B-2016-2017CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2017
10373 TORRE AVE CUPERTINO, CA 95014-3203 (369 40 020) COBE
CONSTRUCTION INC
CAMPBELL, CA 95008
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
r. 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)
z. 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.
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.
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 trust 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 05/26/2016
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 ofAppl
Date: 05/26/2016
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, 5 33, and 25534.
Owner or authorized agent:
Date: 05/26/2016
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
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
OWNER'S NAME: CIVIC CENTER PROFESSIONAL GROUP
DATE ISSUED: 05/26/2016
OWNER'S PHONE:
PHONE NO: (408) 371-3400 ^
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #835122
X BLDG
Contractor COBE CONSTRUCTION INC Date 03/31/2018
—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 full force and effect.
JOB DESCRIPTION:
T.I. PREP 1201 SQ FT - CUPERTINO DENTAL
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.
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.
Sq. Ft Floor Area:
Valuation: $3000.00
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
369 40 020
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 CALLED INSPECTION.
/V avdk/
Signature Date 05/26/2016
Issued by: PAUL O'SULLIVAN *A_Ojuco�
Date: 05/26/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
r. 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)
z. 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.
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.
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 trust 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 05/26/2016
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 ofAppl
Date: 05/26/2016
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, 5 33, and 25534.
Owner or authorized agent:
Date: 05/26/2016
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
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}_ r n
(408) 777-3228 • FAX (408) 777-3333 • building aacupertho.org
❑ NEW CONSTRUCTION ❑ ADDITION
❑ ALTERATION I TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # X/l' p
PROJECT ADDRESS 43 A -,,/P-
APN t! ) 61 q C7 --- o
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OWNERNAME v �� r �! ^ a �.Q�, (•, t tj r a v r
PHONE (40,b)�� Ja I
EMAIL
STREET ADDRESS T y13 -'7o r r e Are
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CITY, STATE, ZIP / ✓ i' �t. ` �/ C 5 ti,
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FAX
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PHONE
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CITY, STATE, ZIP G,., far r 1-j :..,� C � �� 5�' 14
FAX
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT n ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME• �S �� �� e
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LICENSE NUMr� } L2
LICENSE TYPE
BUS. LIC # ry G L
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COMPANY NAME n+'�y� /j
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PHONE (40?,,} 41a
LICENSENUMBER
ARCHITECT/ENGINEERNAME``it77 J.
BUS.LICW
FAX
COMPANY NAME E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
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DESCRIPTION OF WORK
ff
.EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
USE
TYPE OCC.
SQ.PT,
VALUATION (S)
EXISTG
AREA
NEW FI.00R
AREA
DEMO
AREA
TOTAL
NETAREA
boo
34 l/
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODELAREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DHCK/PORC:H AREA
GARAGE AREA: U DETACH
❑ ATTACH
J
-it DWELLING UNITS:
ISASFCONDUNIT OYES
SECONDSTORY ❑YES
BEINGADDED?, ONO
ADDITION? ❑NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APDL # ❑ NO PLANVINO APPROVAL LETTER
IS THEBLDC AV ❑YES
EICHLFR HOT%M ❑ NO
:;RE IVSD,&y:z:''=,
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TOTAL VAI. A I
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By my signature below, I certify to each of the following: I am the property owner or authorized agent t act on kie property owner's behalf. I have head this
application and the information I have provided is correct. I have read the Description of Wolk and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified rd for inspection purposes.
Signature Applicant/Agent: �•^�"' Date: Z�
of --
SUPPLEIIFN1AL,4NT0RMATIONREQUIRED
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t:':- e_:-';__-; V ':: w:>_=a _ :r ;__;;-;i;z;,r.
NeivSFDorMultifamily dwelIings: Apply for demolition permit for
C p\'E[t-THE GQU....
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existing building(s). Demolition permit is required prior to issuance of building
yt:;-::;:.:.,:..:::,
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permit for new building.
b=
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
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form if any Hazardous Materials are being used as pal Gf this project.
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Copy ofPlanum Approval Letter or Meeting Planningannin€Prior to
- -
- -
- - - - -- - -
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SA.\[TAR]
subnntta of]3uildnnaPerznitapplication.
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BldgApp 2011.doc revised 06/21/11
CUPERTINO DENTAL
PROJECTINFO
OCCUPANCY CLASSIFICATIONPIT— F—I:
„TIO IB
OCCUPANT LOAD
EGRESS & EXITING xE
UN
PLUMBING FIXTURE COUNT
PLUMBING FIXTURES REQUIRED PLUMBING FIXTURES PROVIDED
Building #2 Building #1
rking L m
d
Build 0
SCOPE Parking Lot
OF WORK
Building #2
Building #5
N
SITE PLAN rn
NOT TO SCALE
euF sDR UP ,H
DBv ,Cl ltl HomuaucF
SHEET INDEX
Alu SITEPLAN /PROJECT DATA
"I STING AND DEMOLITIONPLAN
VICINITY MAP
PROJECT DATA
APN: Bond D19
ZONING DISTRICT: P(OP) PLANNED OFFICE
CONSTRUCTION TYPE: VR NON SPRINKLERED
PROJECT DESCRIPTION
INTERIOR DEMOLITION OF PARTITIONS, PLUMBING FIXTURES, DOORS,
AND DROPPED CEILING,
GENERAL NOTES
1'1THEISSUANCE OF A BUILDING PERMIT SHALL NOT BE
CONSTRUED AS A GUARANTEE THAT ALL CODE REQUIREMENTS ARE
REFLECTED IN THE DOCUMENTS. i GENERAL CONTRACTOR FOR
THE PROLECTSHALL BE ULTIMATELY RESPONSIBLE FOR INSURING THAT
E FINISHED PRODUCT COMPLIES WITH ALL REGULATIONS, LAWS
AND CODE REQUIREMENTS.
1.D2 THESEPUN
S ARE FOR THE GENERAL CONTRUCfION
UpoS ONLY, THEY ARE NOT EXHAUSTIVELY DETAILED NOR FULLY
THESPONSIRILITY OF THE CONTRACTOR TO
SPECIFIED, ERIFY, RESOLVE AND INSTALL ALL MATERIALS AND
EQUIPMENT.
RE WILL BE NO OBSERVATION RYAN ARCHITECT DURING
CONSTRUCTION,THE CONTRACTOR IS SOLELY RESPONSIBLE FOR THE
QUAUTY CONTROL AND CONSTRUCTION STANDARDS FOR THE
l.Dd ALL CONSTRUCTION WORK(ARCHITECTURAL, MECHANICAL,
IECTRICAL, ETC.( SHALL MEET OR EXCEED THE LATEST EDITION OF
CODES
ADOPTED BY THE LOCAL GOVERNING AGENCIES, THESE
SHALL INCLUDE:
3 CALIFORNIA BUILDING CODE (201 IBC)
2D13 CALIFORNIA RESIDENTIAL CODE -TIiL E2d(2U121RC)
2S13 CALIFORNIA FIRE CODE (201 IFC)
2S13 CALIFORNIA MECHANICAL CODE (2012 UMC)
2S13 CALIFORNIA PLUMBING CODE (2012 UPC)
2S13 CALIFORNIA ELECTRIC CODE (2011 NEC)
3 ENERGY EFFICIENCY STANDARD (TITLE 2d)
BEEN BUILDING CODE (TITLE 2d)
AND ALL OTHER ORDINANCES ADOPTED BY THE GOVERNING
AGENCIES.
1,11 E GENERAL CONTRACTOR SHALL MAINTAIN A CURRENT
AND COMPLETE SET OF CONSTRUCTION DOCUMENis ON THE JOB
SITE DURING ALL PHASES OF CONSTRUCTION FOR THE USE. OF ALL
TRADES AND SHALL PROVIDE ALL SUBCONTRACTORS WITH CURRENT
CONSTRUCTION DOCUMENTS As REQUIRED.
1.D6 GENERAL CONTRACTOR TO VERIFY ALL MEASUREMENTS
SHOWN ON THESE DRAWINGS PRIOR To COMMENCING ANY
WORK OR ORDERING ANY MATERIAL.
DO NOT SCALE THE DRAWINGS, DIMENSIONS SHOWN
SHALL SUPERCEDE SCALE OF DRAWINGS. ANY DISCREPENCY IN
DIMENSIONS OR CONFECT IN PIANS OR FIELD CONDITIONS SHALL
BETO HE ATTENi ON OF THE ARCHITECT PRIOR TO
CONiONUANCEE OF THEWORKN THE AFFECTED AREA, IF WORK S
CONTINUED IN THE AFFECTED AREA WITHOUT INSTRUCTION OR
CLARIFICATION BY NIELSEN ARCHITECTS, THE CONTRACTOR SHALL BE
SOLELY E
POIN LE FOR ANY RESULTANT DEFECT, DAMAGE OR
CHANGE REQUIRE D.
lull AT JOB COMPLETION, PRIOR TO SUBMITTING THE
REQUISITION
FOR I NALPAYMENE THE GENERAL CONTRACTOR
SHALLPROVIDE THE OWNER W HH A REDLINED SET OF BLUEPRINTS
SHOWING AS BUILT CONDITIONS.
1.9GENERAL CONTRACTORTO PROVIDE PROPER CONTAINERS
ON THE JOB SITE TO ASSURE CONTINUOUS RECYCLING OF
MATERIALS.
1L D GENERAL CONTRACTOR Is RESPONSIBLE FOR NOTIFYING
SURCO
AND ASSURING THEIR COMPLIANCE WITH
RECYCLING PRO GRAM,
1.11
NLA
ERC LABELS MUST REMAIN ATTACHED TO THE GZING
UNTIL AFTER INSULATION INSPECTION Is COMPLETED.
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ABBREVIATIONS
KING
CONC.
ROM
CONCRETE
CONT.
CONTINUOUS
DIAFI
DWCS
(E)EXISTING
EA.
DIAMETER
DRAWINGS
CH
EACH
FDTN
END NAIL
ERIO
ECunIEATON
FEET OR FOOT
PBD
NH
GpBD
INT.
INTERIOR
MAX.
LONG
MA%IMUM
MIN.
MINIMUM
(N)
NEW
OVER
C
REE
SC LED
ON CENTER
TREATED
RE
SC H=
s.F
IQ
T.
TD
QUARE FEET
STANDARD
QUARE
Top ROM
TO BE DETERMINED
CAL
N
LNG
UNLESS NOTED OTHERWISE
VERT.
VIF
VERTICAL
VERT%IN HELD
W/
WITH
PROJECT DATA
APN: Bond D19
ZONING DISTRICT: P(OP) PLANNED OFFICE
CONSTRUCTION TYPE: VR NON SPRINKLERED
PROJECT DESCRIPTION
INTERIOR DEMOLITION OF PARTITIONS, PLUMBING FIXTURES, DOORS,
AND DROPPED CEILING,
GENERAL NOTES
1'1THEISSUANCE OF A BUILDING PERMIT SHALL NOT BE
CONSTRUED AS A GUARANTEE THAT ALL CODE REQUIREMENTS ARE
REFLECTED IN THE DOCUMENTS. i GENERAL CONTRACTOR FOR
THE PROLECTSHALL BE ULTIMATELY RESPONSIBLE FOR INSURING THAT
E FINISHED PRODUCT COMPLIES WITH ALL REGULATIONS, LAWS
AND CODE REQUIREMENTS.
1.D2 THESEPUN
S ARE FOR THE GENERAL CONTRUCfION
UpoS ONLY, THEY ARE NOT EXHAUSTIVELY DETAILED NOR FULLY
THESPONSIRILITY OF THE CONTRACTOR TO
SPECIFIED, ERIFY, RESOLVE AND INSTALL ALL MATERIALS AND
EQUIPMENT.
RE WILL BE NO OBSERVATION RYAN ARCHITECT DURING
CONSTRUCTION,THE CONTRACTOR IS SOLELY RESPONSIBLE FOR THE
QUAUTY CONTROL AND CONSTRUCTION STANDARDS FOR THE
l.Dd ALL CONSTRUCTION WORK(ARCHITECTURAL, MECHANICAL,
IECTRICAL, ETC.( SHALL MEET OR EXCEED THE LATEST EDITION OF
CODES
ADOPTED BY THE LOCAL GOVERNING AGENCIES, THESE
SHALL INCLUDE:
3 CALIFORNIA BUILDING CODE (201 IBC)
2D13 CALIFORNIA RESIDENTIAL CODE -TIiL E2d(2U121RC)
2S13 CALIFORNIA FIRE CODE (201 IFC)
2S13 CALIFORNIA MECHANICAL CODE (2012 UMC)
2S13 CALIFORNIA PLUMBING CODE (2012 UPC)
2S13 CALIFORNIA ELECTRIC CODE (2011 NEC)
3 ENERGY EFFICIENCY STANDARD (TITLE 2d)
BEEN BUILDING CODE (TITLE 2d)
AND ALL OTHER ORDINANCES ADOPTED BY THE GOVERNING
AGENCIES.
1,11 E GENERAL CONTRACTOR SHALL MAINTAIN A CURRENT
AND COMPLETE SET OF CONSTRUCTION DOCUMENis ON THE JOB
SITE DURING ALL PHASES OF CONSTRUCTION FOR THE USE. OF ALL
TRADES AND SHALL PROVIDE ALL SUBCONTRACTORS WITH CURRENT
CONSTRUCTION DOCUMENTS As REQUIRED.
1.D6 GENERAL CONTRACTOR TO VERIFY ALL MEASUREMENTS
SHOWN ON THESE DRAWINGS PRIOR To COMMENCING ANY
WORK OR ORDERING ANY MATERIAL.
DO NOT SCALE THE DRAWINGS, DIMENSIONS SHOWN
SHALL SUPERCEDE SCALE OF DRAWINGS. ANY DISCREPENCY IN
DIMENSIONS OR CONFECT IN PIANS OR FIELD CONDITIONS SHALL
BETO HE ATTENi ON OF THE ARCHITECT PRIOR TO
CONiONUANCEE OF THEWORKN THE AFFECTED AREA, IF WORK S
CONTINUED IN THE AFFECTED AREA WITHOUT INSTRUCTION OR
CLARIFICATION BY NIELSEN ARCHITECTS, THE CONTRACTOR SHALL BE
SOLELY E
POIN LE FOR ANY RESULTANT DEFECT, DAMAGE OR
CHANGE REQUIRE D.
lull AT JOB COMPLETION, PRIOR TO SUBMITTING THE
REQUISITION
FOR I NALPAYMENE THE GENERAL CONTRACTOR
SHALLPROVIDE THE OWNER W HH A REDLINED SET OF BLUEPRINTS
SHOWING AS BUILT CONDITIONS.
1.9GENERAL CONTRACTORTO PROVIDE PROPER CONTAINERS
ON THE JOB SITE TO ASSURE CONTINUOUS RECYCLING OF
MATERIALS.
1L D GENERAL CONTRACTOR Is RESPONSIBLE FOR NOTIFYING
SURCO
AND ASSURING THEIR COMPLIANCE WITH
RECYCLING PRO GRAM,
1.11
NLA
ERC LABELS MUST REMAIN ATTACHED TO THE GZING
UNTIL AFTER INSULATION INSPECTION Is COMPLETED.
Q
Z
Z
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EXISITING AND DEMOLITION PLAN
CUPERTINO
a.Blm.o D.R.bN.m
DBv�a ola HomDANCE
NB WEPRR IN TH IS AREA
IF DUTIES NEPTES:
I. REMEPVE ALL LRYWALL FREPM CEILING
LEI ELECT PANEL
I I
2 REMEPVE FNDR FINISH NEWS TEP SEPLFLEPR
TEP REMAIN
�I
L- e y
LEI PLUMBING FIttEPRES
I �,II
T
TEP RE SERGI TYP.
I�
�� II II ��ii ILIJI 4 T
II
II �
T
LENTAL LEI SERGE SPACE
TEP RE LEMEPLSHEL
/ \LL,,
-------�J
I�
__�,
LEI INTERN LEPERS
TEP RE SERGI TYP.
WALL LEGEND
_ (E) WALLS TO B E REMOVED
(E) WALLS TO REMAIN
11
EXISITING AND DEMOLITION PLAN
CUPERTINO
a.Blm.o D.R.bN.m
DBv�a ola HomDANCE