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15020025CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20400 MARIAN AVE CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 15020025 OWNER'S NAME: MISSION WEST PROPERTIES 1460 O'BRIEN DR DATE ISSUED: 02/05/2015 OWNER'S PHONE: 4088628230 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ RR APPLE- PROVIDE POWER, TELE/DATA AND AV BOXES IN License Class IIS Lic. # % �i d �� (2) CONFERENCE ROOMS yy Contractor ril OV C; (cJn�Vt a cLi c. 7 Date�� e/�5 1 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: $10000 performance of the work for which this permit is issued. 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 APN Number: 31622018.00 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 F RMIT 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 FL T 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: 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. RE -ROOFS: Signature/ Date AI I 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 read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will 1 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 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, A permit is issued. Owner or authorized agent: Date: I certify that in the performance of the work for which this permit is issued, l 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. 1 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 CITY OF CUPERTINO F,M--7 FEE ESTIMATOR — BUILDING DIVISION 1AADDRESS: 20400 Marian! ave QTY/FEE DATE: 02/05/2015 REVIEWED BY: Mendez BP FEES APN: BP#: �� 'VALUATION: 1$10,000 %PERMIT TYPE: Electrical Permit 2 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: PENTAMATION 10EAP1 PERMIT TYPE: WORK apple- provide power, tele/data and av boxes in 2 conference rooms SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Appliances 1ECOMAPP Other Elea Insp.0.0 hrs $48.00 2 # $96 PME Unit Fee: $96.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? C) Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $96.00 Strong Motion Fee: 1BSEISMICO NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etr.)_ These fees are hosed on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf 7/1/13) FEE QTY/FEE Elec. Plan Check 0.0 hrs $0.00 _ Elec. Permit Fee: IEPERMIT Other Elea Insp.0.0 hrs $48.00 PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etr.)_ These fees are hosed on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf 7/1/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $96.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? C) Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICO $2.80 Select an Administrative Item 7 Bldg Stds Commission Fee: IBCBSC $1.001 SUBTOTALS: $240.801 $0.00 TOTAL FEE.T $240.80 Revised: 01/06/2015 CUPERTINO GENERAL PERMIT APPLICATION 5/ �� MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ( 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 misc (408) 777-3228 • FAX (408) 777-3333 • building(5cupertino.org ❑ PLUMBING ❑ MECHANICAL WELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS 2_0 ' 1W/,n`I V APN # �J ( G . /[1/� Iln 2 V OWNERNAME PH24 6E• 1O2 � E-MAIL STREET ADDRESS b, ,,Y,,,, I, 1/t CITY, STATE,Zn , FAX CONTACT NAME ; 1.� I O { (J� PHONE a r\ f ) �r�' E-MAIL STREET ADDRESS T.Cv CITY, STATE, ZIP , C.�, L( FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER TENANT CONTRALTOrAME h LICENSENUMBER Z2- LICENSE TYPE i2 BUS LIC# g 1 COMPANY NAME �vVUU n CCS('t'° E-MAIL 1 I.I,rt-"L (10JGi005'Irj.GCAon'LC!`7 FAX STREET AD ESS a 1 �, �;� v �. CITY STATE, ZI " `f d Z� PHONE - CG 71 v 1 — ISDN ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD., DUPLEX ❑ MULTI -FAMILY BUILDING JaCOMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ® NO PROJECT IN ❑ YES FLOOD ZONE NO IS THE BLDG AN ❑ YES EICHLER HOMES NO DESCRIPTION OF WORK Nv��'ff \/ ebK s TOTAL VALUATION $ 1o/ 06267 RECEIVED BY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr per wner's behalf. I have r d this application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate ag _ wl a applicable local ordinances and state laws relating to building construction.II authorize representatives of Cupertino to enter the abov Identified property for inspection purposes. Signature of Applicant/Agent: %- Date: SUPPLEMENTAL INFORMATION REQUIRED OFFtWeS. ONLY w Er OVER-THE-COUNTER E' U ❑ EXPRESS ❑ STANDARD U J❑ LARGE a. ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 M1i