPACE (125 AMP).
Sq. Ft Floor Area: I Valuation: $77854
APN Number: 35720005 .00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST �CALLLED INSPECTION.
Issued by: ,.4 n/ / G�'T Date: f-3-:41
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.
Owner or Ili rized agent:
Mr4w i
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
gwivo'
�St.I9rr
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
CUPERTINO (408) 777 -3228 • FAX (408) 777 -3333 • building(cDcupertino.org
NEW CONSTRUCTION ADDITION ALTERATION / TI ❑ RF.VT.STI}N / T)FFFRRFT) ORT(:TNAT PFRMTT t!
PROJECT ADD S ,
APN # G DD
PHONE ,-MAIL
O ERINAAME / n r
!V
� L'f
v
STREET ADDRESS p /� / ✓ � � CITY, STATE, ZIP // ��l.C� FAX
CONTACT NAME
RIO
PHONE E -MAIL
�b " �l�' - r0 11 i
n n i O
;�0> V 11 t\ tl, ;•� �)V la it;�.>u'. :;
STREET ADDRESS ,
CITY, STATE, ZIP%�(� 1
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER 7
LICENSE TYPE
BUS. LIC #
COMPANY NAME t
E -MAIL
FAX
STREET ADDRESS �..I / V ("�
D� r
CITY, STATE, ZIP M
PHONE
Sl
I� 1
1• ` i, �l }
1
ARCHITECT/ENGINEERNAME j �
I
LICENSENUMBER
BUS. LIC`4
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION (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: EIDETACH
[]ATTACH
# DWELLING UNf &
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 ❑ YES
RECEIVED Y
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
! j l
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 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 I authorize representatives of Cupertino to enter the identified property for inspection purposes.
construction. rabove-
Signature of Applicant/Agent: I Kim, InE / Date: 0
SUPPLEMEN AL INFORMATION REQUIRED
PLAN CHECK rYPE"
iovTiNCSL>P
I� CIVER THI<COUNrER
L BUH.DING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
t
J
permit for new building.
'❑ "EXPRESS ., -
- ❑- PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
E3 STAN DARD
❑ PuBLlcwoxxs `
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
❑; I�IAJOx
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ -- ENVIRONMENTAL HEALTH
B ldgApp_2 011. do c revised 06/21/11
"4.3
FM--1 CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10161 BUBB RD
DATE: 09/03/2015
REVIEWED BY: SEAN
UNITS
APN:
BP #: Q ��
`VALUATION:
1$77,854
xPERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
$48
PENTAMATION
PERMIT TYPE: 1 CEAP
WORK
1 DISTRIBUTION PANEL TO SUPPLY NEW OFFICE SPACE 125 AMP).
[ADD
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPERMIT
Services
1 ECT <200
Other Elec. Insp. 0.0 hrs $48.00
125
Amps
$48
Prrtnit I'ce:
Suppl, Insp Fee
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
C.'olz.m.uction 1 lx:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICO
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 haced on the oreliminary information available and are onlv an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 MI..' 7/1113)
alech. Man Check
Plumb. Plan Check
Elec. Plan Check 0.0 1 hrs $0.00
rbleclr. Permit Fee:
Plumb. Permit Fee.
Elec. Permit Fee: IEPERMIT
Order HeckInsp
Other Plumb Insp.
Other Elec. Insp. 0.0 hrs $48.00
14"(11. hisp. 1 -cc
Phimly. hrsiz F'-e*
L. %t<c. Insp, I-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 haced on the oreliminary information available and are onlv an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 MI..' 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
;S'uppl. PC' Mere
PME Plan Check:
$0.00
Prrtnit I'ce:
Suppl, Insp Fee
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
C.'olz.m.uction 1 lx:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes E) No
$0.00
A(h'C111c.c(l Plurming 1 "Ccs.-
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICO
$21.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$214.80
$0.00 TOTAL FEE:
1 $214.80
Revised: 07/02/2015
i
BUILDING ADDRESS: 10161 BUBB RD I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 15090024 1
OWNER'S NAME: DEVCON/BUBB RD INVESTORS
OWNER'S PHONE: 5104418424
11 LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # -7 � I
Contractor a y y V0 ACS )Skir0c, � k)( Date > / *
� � "" 15
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.
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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. 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
permit is issued,
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.
1460 O'BRIEN DR I DATE ISSUED: 09/03/2015
MENLO PARK, CA 94025 1 PHONE NO: (650)701-1500
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
ADD (1) DISTRIBUTION PANEL TO SUPPLY NEW OFFICE
SPACE (125AMP),
Sq. Ft Floor Area: I Valuation: $77854
APN Number: 35720005 .00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1►0 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Essued by: A/ Date:
RE-ROOFS:
I IAIA roofs shall be inspected prior to any tooling material being installed, If a roof is
Signature Dateq/3ZA5— installed without first obtaining an inspection, I agree to remove all new materials for
inspection,
11 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons-.
1. 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)
2. 1, 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. 1 have and will maintain Worker's Compensation Insurance, as provided for by
Sectiorf3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. 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, 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
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. 1 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.
Owner or an horized agent:
Date- A ZVI —5
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Is] iql 124:4 IT, 1 k911=14 MA IM III
CUPERTINO 1 (408) 777-3228 • FAX (408) 777-3333 • buildingCo-)_ uperfino.orq
L_J NEW CONSTRUCTION L_J ADDITION ALTERATION / TI L_J REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ;2f 02
APN 9 -51
_2
0 ER NAME
15
"
1
E-MAIL
4-
-,,, k (- X
STREET ADDRES CITY, STATE, ZIP FAX
�7
CONTACT NAME PHONE E-MAIL
J r'o
104 NA)l 464
STREETADDRESS
CITY, STATE,
FAX
❑ OWNER 1:1 owNER-BUILDER ❑ OWNER AGENT 5� �CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 171 DEVELOPER ❑ TENANT
CONTRACTOR NAME 14ove) Go (w
LICENSE NUMBER
LICENSE TYPE fR
BUS. LIC 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
tt�
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC Af
COMPANYNAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORX, , \
_Aclii ,.
EXISTING USE
PROPOSED USE CONSTR
TYPE
k STORIES
I
I
USE
TYPE
OCC.
SQ.FT.
VALUATION
EXISTG
NEW FLOOR
DEMO
TOTAL
AMA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH ARE
GARAGE AREA: R DETACH
I
I
FIATTACH
I
4 DWELLING UNITS:
IS A SECOND t1NIT ❑YES
SECOND STORY n YES
BEING ADDED? ❑NO
ADDITION? []NO
PRE-APPLICATION [3 YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
REGEZVBD Y
TOTAL VALUATION:
PLANNING APPL 9 [3 NO PLANNING APPROVAL LETTER
EICHLER HOME? NO
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 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 ofApplicam/Agem: (koo KI Date:
SUPPLEMENTAL rNFORMATION, REQUIRED
PLAN CHEEK= TYPE ,
AO
New SFD or Multifamily dwellings: Apply for demolition permit for
A
OVER THE C,01)) It
-M
existing building(s). Demolition permit is required prior to issuance of building
q
permit for new building,
T
�04 -,"A"',
5 XP I�
PIA?
`4 ? ING
NJ'N G,
2,
'J
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
CD §T S
PLiBLICWARKS
farm if any Hazardous Materials are being used as part of this project.
14
Copy of Planning Approval Letter or Meeting with Planning prior to
------------- . . . . . . . . . . . . .
Tu—binittal of Building Permit application.
. .
--- -------
BldgApp_201 1. doc revised 06/21/11
�. yA) 1q
10.460h
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ECT<200 125 Amps $48
TOTALS:
$48.00
Xfec,h, llkwi Check 111"w1b, PkI f I Check I I Elec. Plan Check 10.0 1 hrs $0.00
P! urno, 1'ermii Fee: Elec. Permit Fee: ]EPERMIT
Other Elec. Insp. hrs $48.00
Orher,,Veck Imp. Ot,wr � Phmib lrtslr.�. ED--L- EHI
J,Wech, hlsp 1"ec": 1Hq). I Aiec- Imp, Fec:
VOTE. This estimate does not includefees due to other Departments (i.e. Planning, Public works, tire, sanitary sewer Vistrict, Mflool
District, eta). These.fees are based on the preliminary information available and are only an estimate Contact the Dgpt.Lor addnl rota.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan ("heck Fee:
Supj)1,.P(,1, Fee
r
PME Plan Check:
$0.00
flcrieit Fee:
Slq,)J,V hisp P,ee
F
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
C,011.vrucfion Tax:
F
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Adww,wed Planning Fees.,
A
Travel Documentation Fee: I TRA VDOC
$48.00
Strong Motion Fee: IBSEISMICO
$21.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SU PTA LS.,
$214.80
$0.00 TOTAL***
$214.
$214.80
Revised: 07102/201 lf: