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15090165CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20705 VALLEY GREEN DR I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 15090165
OWNER'S NAME: BERG FAMILY PARTNERS, L.P. 11460 O'BRIEN DR I DATE ISSUED: 09/24/2015 1
OWNER'S PHONE: 4089743516 1 MENLO PARK, CA 94025 I PHONE NO: (650)701-1500 I
LJ LICENSED CONTRACTOR'S DECLARATION
License Classy f q%3 Lic. # (
(,LyVo Z 2
Contractor JVUVV AAA /�-7 / I r%ate
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:
r. 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.
Z. 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, judgment3' ,
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 so a re ulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
❑ !./ OWNED -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:
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
permit is issued.
s. 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
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
APPLE - TI ON 1 ST FLOOR (WEST WING) (2040SF)
RECONFIGURE (F,) OFFICE SPACE
Sq. Ft Floor Area: I Valuation: $198000
APN Number: 32610046.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OE2ERMU ISSUANCE OR
180 DAYS ASCD INSPECTION.
2
_ — Date: `7 /
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.
agent: 9
Date: a r?i 4 KJ
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 A
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20705 VALLEY GREEN DR
CONTRACTOR: NOVO CONSTRUCTION
PERMIT NO: 15090165
OWNER'S NAME: CAMPUS HOLDINGS INC
1460 O'BRIEN DR
DATE ISSUED: 09/24/2015
OWNER'S PHONE: 4089743516
MENLO PARK, CA 94025
PHONE NO: (650)701-1500
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class %_ Lic. # 0 "Z2
APPLE - TI ON IST FLOOR (WEST WING) (2040 SF) RECONFIGURE (E)
OFFICE SPACE
Contractor V3 D" '� Lo S_le'c-_')Uy`Date
REVISION #1: REMOVAL OF NON-STRUCTURAL WALLS AND DOORS IN
-irhereby affirm that I am licensed under the provisions of Chapter 9
ROOM 181; CONSTRUCT PARTITION WALL TO SPLIT ROOM 181 AND
(commencing with Section 7000) of Division 3 of the Business & Professions
CREATE ROOM 182 WITH ELECTRICAL; REMOVE DOOR FROM ROOM
Code and that my license is in full force and effect.
185.
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: $198000
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
APN Number: 32610046.00
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 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
&0 1 I
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
//
RE -ROOFS:
Signature s -Date i /
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 (Sec.7044,
Business & Professions Code)
1, 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 ad the hazardous materials requirements under Chapter 6.95 of the
At
�OI
alifor 'a Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the f�l
lance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(x) should I 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 I
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, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date:
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, 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
C—�UPERTINO
F-1
I I NFW CONRTRI ICTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(4088)) 777-3228 • FAX ((408) 777-3333 • bu dinn1g,= �aipertlno org
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B% in gignantre below, I certiI% to each }f le folio in�T I am the property omier or aLifto ized gL t to act )n the property owner's hehall I have read this
application and the information I hay rodded Is cot A I lune read the Descnpuon of Wort. and veil Is accwate. I agree to comply with all appllcahle local
ordinance. and state aAv> re a[in To bwldine cons clion. I authori/e re r—entaM es of Cupertino to enter the above-iden lied property(or In<pecu0n purposes
Sienatureol'ApplicantAgog''-�---- - -- Dale,
S[IPPL.I:MI:N l'ORMACION IZ('.O .
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❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SI D or Nlul(i(a 1 dNellin" Applk for demolition permit li)r
existing kllldingW. D U ITiOn perllllt IS reLILllred prior tO issuance 01 building,
permit for new N11](1111P.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed I lazardous Materials Disclosure
❑ SIANDARII
❑ PUBLICAVORKS
101"Dt ifam lia7ilr(IOLIS NIatertalS are bl4tng Used as part of this project.
❑
❑
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FIRE DEPT
opV OI Planning Approval Letter Or Meeting N Id) Nanning prior t0
❑ MAJOR
❑ SANITARY SEWER DISTRICT
Submittal of Buildin g Permit application.
❑ ENVIRONMENTAL HEALTH
Bldg.lp�) 2011.doc revised 06 _'1 11
>s
CUPERT[NO
CONSTRUCTION PERMIT APPLICATION
COMMiiUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 'el
(408) 777-3228 • FAX (408) 777-3333 • buildinaQr-uDetL no.org
❑ NEW CCINSTRUCTION ❑ ADDITION ❑ AL T ER4TION / TI REVISION / DEFERRED ORIGINAL PERMIT / 6 )
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By my signature below, I certify to each of the following: I am the property ov,Ter or authorized
agent to act on the prop, -,—,y owner's behalf I have read this
application and the information I have p 'id Is con ec read the Description of Work
and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating o b iid n c ,strut on. I a+!thorize representatives'of Cupe.r Ino to enter the owe -id d proplry for inspection purposes.
Signature of Applicant/Agent: T
Date: Lit^/
SUPPLEMEN FORMATION REQUIRED
O«RTHIrCUII�TERBUIIDL�GPLANREVIEFY-
New SFD or Mu It >-e mgs:.4pply for demolition permit for—
existing budding(s). Demolition permit is required prior to issuance of building
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permit for new building.
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Bidgr4pp_2011.doc revised 06/21111
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CITY OF CUPERTINO
FEW FEE ESTIMATOR - BUILDING DIVISION
lalADDRESS:
20705 Valley Green Dr
DATE: 11/02/2015
REVIEWED BY: Sean
MISC ITEMS
APN:
BP#: 15090165
'VALUATION: Iso
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE:Commercial Building
Civil / Religious activities
inB zone?
Q Yes No
PENTAMATION
1GENCOM
PERMIT TYPE:
WORK
Revision #1: Removal of non-structural walls and doors in Rm 181 • construct partition to split Rm 181
SCOPE
to creat room 182 with electrical changes; remove door from Rm 185.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt etc )_ These fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (E) No
$0.00
hours Plan Check, Hourly
$286.00 1STPLNCK
Suppl. PC Fee: (E) Reg. Q OTT
0. 01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.0 Reg. Q OT
0,0hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXCF7__
$0.00
�i/%71,;71.@ZPctllY'f' Fee:
0
E)
Work Without Permit? Yes (j) No
$0.00
Advanced PlFannin Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
It°crs E I?<=cuf��rri rf Pi'VX"
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Cqmmission Fee:
$0.00
SUBTOTALS:
$0.00
$286.00
TOTAL FEE:
$286.00
Revised: 10/01/2015
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
lalADDRESS:
20705 VALLEY GREEN DRDATE:
09/24/2015
REVIEWED BY: PHUONG
PC FEE ID
APN: 326-10-046
BP#:
VALUATION: 1$198,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1BTIPLNCK
PENTAMATION 1B TI
PERMIT TYPE:
WORK
APPLE - TI ON 1ST FLOOR WEST WING 2040SF RECONFIGURE E OFFICE SPACE
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
2,040
$2,247.76
1BTIPLNCK
$1,890.86
1BTIINSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,890.86
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
2,040
$2,247.76
$1,890.86
MECH, HOURLY 0 Yes Q Na PLUMB, HOURLY Q Yes 0 No ELEC, HOURLY ® Yes o
E3
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 hosed an the nreliminary information availahle and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1,113,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,247.76
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j)Reg. 0 OT
Q,Q
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,890.86
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
clPi?i,'L4Cr'c 1i!°cr a' 'P:
7
Q
E)
Work Without Permit? ® Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
�
Strong Motion Fee: IBSEISMICO
$55.44
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$8.00
SUBTOTALS:
$4,202.061
$0.00
TOTALFEEi
1 $4,202.06
Revised: 07/02/2015
FILE
Test, Adjust & Balance Report
PROJECT: Apple VG06
ADDRESS: 20705 Valley Green Drive
Cupertino, CA. 95014
ARCHITECT: Not Listed
ENGINEER: Silicon Valley Mechanical
GENERAL CONTRACTOR: Novo Construction
HVAC CONTRACTOR: Silicon Valley Mechanical
LEAD BALANCE 'TECHNICIAN: Scott McClung
DATE: 10/29/2015
DATE:
PROJECT: Apple VG06 PAGE
10/29/2015
CFM
Cubic Feet Per Minute
FPM
Feet Per Minute
RPM
Revolutions Per Minute
HP
Horse Power
BHP
Brake Horse Power
FLA
Full Load Amps
SF
Service Factor
" W.G.
Inches of Water gauge
SP
Static Pressure
TSP
Total Static Pressure
ESP
External Static Pressure
AP
Differential Pressure
AT
Differential Temperature
OF
Degree Fahrenheit
°C
Degree Celcius
CD
Ceiling Diffuser
CS
Ceiling Supply
CR
Ceiling Return
WS
Wall Suppy
WR
Wall Return
CE
Ceiling Exhaust
WE
Wall Exhaust
EDS
Exposed Duct Supply
ODUCT
Open Duct
DSOX
Duct Sox
LSD
Linear Slot Diffuser
HEPA
High Efficiency Particulate Air Filter
FP -NEPA
Fan Powered -High Efficiency Particulate Air Filter
DNA
Data Not Available
DNL
Data Not Listed
NA
Not Applicable
LOA
Lack of Access
NI
I Not Installed
GENERAL NOTES
DATE:
PROJECT: Apple VG06 PAGE:
1 jUnless otherwise noted, indicated CFM (Cubic Feet per Minute) is a standard condition.
2 Unless otherwise noted, indicated GPM (Gallons per Minute) is a standard condition.
Unless otherwise noted, all sizes are measured in inches.
10/29/2015
PROJECT: Apple VG06 DATE: 10/27/2015
SYSTEM: ( E ) Supply air PAGE: 3
AREA
SERVED:::
:.:: : OUTLET{ INLET: =
DESIGN .:.:.
PRELIMINARY_-. : -
FINAL:::. .:
NOTE.
....NO.
TYPE .::.
SfZE'-...:.
MIN:..MAX::::
:MIN:: -
::.MAX
MIN:. '
.. ; MAX
1828
1
CD
8
DNA
100
180
10
110
1828
2
CD
10
DNA
240
195
44
230
1828
3
CD
10
DNA
240
205
58
240
1828
4
CD
10
DNA
240
205
50
235
1828
5
CD
10
DNA
240
200
45
235
1828
6
CD
10
DNA
240
205
49
250
1828
7
CD
10
DNA
240
210
58
245
VAV 1-31
TOTAL
310
1540
1400
314
1545
181
1
CD
10
DNA
240
220
55
235
181
2
CD
10
DNA
240
195
37
220
181
3
CD
10
DNA
240
220
58
255
181
4
CD
10
DNA
240
215
36
230
VAV 1-39
TOTAL
192
960
850
186
940
REMARKS:
s
Silicon Valley
eigho7nical
50 San Jose,
JCI DDC VAV DATA REPORT
PROJECT: Apple VG06 DATE: 10/27/2015
SYSTEM: ( E ) Supply air PAGE: 4
..
' UNIT
SIZE /AREA.
. ADDRESS
DPO
......
...
FLOW GAIN
. :....::...
MAX:..C..... ...F......M..........
MIN'CFM .
HEAT CFM
NOTE
VAV 1-31
12 /0.79
60
0.34
2.524
960
192
NA
VAV 1-39
14/1.07
55
-2.39
3.340
1540
310
NA
REMARKS:
JCDATA
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20705 VALLEY GREEN DR
CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 15090165
OWNER'S NAME: CAMPUS HOLDINGS INC
1460 O'BRIEN DR DATE ISSUED: 09/24/2015
OWNER'S PHONE: 4089743516
MENLO PARK, CA 94025 PHONE NO: (650)701-1500
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic. # `T k d 7-1—
APPLE - TI ON 1ST FLOOR (WEST WING) (2040 SF) RECONFIGURE (E)
OFFICE SPACE
Contractor 13 ' "' LoV-� 5-1 't;7 C: ')CV"Date
REVISION #1: REMOVAL OF NON-STRUCTURAL WALLS AND DOORS IN
hereby affirm that I am licensed under the provisions of Chapter 9
ROOM 181; CONSTRUCT PARTITION WALL TO SPLIT ROOM 181 AND
(commencing with Section 7000) of Division 3 of the Business & Professions
CREATE ROOM 182 WITH ELECTRICAL; REMOVE DOOR FROM ROOM
Code and:that my license is in full force and effect.
185.
l ,
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: $198000
performance of the work for which this permit is issued.
I have andwill maintain Worker's Compensation Insurance, as provided for by
APN Number: 32610046.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I 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
180 DAYS FROM LAST CALLED INSPECTION.
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
Issued by:��C) Date:
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.
Jr /
RE -ROOFS:
Signature Date / /
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
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)
HAZARDOUS MATERIALS DISCLOSURE
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I have ad the hazardous materials requirements under Chapter 6.95 of the
®aliforgi a Health &Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under of perjury one of the f
. is lance with the Cupertino Municipal Code, Chapter 9.12 and the
penalty J
declarations:
Health &Safety Code, Section 25532(a) should I store or handle hazardous
I use equipment or devices which emit hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should
defined by the Bay Area Air Quality Management District I
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as
the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
will maintain compliance with
the Health & Safety Code, Sections 25505, 25533, and 25534.
I have andwill maintain Worker's Compensation Insurance, as provided for by
}
Section 3700 of the Labor Code, for the performance of the work for which thisDate:
Owner or authorized agent:
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
firm that there is a construction lending agency for the performance of
I hereby affirm
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read thisapplication 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
ARCHITECT'S DECLARATION
indemnify.and keep harmless the City of Cupertino against liabilities, judgments,
which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
costs, and expenses
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
COMMIUNIT`( DEVELOPMENT DEPARTMENT - BUILDING DIVISIO
10300 TORRE AVENUE • CUPERTINO, CA 35014-3255
(408) 777-3228 - FAX (408) 777-3333 building(d_)cuDertino.oro
❑ 117-W CONSTRUCTION ❑ ADDITiON
❑ ALTERATION / TI REVISION l DEFERRED ORIGakL PERI ---9
B1dgApp_20]1.doc revised 06/21/11
a
PROJECT ADDRESS , �^y
APN R 4
OSS TERN'AIM �L ( PHONE
E-MAIL
STREET ADDRESS �® IC c ATE ZIP
I FAX
CON?ACT NAME PH
r ,,a. Q ( `-N G�• �1 G
STREET ADDRESSp� �VU_. MobCITY,
E, P
FAX
I❑ OWNM ❑- OWN -EP, -B=E& ❑ O'AMERAGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT 4 ARCHEECT 0 MgCD�-cR ❑ DE-'zLOPER ❑ TENANT
CONTRACT OR NAME I LICENSENTUM,BER
I LICENSE i YPL
( BUS. LIC 4
CO1VIPANYNAl,S, �4/
£-N�0.IL
I FAX
STREET ADDRESSST
I �'
TE, ZIP
r,
CAAROUTECTTNG
PHONE,0
EFR NE J, LIC' `SEN°S ER
.y
BU'S. LIC n
�
e
CONT M AIL
f
.OA
STREff A.ODRESSte' CITY' SPTE•ZIP
�k! �`jG' /
,j/ L
P ONE G
DIWTI OF CORK � / � -
_
dW
- l ®Y Orl a efl
V' o9 ° 6
EXISTING USEI PROPOSED USE CONSTRTYPE ?STORIES
i I
USE ( 'TYPE ( OCC. (
SQ.FT. (
VALUATION (S)
EXISTG
NTEW FLOOR
DEMO
TOTAL
AREA
AREA
7
AREA
14ET AREA
BATHROOM
REMODEL AREA
KITCHEN
TMIODEL.AaEA
OThm
REMODEL AREA FIEVISON
#LL-
I
PORCH AREA
DECK AREA
TOTAL DECKTORCH AREA
GARAGE AREA: UDETACH
ATTACH
,DWELLINGUNTTSc
ISASECONDUNTT [:]YES
SECOND STORY ❑1rS
I
BEING ADDED? EINO
ADDITION? ONTO
PRE.APPLICATION ❑= IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ Yt5
t0 'IZTrD $1• ._ - `'
-
TOTAL. V? ION:
PLAT.TNING ADPL - []NO PLANNING APPROVAL LETTER I
EICHL£R HOME? ❑ I`0
By my signature below, I certify to each of the following: I am the property ovmer or authorized agent to act on the property ovmer's behalf. I have read this
application and the information I have p Tid correc read the Description of Work and verify it is accurate. I agree to comply -with all applicable local
ordinances and state laws relating o b,Lfiild r cpnstruc oma uthorize representatives 'of Cupertino to enter the fbove-id n if d property for inspection purposes.
SignatureofApplicant/Agent: �: } r
Date: a(F'
SUPPLElfiEITT OR1tTI0N REQUIRED'ggv
P.LAIZ,CHECK1gE z>.-OT3TGSLIP
4
New SFD or ?`4ultifamily {Te Ings:.ADply for demolition permit for
b�OvzRTH)<COL�TER
BUILDL�GPLANP2rV7E4ir
existing building s). Demolition permit is required prior to issuance of building
permit for new building.i.
GPI 4*t RESE4
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Q 9xD
PLBLSC4P ORKS
_
form if any Hazardous Materials are being used as part of this project.
�aaZ
RG
JSEWM-z
Copy of Planning Approval Letter or Meeting with PIanning prior to
Building Permit application.
n
�,.I+2470R � �
4��
yam-
`��s12I�.5SiiER�ISTP2ICT � -�:
A'N'iZ'3
�_
submittal of
€ ~.
-
4,OrE�a::OJ3'I✓aET4T_4-L.
EE.4I3TA
B1dgApp_20]1.doc revised 06/21/11
a
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20705 Valley Green Dr DATE: 11/02/2015 REVIEWED BY: Sean
APN: BP#: 15090165 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building Civil / Religious activities PENTAMATION 1 GENCQ
USE: in BQ zone? 0 Yes No I PERMIT TYPE:
WORK I Revision #1: Removal of non-structural walls and doors in Rm 181 • construct partition to split Rm 181
SCOPE Ito creat room 182 with electrical changes; remove door from Rm 185.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, rare, 3anuary newer uaslricr, acnuol
rimmet thn Dont for adds l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
hours Plan Check, Hourly
$286.00 ISTPLNCK
Suppl. PC Fee: (F) Reg. 0 OT
0,0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCONSTAXC
$0.00
tcdntiai,str^^criivE> .Fec3:
0
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure 0
A
Travel DocumentationFees:
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
UBTTALS:
$0.00
$286.00 '. Tt�TAL FEET:
$286.00
meviseu. ivjv uGv j.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20705 VALLEY GREEN DR
CONTRACTOR:. NOVO CONSTRUCTION
PERMIT NO: 15090165
OWNER'S NAME: BERG FAMILY PARTNERS, L.P.
1460 O'BRIEN DR
DATE ISSUED: 09/24/2015
OWNER'S PHONE: 4089743516
MENLO PARK, CA 94025
PHONE NO: (650)701-1500
b LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
1`2 �
J
APPLE - TI ON 1 ST FLOOR (WEST WING) (2040SF)
License Class Lie. # t QZ
RECONFIGURE (E) OFFICE SPACE
,,""� /�
Contractor _ /(-(?0Vate
Cy 071._
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:
Sq. Ft Floor Area:
Valuation: $198000
�. 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
APN Number: 32610046.00
Occupancy Type:
erformance of the work for which this permit is issued.
16—p1have 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.
PERMIT EXPIRES IF WORK IS NOT STARTED
- APPLICANT CERTIFICATION
WITHIN 180 DAYS_ OF + ISSUANCE OR
I certify that I have read this application and state that the above information is
180 DAYS AS ED INSPECTION.
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
---
sue Dater
indemnify and keep harmless the City of Cupertino against liabilities, judgmen
- -
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 soytrbe re ulations 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
Signature Date (
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
s OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
sale (Sec.7044, Business & Professions Code)
I have read the hazardous materials; requirements under Chapter 6.95 of the
2. I, as owner of the property, am exclusively contracting with licensed contractors to
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
construct the project (Sec.7044, Business & Professions Code).
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations:
Additionally, should I use equipment or devices which emit hazardous air
�. I have and will maintain a Certificate of Consent to self-insure for Worker's
contaminants as defined by the Bay Area Air Quality Management District I will
Compensation, as provided for by Section 3700 of the Labor Code, for the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
performance of the work for which this permit is issued.
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner a horized a ent:
g Date:'
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued, I shall
CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. It after making this certificate of exemption, I
I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code, I
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked.
Lender's Address
APPLICANT CERTIFICATION
ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is
I understand my plans shall be used as public records.
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
Licensed Professional
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
CUPERTINO
El NEW CONSTRUCTION
CONSTRUCTION IT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buiiclingt , Cupertino org
F1 n nnrr-lnm r 71 r T r l—1
PROJECT ADDRESS
LICENSE NUMBER
°t
-- — ' 'u
r�r✓L
.,J11N,J- 1-r.KIVII 1 F
_
�-L-L.
API #
E-MAIL
OWNER NIA\. -
r
-S!; I U
EMAIL
1(4 IAOW LCC- Lo
STREET ADDRESS
PHONE
- S'L t - 7 (e0 9
1- T/ENGI 'EER iCENSENUMBER
AQC tqa6jZk
CIT 'TATE, ZIP �
FAX
CONTACT NAME,� ` -
l CLE -2
PHONE
1,0 - SZi - 3la ot3
E-NIAIL
d+1t11.1.�%AiCltO�• SrQ�cr
STREETADDRESS
CITY, STATE,. ZIP
AREA
FAX
,❑ OWNER. ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ rnNTRarTn* 1-lrnraTn11— 11--r f 1 .. -c..r n n _...._... n __._..._ m
CONTRACTORNAME
PAcAe- M yt4
LICENSE NUMBER
°t
LICENSE TYPE
BUS LIC#
-
�-L-L.
COMPANY NASI SIE
E-MAIL
USE
STREET ADDRESS`
ta. a v & a -i � v
CITY, STATE, ZIP �
I.o PAR2IIG. LA I(OZ� �
PHONE
- S'L t - 7 (e0 9
1- T/ENGI 'EER iCENSENUMBER
AQC tqa6jZk
BUS. LIC
CQMPANY NAME
M¢ApfLt,. p. pr
oat,
FAX
GE"C ADDRESS
i0Q --�]
CITY, STATE, ZIP
iI`
PHONE
AREA
EXISTING USE
PROPOSED USE
CONSTR TYPE
T, STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DET40
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM KITCHENOTHER
REMODEL AREA REMODEL, AREA
REMODEL AREA
PORC14 AREA
DECK AREA TOTAL DECK/PORCH AREA
GARAGE ARBA: DETACH
( 3 ATTACI-I
4 DW ELLMG UNITS'
IS A SECOND UNIT [3YES SECONDSTORY YES
BEINGADDED? [3NO ADDITION? QNO
_
PRE -APPLICATION YES - IF YES, PROVIDE COPY OF IS THE BLDG AN YES
'% ', - -
T�AjaYA ATION
PLANNMIG .APPL:: [3NO PLANNING APPROVAL LETTER EICHLERHOME? .ONO
�Cy
t
S�}ay
By my signature below, l certify to each %the following I am the property owner or auitioi izedg tt to act n the property owner's behalf. I have read this
application and the information I hav rovided is cor ct. I have read the Description of Work and vers is accurate. I agree to comply with all applicable local
ordinances and state laws relatil o building cons coon. I authorize re r entatives of Cupertino to enter time above -Iden tied proper tyw f ar inspection purposes.
Signature of Applicant/Agent _. Date:
New SFD or Multifa i dwellings: Apply for demolition permit for
existing building(s). DOifolition 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 ofthis project.
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
❑ OVER-TEC-COtINTER
❑ EXPRESS
El STANDARD
❑ LARGE
El MAJOR,
ROUTING SLIP
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ PUBLIC WORKS
❑
]FIRE DEPT
❑ SANITARY SEWER DISTRICT
GNVIROiNNiENTAL 1fEALTH
Bhlg,417p 201 Woe revised 06/2 // 17
X'J, C -D d,—
CITY OF CUPERTINO
FFF FCTT1%4ATn1I? _ III TTT .T11r1V!"_' TY1rF774Z7l1XT
VdADDRESS: 20705 VALLEY GREEN DR
DATE: 09/24/2015
REVIEWED BY: PHUONG
APN: 326-10-046
BP#:
-VALUATION: $198,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
2,040
PENTAMATION 1 B Tr
PERMIT TYPE:
WORK
APPLE - TI ON 1ST FLOOR WEST WING 2040SF RECONFIGURE E OFFICE SPACE
SCOPE
Permit Fee:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
2,040
$2,247.76
IBTIPLNCK
$1,890.86
IBTIINSP
Permit Fee:
$1,890.86
Suppl. Insp. Fee:(E) Reg. 0 OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Cons1ruction Ta'X:
Admin.islr ative Fee:
0
G
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
2,040
$2,247.76
:e
$1,890.86
Strong Motion Fee: IBSEISMICO
it ch, Plart Check
tech. 1'erwii Fee:
Other ;i e h. trrsr .
1'htwb. Ya rpt Cbeek
Ph'-m7r, Permit Fee:
Other Plun2b lrrs ,.
_I'Iech Ins7x Fee: 11'1711,115. ImP. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e.
Flee. P/an Checic
F ec. Permit Fee:
0[he r 1 r'ec. Mvo,
I Elec. lYrir Fee:
Public Works, Fire, Sanitary Sewer District,
7Dictrirt atr I Thoco foac n Ancon n tl.a nrn7:nr.r ..s..7 n -h, "" 4-- "t1, f tho 7Dnnt fnr ".4,1"17 infn_
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,247.76
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,890.86
Suppl. Insp. Fee:(E) Reg. 0 OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Cons1ruction Ta'X:
Admin.islr ative Fee:
0
G
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
I r"L;tE'el 1�f1£'2l7YtC�ntGtl7tlFt Fees:�
Strong Motion Fee: IBSEISMICO
$55.44
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$8.00
1�TBTOTALS°'
$4,202.06
$0.00 TOI`ALIEE
$4,202.06
Kevisea: unurtzu15
r■vv �.0
CONSTRUCTION
Apple VG6.11 W -1 0
Permit nubrh er;,15090165_�
Su>_is
Demo
Doors, frames, and hardware
Drywall
Paint
Ceilings
Flooring
Fire Sprinkler
Mechanical
Electrical
TNT I ° f$�;
Walters & Wolf
Magnum
Magnum,5a2f
Northgate
SD Flooring q57
BFP
Silicon Valley Mechanical
Redwood Group Electric
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