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15090125CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10101 BUBB RD CONTRACTOR: SC BUILDERS INC OWNER'S NAME: CAMPUS HOLDINGS INC 910 THOMPSON PL OWNER'S PHONE: 9175660765 XJ LICENSED CONTRACTOR'S DECLARATION License Class-- Lic. 9-2f 7 Contractor ,�. Date %/ I hereby affirm that I am ed u er 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. SUNNYVALE,-CA 94085 PERMIT NO: 15090125 DATE ISSUED: I1/17/2015 PHONE NO: (408)328-0688 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL APPLE BUBB 4 - T.I. (14,943S.F.); INSTALL 8 (N) EV CHARGING STATIONS REV # 1- DELETE 2 LAVATORY SINKS FROM ORIGINAL SCOPE OF WORK - ISSUED 12/7/15 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 yLrfformance of the work for which this permit is issued. 7and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Se ion 3700 of the Labor Code, for the performance of the work for which this rmit is issued. APN Number: 35720003.00 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 PERMIT WITILVi of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save A indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of t granting of this p rmit. Addit' the 000 nally, applicant understands and will comply with all non- po' t source re la "ons per the Cupertino Municipal Code, Section 9.18. Issued b L>1 171 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. I£ after making this certificate of PYPtYlntinn r Valuation. $2200000 Occupancy Type: IS NOT STARTED IT ISSUANCE OR Date: 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 eq 'pmentor devices which emit hazardous air contaminants as defined by the B Area Air ' ality Management District 1 will maintain compliance with the ertino M `cip Code, Chapter 9.12 and the Health & Safety Code, Sectio 25505,255 a 5534. Owner or authorized age Date: f CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I 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, 11 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 Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional H CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(Wcupertino org PROTECTADDRESS 10101 Road Bubb C OWNER NAME Apple Inc. 13tJ ii U STREET ADDRESS 1 Infinite Loop CONTACT NAME Victoria Ng STREET ADDRESS 1 Infinite Loop rr IVIv�i VISIO / DEFERRED ORIGINAL PERMIT # APN # PHONE 917/566-0765 E-MAIL victoria_ng@apple.com CITY, STATE, PHONEZIP Cupertino, 95 1 A FAX .917/566-0 65 E-mAIL victoria_ng@apple.com CITY, STATE, ZIP Cupertino, 95014 FAX ❑ OWNER. ❑ owNER,B LDER XN OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 13ARCHITECT 11ENGINEER 11DEVELOPER ❑TENANT CONTRACTOR NAME Michael Soik Li CENSE NUMBER 7671 96 LICENSE TYPE B BUS. LIC# 24074 COMPANY NAME SC Builders Inc. E-MAIL msoik@scbuilderSmc.com FAX STREET ADDRESS 910 Thompson Place CrrY,STATE,ZIP Sunnyvale, 94085 PHONE 4081326-0688 DESCRIPTION OF WORK 61 LICENSE NUMBER eT- ATE, '2:-A- 9.40., 0-- ,G. O f / I USE I TYPE I OCC. NhW FLUOR DEMO TOTAL AREA AREA AREA NET AREA 9 L BATHROOM - KITCHEN - OTHER.. REMODEL AREA REMODEL AREA REMODEL AREA BEING ADDED? EJNO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER By my signature below, I certify to each P,the follo ' ?. I application and the information I have ovided is c rr ct. I ordinances and state laws relating to ilding co tion. Signature of Applicant/Agent: ATTACH ADDITION? IS THE BLDG AN EICHLER HOME: BUS. LIC # SQ -FT. I VALUATION ($) Wproperty owner o�,efithorize ent . ct on the property owner's behalf. I have 's—_ read the Description of erify it is accurate. I agree to comply with all applicable I= ari e representatives of upertino to enter the aboid'fled property for inspection purposes. Date:/ 177 ,o t 3 �iUFFLENJEN'1'AL INFORMATIO& REQUIRED _ 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. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. B1dgApp_2011. doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10101 BUBB RD DATE: 12/07/2015 REVIEWED BY: MELISSA APN: 357 20 003 BP#: 15090125 'VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement USE: ARY Commercial BuildingT PE PERMIT TYPE: 1 GENCOM WORK REV # 1 - DELETE 2 LAVATORY SINKS FROM ORIGINAL SCOPE OF WORK - ISSUED 12/7/15 SCOPE f FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 1 hours Plan Check, Hourly $143.00 ZSTPLNCK c,. ... �s £ ....,,.,.. 0.0 1hrs $0.00 st.. r. t.. Nim,. Ch, $0.00 'Iec,, Permit Fee: $0.00 Suppl, Insp. Feer Reg. OT0,0 hrs $0.00 F. PME Unit Fee: $0.00 PME Permit Fee: $0.00 6 i i.. ig ; / i. :::. 0 G X3 Lj Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBT6TALS: $0.00 $143.00 , TOTAL FEE: $143.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School vasiricz, etc.. L hese tees are based on the preliminar information available and are onl an estimate Contact then t or addn"in o " FEE ITEMS (Fee Resohition 11-053 E f 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 1 hours Plan Check, Hourly $143.00 ZSTPLNCK Suppl. PC Fee: F Reg. 0 OT 0.0 1hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl, Insp. Feer Reg. OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ',hhninislralire T'ee: 0 G Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBT6TALS: $0.00 $143.00 , TOTAL FEE: $143.00 Revised: 10/0112015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10101 BUBB RD CONTRACTOR: SC BUILDERS INC PERMIT NO: 15090125 OWNER'S NAME: CAMPUS HOLDINGS INC 910_ THOMPSON PL DATE ISSUED: 11/17/2015 OWNER'S PHONE: 9175660765 SUNNYVALE, CA 94085 PHONE NO: (408)328-0688 LICENSED CONTRACTOR'S DECLARATION License Class Lic. Contractor , 6 )ate_j / g7.115 � I hereby affirm that I am licensed under the provisions of Capter 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 pard will maintain Worker's Compensation Insurance, as provided for by Sec 'on 3 of the Labor Code; for the performance of the work for which this perms 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 'Addit , ly, the applicant understands and will c with all non -point source i ns per the Cupertino Municipal Code, Section 9.18. Date ® OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL APPLE BUBB 4 - T.I. (14,943S.F.); INSTALL 8 (N) EV CHARGING STATIONS Sq. Ft Floor Area: I Valuation: $2200000 APN Number: 35720003.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 18QJM-=FIT ISSUANCE OR D INSPECTION. Date: 6. 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 Qualie54. gement District I will maintain compliance with the Cupertino MunicipaChapter 9.12 and the Health & Safety Code, Sections 25505, 25533, an Owner or authorized agent: t 1 / -7 Date: : e 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 CONSTRUCTION PERMIT APPLICATION ` COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 buildingacupertino orq EXISTING USE - PROPOSED USE CONSTR. TYPE #STORIES - - USE TYPE OCC: $Q.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL - AREA - - AREA AREA NET AREA J. .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 UNIT ❑ YES SECONDSTORY - ❑ YES BEING ADDED? []NO ADDITION? []NO CATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EI' EIi$Y �� TOTAL VALUATION - EICHLER HOME? ❑ NO m'k ;, s Q. By my signature below, I certify to each of the following: application and the information I have p9ovided is corr t ordinances and state laws relating to Iding constr t or Signature of ApplicantlAgen I am the property owner or autho ized agent to act on the property owner's behalf. I have read this I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local oriz&representatives of Cupertino to enter the above -identified prpperty for inspejoa purposes. SUPPLEMENTAL INFORMATION KEQUIRED — 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. —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ,60gApp_2011,doc revised 06/21/11 MR CITY OF CUPERTINO FEE ESTIMATOR BUILDING DIVISION ADDRESS: 10101 Bubb Rd DATE: 09/18/2015 REVIEWED BY: PAUL APN: 357 20 003 *VALUATION: *PERMIT TYPE: Building Permit aB:P�97-7_ i PLAN CHECK TYPE: Tenant Improvement mprovement USE: Commercial Building PEN-TAMATION VPV� IBTI WORK I Apple Bubb 4 --T.I. (14,943S.f); Install 8 (N) EV Char in Stations PERMMITIT TYPE: SCOPE I OCCUPANCY TYPE: TYPE OF -- CONSTR.- B (Tenant Improvements) 11-B,111-B,IV,V-B Nfech. Plan Check zvfech- 1'erwif Fee: TOTALS: FLR AREA PC FEESPFEE ID (S-0 I 'q 14,943 $2,973.80, IBTIPLNCK injurmurton avaitaote BP FEES BP FEE ID $8,434.50 IBTIINSP QTY/FEE MISC ITEMS Plan Check Fee: 9 $2,973.80 8 # Alternative Energy System $872.001 ICHRGSTA EV Charging Station Suppl. PC Fee: 0 Reg. 0 OT $0.00 $0.00 PME Plan Check: $0.00 Permit Fee: $8,434.50. 14,943 $2,973.80 hrs $8,434.50 PME Unit Fee: Numb. Phin Cheek I I . IPlumb. Permit i,'ee.. E�/ec..Plan Chxck Elec. Pemir Fee: , VierHc%:�h, frj, ,V. 1 P, I it — —=--I 01,1LI, iurno sp, Other Ele�c. 1rup w"', 71", Inst. ,14ech MS1.2. Fee: 1'hanb.hiq). F-ee: 17es. [cc. In'sp'. I ire: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary nktrh-t f, 1 rp Sewer District. FEE ITEMS injurmurton avaitaote ana are onlY an estimate Contact the Dgptfqraddnl info. free Resolution 11-053 Eff LL 13) FEJE QTY/FEE MISC ITEMS Plan Check Fee: 9 $2,973.80 8 # Alternative Energy System $872.001 ICHRGSTA EV Charging Station Suppl. PC Fee: 0 Reg. 0 OT $0.00 $0.00 PME Plan Check: $0.00 Permit Fee: $8,434.50. Suppl. Insp, Fee.(E) Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Adininistrative Fee: 0 E) Work Without Permit? 0 Yes E) No $0.00 Advanced PlgRnjngjge• $0.00 Select a Non -Residential 0 Building or Structure 0 Tr cli,el Duca inentalion fi'ees: StrongMotionFee: IBSEISMICO $616.00 Select an Administrative Item Bldg, Stds Commission Fee IBCBSC $88.00' 2,112.30 $872.00 $12,984.30 Revised: 07/02/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 10101 PERMIT # 1,50q©1 OWNER'S NAME: PHONE # `]'3 5;— GENERAL CONTRACTOR: GENERAL BUSINESS LICENSE # 'IIo 1t b ADDRESS: CITY/ZIPCODE: O *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 40��V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork 2, Cement Finishing Electrical' Excavation Fencing Flooring / Carpeting 1 Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing ST' Septic Tank Sheet Metal Sheet Rock Z Tile 40��V 11-30 " /T Owner / Contractor Signature Date TO CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10101 BUBB RD CONTRACTOR: SC BUILDERS INC PERMIT NO: 15090125 OWNER'S NAME: CAMPUS HOLDINGS INC 910 THOMPSON PL DATE ISSUED: 11/17/2015 OWNER'S PHONE: 9175660765 SUNNYVALE, CA 94085 PHONE NO: (408)328-0688 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ APPLE BUBB 4 - T.I. (14,943S.F.); INSTALL 8 (N) EV r l License Class�� Lie. # '� CHARGING STATIONS ontractor_���_' Ru_, r�e '��Date —rte RI;V # •=ARE ISP,CCESSIBLEPARYrTG_`STpLTJS'AND' I hereby afl-trm that I am licensed under the provisions of Chapter 9 AD ° 1�IDSO PING: ISSUED 1=S-16 " ' `" (commencing with Section 7000) of Division 3 of the Business & Professions itr Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: r} REVISION 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 $2200000 erformance 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: 3 5720003 .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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to euter 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 Cupertiuo 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 ail non-point source rep4ati/nI per the Cupertino Municipal Code, Section 9.18. RE-ROOFS: Signature Date L All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for iuspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant; Date: I hereby affirm that i am exempt From the Contractor's License Lawfor 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 (Sce.7044, Busiuess & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (See.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 maiutain a Certificate of Consent to self-insure for Worker's material. Additionally, should 1 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 A' ality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuperti n' i 1 Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio 0 , 2 5534. Section 3700 of the Labor Code, for the performance of the work for which this il ❑ncr or authorized ages 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, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisious 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 pennit 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 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 f 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 Ig -C 005, COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinclAcupettino.org ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT 4 PROJECTADDRESS APN k�` j�/ 003 VV161K 3 %u ll LLi 76JE-MAIL t�cqcvx -C S'i�EET A { 1`"E `F�., CITL�Y,`J A �, S i fel ♦� FAX ry ,,`CO 1Z%TkIA PHO `^ Q�b.:) Irk! . P h LGA.. 5-0 EEj4l STREET fDDfjE 1 %�! Y,1 C!IT J A AV I A j' V j FAX ❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO ACTOR NA E L[F§y5 E LICEN E BUS;LIC O 4— © 7 CO PEjNYALp I � b t �S tN E-MAIL'.IDP 7�� 1J ✓1 j f� ✓N L� / 0L og i iC+ S 1 440 M D`4 r I t`Z. , C VIVAE1ZI V 17 :i 4 ��J P!D �rZei TECTIENOINEER NAM LICENSE NUMBER BUS. LIC # IV99I � o CO NYN E -MAIC i`I �+ '!N F V a— . e—& P, STRE DRE S 3Y,'T$ ZIP PID { } DESCRII �j OF WORK `l\ ZM:M�OA., od^', "9 t„, 111 AT IIA RoJem-e xrrdcz eV' c14 ns '' EXISTING USE PROPOSED USE CONSTR. TYPE 8 STORIES USE TYPE OCC. SQ.FT. VALUATION (5) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NETAREA I mA 1 • �� 1 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: DETACH []ATTACH N DWELLING UNITS: IS A SECOND UNIT 0 YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES EIVEp`BY:' �. `=- TOTAL VALUATION: PLANNING APPL it ❑ NO PLANNING APPROVAL LETTER L1C1lLER fIOME? ❑ NO .� r'. '” a 7 11 1 ..�`+ rread dtthis By my signature below, I certify to each of the following: I am the property owner or authO ized agent to act on the property owner's behalf. I have application and the information have p I havided is torr t, t 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 [ding constn on, IOfCupertino to enter the above -id e tified pr perry for inspSg iawpurposes, —prizeeeprescntatives Signature of Applicant/Agen Date: 0 / SUPPLEMtNTAL INFORMATION'KEQUIIRED �. PYSANi 'CKT.YPE URN :- _New SFD or Multifamily dwellings: Apply for demolition permit for ❑`x t7Yl A=THE COl1NTER BInLDINGPUAiTREV[EW existing building(s). Demolition permit is required prior to issuance of building for building. ❑: "� permit new Exaso itLANN1I+1fiIPASY - _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure _sTANDARD w I'tiHLtC1fSTtKS , ` �, " form if any Hazardous Materials are being used as part of this project. / ❑- LARGE r .. c FDEPT 1 _ Copy of Planning Approval Letter or Meeting with Planning prior toEl ; '� ❑ SAi31SARY.SCsiD(R submittal of Building Permit application, ;117AJOR DTSTRrGT N; f � '� :ENVIRDNMENT,A4.IIEALTtt.0 ��'.°r"<��', Bldg,4pp 2011.doc revised 06/21/11 9- Z(v\ CUPERTINO ❑ 1NEw CONSTRix-FIOis CONSTRUCT [ON PERMIT APPLICATION CCIVLMUNITY DEVELOP kliEN I DCPAR I IJIENT . BUILDING DIVISION-�- 1 O30DTORRE AVENUE • CUPERTINO, CA °5D1��I A■ O �2— ED ts (408) 777-3228 • FAX (4{06) 777-3333 . buildlnal� uOio. ON AUDI 71ON . ILS. ALTEE-RATION / T I ❑ REVISION / DEFFE= MUGS UJ_ P1r= P_?N o 7 - [ PROTxr f.DDF= fO 10 4 (I I -7J C ( `d( NAPHM _•M4SL Ohr.t M= Gj(�—s -b• ((► Vic o�l`�_ cc � sTR:Er fsaR=ss .i � � [+•t.. � crY, srA'tz, zip � � VCD C b� I FAX CONTACT Nh.'vR � � - PHOkL E-NlAi1. 1 STA=El .ZDR=SSl ti mY, STA7-=- r? r 4 ?AX e ❑ N,,zm Q O]l'1 •3LiII9 �^� ACM T ❑ CO. -,' 4CO? ❑ Mr, ?4CORAC=7' ❑ AM -MCT ❑TL�+T�il ❑ iz-z,, i ❑ a=i;s�0 CONT;ZACiORN,,J.lzAcef LI Cr"�'S'sivlJiJ3ER } � LIM"SETYPE I BUSJJC o2 q 0 �q (j CO1ai6Nl' NAA r.MAIL r i FAX S C STMET ADDRr5S y� {'( Cr 1', STA, % Z1P,5� �K � T PHONE i� -� ARG�i--'CT1=.NG7v___:__RNfJiS Dt]C?.'S7N1x3ER .J Uoe�l��e� BUS.Llco L COW.PAN. t �) s•N�JL , -rAX Il D O STPaZADDR.SS oP ic�-e I Cny,.WAr ZFPi��'Cb y PHOT "( DESCRlP i 10N OF WORK ` LG E7OSTAG USE PROPOSED USE CONSiR I s 8 iF STOR*FS (_`O J' k CCtit � uss TYPE Occ. SQ.FT. vds tFa noh� (s) EYISTG RM FLOOR DEMO TOThL AREA AP.F.! A_R� I KFrAZA BATFROOI SzfC _=_ q OTHZR R' VODM_ J.R:h Ra1ODE MLEA RE] 1SODM.! •A. II PORCrIAR'.A DECKARsA TOTALDEC:!'_ORCi!.�h:_'A G!%ACGZAX-A DcrACH hiThC:l 1 ;7DN'ELLINGUNMS: 15 A SECOND UNIT ❑Y`s SECOND STORY []SFS BEING ADDED? QNO ;DDMON? ❑NO PRZ,! nPUCAT3ON ❑ YES IF Y S, PANROVME COPY OF PLLNtr7NG!3PLR ❑NO PLA1+TIn'GfPPP.OV!.LL�rr=R IS THE BLDG A ❑ ] sS EICtLEZHOhSE? k0 > �1\ , ° _ TOTAL ATION; By my signztre below, I ceriiy to each of the fallowing: I am the property o-mntr or authorized sent to act on the property wmner's behalf I have read this -id Th-- I have vidcd is act. I have rea3 the Description of lWork end verij it is accurate. I agree to comply •with all zpplicable loyal application Th-- i, -I ?ry Ordinances and state ievs relit Dil g cD- ion. I zuthonz- repreSenuives of Cupertino to enter the above -identified pr Dpe-�'y for i.-Ispection pwpeses. Siatztur a of App}icanVAvent: Dzte: f� SUPPLEMENT ItvFORMATIO-N REQUIRED } G y1� i;]� ' 8T!ILDLhG'�LdM RcS r r New 5FD or Multifamily dNvellings: Appy far demolition pt, -,nit for existing building{s}. Demolition pe„ait is required prior 10 i55Urilce OI buildingtr.-M permit for new building. _ Co::t, ]ercial Bldgs: Provide a completed Hazardous Materials Disclosure r � ' u s a a y w- �'~ ,a o fon if any Hzzztdous Materials are used as part of this project. Q Q h P1ErL��g prior to Copy of Plartning Approval Letter or A,eetin wit s _ sUb,Prh 21 of Building Pennit application. 'ZG �R ..r A'R ' T _ E ; `J✓RDz I�C e�`i-`f ram. 07x S. ?iEY 13Sli�iq, Bind-Xpp_?011,doc revised 06/21/11 CITY OF CUPERTINO ON 01 j . P" -ft FEE ESTIMATOR - BUILDING DIVISION Y ADDRESS: 10101 Bubb Rd DATE: 09/1812015 REVIEWED BY: PAUL C FEE APN: 357 20 003 BP#: 'VALUATION: 1$2,200,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building 14,943 PENTAMATION PERMIT TYPE: 1B T; WORK A le Bubb 4 - T.I. 14 943S.f. ; Install 8 N EV Charging Stations SCOPE Elec, Insp. Fee: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA�:: s.f. C FEE P -FEE ID BP FEES BP FEE ID B (Tenant Improvements) 1[-B,111-B,[V,V-B 14,943 $2,973.80 KIBTIVAFCK $8,434.50 IBTIINSP Elec, Insp. Fee: $0.00 Permit Fee: $8,434.50 Suppl. Insp. Fee. -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 14,943 $2,973.80 $8,434.50 MECH, HOURLY O Yes G No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No Afech. !Tarr Check 11honh. Non CeccF Glcc. Plan Check mech. Perini! Fee: Plumb. 1'ermit Fee: Elec, Permir Fee: Orher klech. Insp- 011jer Plumb Insp.Lj I Other Elm hrsp. ET dlech. hrsp. Fee: Phtn & hNp. Tee: Elec, Insp. Fee: NOTE: This estimate does not include fees due to other Departments C.e. Planning, Public Works, Fire, Sanitary Server District, School District, etra. These fees are based on the preffinina . information available and are only an estimate: Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolulion 11-053 Eff. 7111131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,973.80 $ # $872.00 Altemative Energy System ICHRGSTA EV Charging Station Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $8,434.50 Suppl. Insp. Fee. -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax.- ax:Administratitie AdministrativeFee: Q 0 Work Without Permit? O Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure O o I Trawl Doc•uinewalion Fees: Strong Motion Fee: IBSEISMICO $616.00 Select an Administrative Item Bldiz Stds Commission Fee: IBCBSC $88.00 SUBTOTALS: 12,112.30 $872.99 TOTAL FEE: $12,984.30 Revised: 07/0212015