15110112V
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10250 BANDLEY AVE
CONTRACTOR: NOVO CONSTRUCTION
PERMIT NO: 15110112
OWNER'S NAME: CAMPUS HOLDINGS INC
1460 O'BRIEN DR
DATE ISSUED: 11/17/2015
OWNER'S PHONE: 4155950430
MENLO PARK, CA 94025
PHONE NO: (650)701-1500
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMOVE THE (2) ENTRY GATES WITH CARD READERS
License Class Lie.# Z
AND
RELOCATE CARD READERS TO EXTERIOR DOORS.
Contractor N+� e Co N S cT ► N t ►1eDate ti ti'
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.
1 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: $1; i n n i
of the work for which this permit is issued.
.Performance
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: 32634069.00
Occupancy 7 N pc:
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
Issued by: Date:
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granting of this perm' Additionally, a applicant understands and will comply
with all non-poin ce regulatio pe the Cupertino Municipal Code, Section
RE -ROOFS:
9.18. !
t
Signature Date I 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 1 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)
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 read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
1 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 Muni . al Code, Chapter 9.12 and
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
the Health & Safety Code, Sections 05, 25533 d 25534.
permit is issued.
Owner or authorized agent: Date:l
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, 1
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
CONSTRUCTION PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014.3255 / O
CUPERTINO
(408) 777-3228 - FAX (408) 777-3333 - buildingP_cupertino.orq
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NEW CONSTRUCTION El ADDITION A1. Il'RATION / TI REVISION/ DEFERRED ORIGINAL PERMIT #
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❑ OWNER ❑ OWNER•BUILDFR ❑ OWNERAGENT pPC'ONT'RAcTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ FNGINFGR ❑ DFVFLOPFR ❑ TENANT
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HITEC /ENOINEE NANIF
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COMPANY NAEMAIL
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DESCRIPTION OF WORK
"MOVE s cA 9,n 2,UArQ
,i1I ING USE
PROPOS D( SF -OA.SI
It 1) Ili
N STORIF.s
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
FXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREAA C II
I
ATTACH
DWELLING UNITS'
IS A SECOND UNIT YES
SECOND STORY 'YES
BEING ADDED? ❑NO
ADDITION? ❑NO
I'KL-APPLICATION BYES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RF:CF.I ' ') BY:
l'AI VALUATION.
PLANNING APPL q NO PLANNING APPROVAL LETTER
EICHLER HOME? [3 NO
Tio's,000_ o0
By my signature below, l certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have pro v' ed is correct. I hav d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil construction. 1 ai I lze representatives of Cupertino to enter the above -intif d property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLANCHECKTVPE
ROUTING SLIP
OVER -THE COUNTER
���7rrr
BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardou� Materials Disclosure
El STANDARD
❑ PUBLIC WORKS
To—nn if any Hazardous Materials are being used as part of this project.
❑
LARGE
T FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_201 Ldoc revised 06121, 11
C r�1
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
10250 Bandley Ave
DATE: 11/17/2015
REVIEWED BY: Sean
MISC ITEMS
APN:
BP#:
`VALUATION: 1$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? E
Yes No
PENTAMATION
1GENCOM
PERMIT TYPE:
WORK
Remove the 2 entry gates with card readers and relocate card readers to exterior doors.
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are hated on the nreliminary infnrmatinn availahle and are nnly an e.ctimata rnntart tho Dont fnr addn'1 infra
FEE ITEMS (Fee Resolution 11-0.53 a.-7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes No
$0.00
2 hours Plan Check, Hourly
$286.00 ISTPLNCK
Suppl. PC Fee: Reg. OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes (F) No
$0.00
Suppl. Insp. Feer Reg. 0 OT0
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
Work Without Permit? Yes No
$0.00
Advanced Planning Fee:
$0.00
hours Inspections
$286.00 ISTINSP Inspection, Hourly
0
'frol£'/
Strong Motion Fee: IBSEISMICO
$4.20
Select an Administrative Item
Bldg; Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS':''
$5.20
$572.00
TOTAL FEE:
$577.20
Revised: 10/01/2015