B-2016-1744G
CITY OF CUPERTINO BUILDING
PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1744
10200 N TANTAU AVE CUPERTINO, CA 95014-2557 (316 19 062)
NOVO
CONSTRUCTION
INC
MENLO PARK, C
94025
OWNER'S NAME: PR CUPERTINO GATEWAY LLC
DATE ISSUED: 04/18/2016
OWNER'S PHONE: 408-783-4731
PHONE NO: (650) 701-1500
LICENSED CONTRACTOR'S DECLARATION
BUILDING PEIMT
INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #791022
Contractor NOVO CONSTRUCTION INC Date 02/28/2017
X_ BLDG X_ ELECT
_PLUMB
X MECH RE
DENTIAL 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 full force and effect.
JOB DESCRIP
ION:
1 ST FLOOR, AD
D (1) ELECTRICAL PANEL AND (N)
I hereby affirm under penalty of perjury one of the following two declarations:
SUPPLEMENTAL
10 TON SPLIT SYSTEM (ROOF TOP.EQUIP)-
1. I have and will maintain a certificate of consent to self -insure for Worker's
APPLE
Compensation, as provided for by Section 3700 of the Labor Code, for the
REV #1 - ADD 1
(l) 400 AMP SERVICE PANEL 2.1
erformance 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
Sq. Ft Floor Area:
Valuation: $79076.00
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
316 19 062
A (Tenant 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
80 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 CALLED INSPECTION.
cl&
S�ture _— Date 2/112417
Issued by: ABB
AYENDE
Date: 04/18/201
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be
RE -ROOFS:
spected prior to any roofing material being installed. If a roof is
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
installed without ft
-st obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Appli
t:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 2/1/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL R
OF COVERINGS TO BE CLASS "A" OR BETTER
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.
k
AZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance, as provided for by
I have'read the
azardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California He
Ith & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain complia
ice with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safe
material. Additio
Code, Section 25532(a) should I store or handle hazardous
ally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants
as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain co
plane with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Heath
& Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
l
C"116t,
be deemed revoked. /
Owner or authorized
agent:
APPLICANT CERTIFICATION
Date: 2/1/2017
1 certify that I have read this application and state that the above information is
I hereby affirm th
CONSTRUCTION LENDING AGENCY
t there is a construction lending agency for the performance
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
of work's for whic
this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Addre
s
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my
AR T' DECLARATION
tans shal1l1 bbe e used as public records.
Code, Section 9.18.
Licensed
Signature Date 21/ /2017
professional
CONSTRUCTION PERMIT APPL[GA [CSI
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING, DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPER'€`INO (408) 777-3228 - FAX (408) 777-3333 - buildin w ertino.or
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PROJECT ADDRESS JD2OO A). T Av} au
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OWNER NAME
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❑ OWNER ❑ OWNER-BIIIIAER ❑ ORTTERAGEI;T CONTRACTOR ❑ CONTRACTORAGENT ARCHITECT ❑ EI 'EER ❑ DEVELOPER ❑ TET.,-�'T
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ARCHITECT/ENGINEER NAME LICENSE NUMBER
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10200 N TANTAU AVE CUPERTINO, CA 95014-2557
CONTRACTOR:
PERMIT NO: B-2016-1744
(316 19 062)
NOVO
CONSTRUCTION INC
MENLO PARK, CA
94025
OWNER'S NAME: PR CUPERTINO GATEWAY LLC
DATE ISSUED: 04/18/2016
OWNER'S PHONE: 415-399-5326
PHONE NO: (650) 701-1500
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL R to DING CONTRACTOR Lic. #791022
Contractor NOVO CONSTRUQTION INC Date 02/28/2017
X BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH _ RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations:
1 ST FLOOR, ADD (I) ELECTRICAL PANEL AND (N)
r. I have and will maintain a certificate of consent to self -insure for Worker's
SUPPLEMENTAL 10 TON SPLIT SYSTEM (ROOF TOP EQUIP)-
Compensation, as provided for by Section 3700 of the Labor Code, for the
APPLE
'performance of the work for which this permit is issued.
2. Ilhave and will maintain Worker's Compensation Insurance, as provided for by
`j Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $79076.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. 1 agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
316 19 062
A (Tenant 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.
Additionally, the applicant understands and willl comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST C LF -D JQPECTION.
Signature 1 Date 04/18/2016
Issued by: ME
Date: 04 6
OWNER -BUILDER DECL RATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 04/18/2016
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
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
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534..
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent: 4
APPLICANT CERTIFICATION
Date: 04/18/2016
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 04/18/2016
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
_ COMMUNITY DEVELOPMENT DEPARTMENT ® BUILDING DIVISION
10300 TORRE AVENUE g CUPERTINO, CA 050144255
(408) 777=3228' FAX (406) 777=3333 • build iriggougettino:org
[1NEW CONSTRUCTION El ADDITION -ALTERATION /Ti E] REVISION / DEFEItR
9
ORIGINAL PERMIT #
PROJECT ADDRESS APN # '' ( s
( C
W.L226-U,✓ `S✓
OWNER NANLE PHONE p may/ E-MAILI)Dq p 11
STREET ADDRESS CITY, STATE, 7 -IP FAX
CONTACT NAME gun ar _ EMAIL
Ifl`n<+"� �j(/�.�✓,�. 'e%✓— t��l"�ti16✓�-i. �� ���/9 R1s�69�'6S (,•I,"d0�i�_--
19Ti FET ADDRESS - CITY S`CATE,. ZIP q j�� FAX
( V'Rt r-c�' 1 �_ G2s c
(b , T6 T1
0 QWN> R ® OWNER -BUILDER ® OWNER AGENT ❑ CONTRACTOR ® C.ONTRACTOR AGENT ® ARCHITECT ® ENGINEER ® DEVELOPER ❑ TENANT
CONTRACTORNAIviE LICENSE NI?ATBER LICENSE TYPE BUS.�LyyIC #
COMPANY NAME E=MAIL FAX
STREET ADDRESS CITY, STATE, 71P PHONE
0I'
ARCHITECT/ENGINEER NAME LICENSE NUMBER BU.S, LIC #
CONWANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK
Q 7-0 T -A n
EXISTING GSE PROPOSED USE CONSTR. TYPE # STORIES
USE TYPE OCC, SQ.FT. VALUATION (�)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODEL AREA REMOORL AREA
REMODEL;ARBA
PORCHAREA DECK AREA TOTALPECKPORCHAREA
GARAGEAftEA: pET'
ATTACH
# DWE1 LING UNITS: IS A SECOND t N[T YES
SECOND STORY YES v
BEING ADDED? ®No
ADDI'rIQN? ANO
In
11
PRE=APPLICATION ®YES IF YES, PROVIDE COPY OF IS TAE BLDG AN 0 YES
RECEIVED BY
4
TOTAL VALUATION:
PLANNING. APPL# ❑NO PLANNING APPROVAL LETTER EICHLGRHPME? 0 N
0-77-6—
By my signature below, I certify to each of the following: I am , e property owner or authorized agent t act _ the pro erty owner's behalf. I have read this
By
application and the information I have p - v del is correct, I e read the Description, of Work and verify it is accurate: I agree to comply with all applicable local
ordinances and state laws relating to b leg g construction, s uthorize represenkatives of Cupertino to enter the above dentifled property for inspection purposes.
Signature of Applicant/Agent: Date: L.
SUPPLEMENTAL, INFORMATION REQUIRED PLAN C R ECK TYPE ROUTING SLrP
_ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE—COUNTER UILI) G PLAN REVIEW
building(s). Demolition is to issuance of building
existing permit required prior W
V
permit for new building. ❑ EXPRESS LANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑- STANDARD ❑ PUBLIC WORKS
form, if any Hazardous Materials are being used as part of this project.-
LARGE IaEAEPT
_
Copy of Planning .Approval Letter,or Meeting with Planning prior to ❑ MAJOR p SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL IIEALTII
BldgApp_2011.doe revised 06121/11
Date;
proJect ##;
Project Name;
Address;
City;
-Requested by;
c -, 'V --n
61Ztr16
MAS; & #6; �
New
OSHA_ ##;
Tantau Seven
_ Aerrnit/ _pp, #€
10200 Na Tantau Ave.
Tow Co. e;
Cupertino
Start Time-,
Travis -
Hours,
QrfalGty'.`ISb'i1P'LinC'C' SBP'i'iCeS
Materials Consulting
Sine 1954
r:.,,,
I �ge -- ___ - of
Post -Installed Anchor Testing Report 1
Applied a tension proof 77X torque load of lbs. or 40 ft,=1_bs, (0srfrte .. , Qr �Titcattrtetl )'.
to 1/2 (ske-) diameter Ilild I B qI ( brand) epoxied dowels _ epoxied Allthread anchors
._._
--LXJ expansion anchors powder actuated pins T other;
Located in the r floor Walt X ceiling other at Ceilin Fan Coil
For —
- -
(Na, ) anchors /dowels of a total of 4 installed Were tested representing 100 percent
without visually apparent distress or failure,
( Nos ) atichors/dowels failed to meet proof load requirements,
IdentiFed and repot'ted_failhig anchors/dowels toat the jgbsite for appropriate action,
Applied a tension proof ortorque load of lbs, 9r ft,=lbs, (C'onfrtet� ; of Utteatlte(t )
to __.____ (size) diameter ( brand) epor led dowels epoxted AllthrQad anchors
expansion anchors powder actuated pins other;
Located in the floor wall ceiling El other at
For
(No,)anchors /dowels of a total of Installed were tested representing percent
without visually apparent distress or failure,
(No, ) anchors/dowels failed to meet proof load requh'ements,
at the jobs ite for
Proof loading values and rate of testing were supplied by = Drawings No(s)
Final acceptance is pending written approval or corrective action as noted. _ See attached RFI,
All non�wmpliance items were brought to the attention of at the job site,
Notes:
Show«p; = Stand-by time; = Job Cancelled; = Re -inspection; Hours;
The work X was was not tested in accordance with the Building Department or DSII or OSFTBD approve docs,
The work tested X met did not meet the requirements of the Building Department or DSW or OSHPD approved does,
except as noted above,
Drawings S-2 Dated 4/11/16 X City= DSA =Shop
Inspector Signature Certification # 5280707 Date:
Printed Name: Jason Souza Received by: Date: -�
Corporate Office - 2811 Teagarden Street - San Leandro, California 94577 - (510) 835-3142 - FAX (510) 834-3777
www.Testing-Engineers.com