B-2016-1612CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1612
20705 VALLEY GREEN DR CUPERTINO, CA 95014-1703 (326 10 046)
NOVO
CONSTRUCTION INC
MENLO PARK, CA
94025
OWNER'S NAME: BERG FAMILY PARTNERS, L.P.
DATE ISSUED: 03/23/2016
OWNER'S PHONE:
PHONE NO: (650) 70M500
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lie. #791022
Contractor NOVO CONSTRUCTION INC Date 02/28/2017
X BLDG —ELECT —PLUMB
MECH RESIDENTIAL X COMMERCIAL
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 fall force and effect
SOB DESCRIPTION:
APPLE - TI ON 1ST FLOOR EAST WING WITH MODIFICATION OF
I hereby affirm under penalty of perjury one of the fallowing two declarations:
(E) LAB AND (E) STORAGE ROOM (145 S.F.)
r. 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
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $46000.00
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
APN Number:
Occupancy Type;
and state laws relating to building construction, and hereby authorize
326 10046
B (Tena❑t Improvements)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLE/(D INSPECTION.
Signature Date 3/23/2016
Issued by: PAUL O'SULLIVAN I juj�
jA
A
Date: 3/23 016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one or 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 properly, 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 die 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.
3. I certify that in the performance of One 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 certlfy 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.
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: 3/23/2016
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 mid the
Health & Safety Code, Section 25532(a) should I sto a or handle hazardous
material Additimrally, should 1 use equipment or devices which emit hazardous
air contaminants as defined by the Bay Arca Air Quality Management District I
will maintain compliance with (lie Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety CoSections 25550�55,, 2255533, and 25534.
Owner or authorized agent:
Date: 3/23/2016
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
Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Date 3/23/2016
CONSTRUCTION PERMIT APPLICATION `b—`bl
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 06014.3256
1 1 (400) 777-3226 • PAX (406) 777-3333 , building(U)CLlpertlno.Org
CUPERTINO
NHW CONSTRUCTION Q.ADDITION ALTERATION i T'1 El REVISION / DUEIiREI) ORMINAL PFRMPF N
PROJECT ADpRESS
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13y my signature below, I certify to eucll of the following: I mn the properly owner or authorized agent to act on the property owner's behalf. I ]love read this
application and the information I have provided is consul. I have read the Description GF Work and verify it is accurate. 1 agI'ee to comply With all applicable local
ordinances and state Imes relating to building construction. I uthol'ize I'npreSQiIRHives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:_ Gr _ Date: 2 /20/_�O
SUPPLEMENTAL INFORMATION RP.QUIRED
PLAN CHECK TYPE
ROU INGSLIP
—New SFD or Multifamily dwellings: Apply for deunolition permit t'or
1�oYEIt-T'x�couNTEn.
�ewwwc r •, EW
existing building(s). Demolition pei'init i5 required prior to isstinnceof building
.
pernnit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed flazal'dous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form If any Ha"/,nrdoust Materials are being LISOd Its part Of this profeeL
❑ LARGE
� FIRE DEPT R� y.
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY 9EWF,R DISTRICT
submittal of Building Permit application.
❑ ENVIRONNIENTALBEALTH
BldgA/ap_2011.doc revised 06/21/11