15090155I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10440 BUBB RD CONTRACTOR: SC BUILDERS INC I PERMIT NO: 15090155
OWNER'S NAME: M WEST PROPCO II LLC
OWNER'S PHONE: 9175660765
❑ 2LICENSED CONTRACTOR'S DECLARATION
License Class!.yZG Lie. #�
Contractor C~ 'GI/1`1 Date
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. 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 Ocrue against said City in consequence of the
granting of this permit. do 1 the applicant understands and will comply with
all non -port O e re I ion a Cupertino Municipal Code, Section 9.18.
Signature Dater%_
❑ 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:
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.
3. 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
910 THOMPSON PL i DATE ISSUED: 09/23/2015
SUNNYVALE,'CA 94085 I PHONE NO: (408)328-0688
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALLATION OF (1) SECURITY DOOR; INSTALL OUTLETS
AND POWER POLE IN PRODUCTION ROOM 125 AND OUTLETS
IN PANTRY ROOM 123.
Sq. Ft Floor Area: I Valuation: $16500
APN Number: 35720036.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: �,�✓ 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 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 & SafetyJea
ections 25505, 25533, and 25534.
O.,wne o th 'ent:
Date: 9-23- i
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
CUPERTINO
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
NEW CONSTRUCTION ❑ ADDITION n✓ ALTFR ATTON / TT n . DTl -TAT ---
PROJECT
L
-7
PROJECT ADDRESS 10440 Bubb Road, Cupertino
APN# 857-20-036
OWNER NAM
a /% G
PHONE 917-566-0765
E-MAIL victoria_ng@apple.com
STREET ADDRESyS� _
0'/i r� 1, �r�%
LCITY STATE, ZIP -
�f�t0�lF%dl%! G C`f
FAX n/a
CONTACT NAME Candice LUi
PHONE 650-364-6453
&MAIL clui@des-ae.com
STREET ADDRESS
DES Architects, 399 Bradford Street, Suite 300
CITY, STATE, ZIP Redwood City, Ca 94063
FAX n%a
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT- ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Michael Soik LICENSE NUMBER 767196 LICENSE TYPE B BUS. LIc# 24074
COMPANYNAME SC Builders, Inc. E -MAI, msoik@scbuildersinc.com FAX n/a
STREETADDRESS 910 Thompson Place cITY,STATE,zIP Sunnyvale, CA 94085 PHONE 408-328-0688
ARCHITECT/ENGINEERNAME Chi -Wing WOng LICENSENUMBER C-29630 BUS. LIC#
COMPANY NAME DES Architects + Engineers, Inc. E-MAIL cwwong@des-ae.com FAX n/a
STREETADDREss 399 Bradford Street, Suite 300 CITY, STATE, ZIP Redwood City, Ca 94063 PHONE 650-364-6453
DESCRIPTION OF WORK Installation of (1) security door
EXISTING USE - PROPOSED USE CONSTR. TYPE # STORIES
Office Office VB 1 USE 7 TYPE OCC. SQ.FT. VALUATION ($)
EXISTG NEW FLOOR DEMO TOTAL
AREA $,985 sq, ft, AREA $ 985 Sq ft AREA 0 sq. ft. NETAREA8,985 sq. ft. Office V B same $16,500
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELAREA REMODEL AREA
Existing to remain I no kitchen no other remodel area
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LIDETACH
0 sq. ft. 0 sq. ft. 0 sq. ft. 0 sq. ft. El ATTACH
# DWELLING UNITS: - IS A SECOND UNIT ❑ YES SECOND STORY []YES
n/a BEING ADDED? VNO ADDITION? i2rNO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES = REG .. BY., ' � - .TOTAL VALUATION:
PLANNING ADPL # VNO PLANNING APPROVAL LETTER EICHLER HOME? �WNO
$16,500
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:/
SUPPLEMENTAL -INFORMATION -REQUIRED ipv$ECK rpE ROUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
O I2-THE-COUNTF;R ' BUIT.DIN�PLANREVIEw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ - EXPRESS PLA ,NINIINGPLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srArmArID ❑ ^ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project, p•LAiic 1 nEP2
Copy of Planning Approval Letter or Meeting with Planning prior to ❑�SOR` QSANITARY SEWER ISTRiT
submittal of Building Permit application.
❑ ENVIItONMENTAL HEALTH,
BldgApp_2011.doe revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10440 Bubb Rd DATE: 09/23/2015 REVIEWED BY: Sean
APN: BP#: 1 - *VALUATION: $16,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE., Tenant Improvement
PRIMARY Commercial Building PENTAMATION
USE: g PERMIT TYPE: 1 GENCOM
WORK Installation of 1securit door; install outlets and power pole in Production Room 125 and outlets in
SCOPE Pantry Room 123.
x a �
d��.d mSLJ' �vf� X �• .,sh� `� ��
tblech. Plan Check
Plumb. Plan Check
Elec. Plan Check
hlech. Pernzit.Fee:
Plwnb, Permit Fee:
I Elec. PerinitFee:
Other Mech. Insp.
Other Plunzb Imp.Ll
Other Elec. Insp.
Mech. Insp. Fee:
Plumb. Insp. Fee:
Elec. Insp. Fee:
Pormit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
Cl
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Feer
$0.00
L_I_j hours Inspections
$429.00 ISTINSP Inspection, Hourly
x
Strong Motion Feer IBSEISMICO
x a �
d��.d mSLJ' �vf� X �• .,sh� `� ��
tblech. Plan Check
Plumb. Plan Check
Elec. Plan Check
hlech. Pernzit.Fee:
Plwnb, Permit Fee:
I Elec. PerinitFee:
Other Mech. Insp.
Other Plunzb Imp.Ll
Other Elec. Insp.
Mech. Insp. Fee:
Plumb. Insp. Fee:
Elec. Insp. Fee:
/VUII;t Ms estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are haled nn the nreliminary infnrnxatian availahle and are nn1v an estimate. Cnntart the lent fnr addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes No
$0.00
1 hours Plan Check, Hourly
$143.00 1STPLNCK
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Pormit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
Cl
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Feer
$0.00
L_I_j hours Inspections
$429.00 ISTINSP Inspection, Hourly
Travel Documentation Fees:
Strong Motion Feer IBSEISMICO
$4.62
1 # Alternate Materials and Methods
$187.00 IALTMAT
Bldg Stds Commission Fee: 1BCBSC
$1.00
x £ r SUB�dTALS
$5.62
$759.00„ y >� f... £ .
$764.62
Revised: 07102/2015