15110098CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20085 STEVENS CREEK BLVD CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 15110098
OWNER'S NAME:;'; J & D..CUPERTINO LLC
OWNEWS PHONE:' 4083718770
❑ .. .�.!'. LICENSED CONTRACTOI
L,cerise''Class 1 i d Lic. # �� 0111
v
Contractor:' Date 11 (S
I hereby Afirm that I am lieensed under the provisions of Chapter 9
(commencing with'Section 7000) of Division 3 of the Business &Professions
Code and jtn#,t :imy lcense i is.iu full force and effect.
I hereby, affirm under peiII 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
perfarrnance,of;the work;foriyhich this permit is issued.
i IiI andmill 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,;i.
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 perrititi Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.'
Signatur. ` Date i I g�
❑ OWNER- BUILDER DECLARATION
1 hereby affirm thatFI am exempt from the Contractor's License Law for one of
the following two reasons: "1' '
1, as owner of the pro'perfy',,or °my employees with wages as their sole compensation,
iur
will do lh'e work, and'the strd le is not intended or offered for sale (Sec.7044,
Business &Professions Code)! i,
1, as owner of the propertyy', gin exclusively contracting with licensed contractors to
construct the pr6ject(Sec.7044, Business & Professions Code).
I hereby affir '.under eialty'of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self - insure for Worker's
Compensation; as'proyided for by Section 3700 of the Labor Code, for the
performance of the work for „which this permit is issued.
I have andlwill 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.- I,,;,;,,,.
I certify that in the performance of the work for which this permit is issued, I shall
not emplo ,any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia.t 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.
PLICANTCERTIFICATION
I certify; that,I haveread 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 pioperty for inspection purposes. (We) agree to save
indemnify'and keep harrriless the City of Cupertino against liabilities, judgments,
costs, and, expenses which may 'accrue against said City inconsequence 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 r Date
1460 O'BRIEN DR 1 DATE ISSUED: 11/16/2015
MENLO PARK, CA 94025 1 PHONE NO: (650)701 -1500
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
APPLE TENANT IMPROVEMENT ON SECOND FLOOR (950
SQ
FT).
Sq. Ft Floor Area: I Valuation: $250000
APN Number: 31623025.00 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: �!�/ LiP!°i Date: 11-16-1-S
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
1 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.
Owner or authorized agent: Daterll! 11
CtanS�u Chomp
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 Ad
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profess
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20085 SCB DATE: 11/16/2015 REVIEWED BY: Sean
APN: BP #: *VALUATION: $250,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION
USE: PERMIT TYPE:
WORK Apple tenant improvement on second floor 950 sq ft).
SCOPE
1 B 1-I
OCCUPANCY TYPE: TYPE OF FLR AREA I PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II- B,111- B,IV,V -B 950 1 $2,133.82 1BTIPLNCK 1 $1,066.52 1BTIINSP
I TOTALS: 950 I $2,133.82 $1,06652 52 ! E I
h ��..TLi 9-
NOTE. This estimate does not include fees due to other Departments (i.e. PlanninQ, Public Works, Fire, Sanitary Sewer District, School
utstrtct, etc.). I nese fees are basea on the preliminary information avatlaote ana are only an estimate. contact the Uept for aaan't info.
FEE ITEMS (Fee Resohition 11 -053 & 7/1/13)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$2,133.82
Select a Misc Bldg /Structure
or Element of a Building
• Re OT
Suppl. PC Fee: g. �
0,0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,066.52
Suppl. Insp. Fee: Reg. OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C'ansf"'Ucl'on Tax:
Work Without Permit? Yes No
$0.00
Advanced Plannin Fee:
$0.00
Select a Non - Residential
Building or Structure
i
arr, -e/ I:r)c;t�atra��tr�ttofl I x ,s:
Stron' Motion Fee: 1BSEISMICO
$70.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$10.00
�, SUBTOTALS;`
, ..
$3,280.34
$0.00 TOTALFiEE
. �
3 280. 4
,
Revised: 10101/2015