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15090061CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10100 N TANTAU AVE e CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 15090061 I OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC 11460 O'BRIEN DR I DATE ISSUED: 09/10/2015 1 OWNER'S PHONE: 4088624397 0— LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # 71162-2 Contractor //el/b CO&5l"f2yCno ✓ Date D /S" 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. 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. 2. 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. 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 relates 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, G 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 th Cupertino Municipal Code, Section 9.18. Signature Date ro%S ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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. 2. 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 permit is issued. s. 1 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, 1 must 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. Date MENLO PARK, CA 94025 PHONE NO: (650)701-1500 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ APPLE - T. I., 2ND FLR - RECONFIGUREIREMODEL (E) AREA (3,143 S.F.) Sq. Ft Floor Area: Valuation: $68000 APN Number: 3I619061.10100 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR �LLED INSPECTION. Date: 11 O 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 Appl Date: 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, 25533, and 25534. Owner or authorized % Date: CONSTRUCTION LENDING AGENCY 1 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(c cupertino orq / 00,6 I ( / 7 NFW (OMNIS"'RI JCTION 7 AF)DITICIN 71 AI EFRATICIN;'I'I M RFVIQI0N i IIPRFRRI-'1) 01ZI(7INAI 4�PR MITN PROIECF ADDRESS 10100 N Tantau J.d���� APN i.' A PHONu le, Inc. "'d cog NIAII . OWNER NAME Apple,Z'ALA.Y35�-- efb�,r��✓v✓oc�MsT STRFF.I'.ADDRFSS I Infinite Loop CITY, STA I Fi, ZIP Cupertino, CA FAX CONTACT NAME Anh Vu TNF q0 - 7 L NIAILA1YhV� 62-1-(3g .co STRFt`IADDRIBS 1 Infinite Loop CIT'. STATE, 41P Cupertino CrA IAN ❑ OWNER ❑ OWNER -D(1:11 DIR ❑ OWNFRAGENT ❑ CONTRACTOR ❑CONIRACTORAGENI' ❑ ARCHI'l-ECI❑ ENGINEER ❑ DEVI LOr�Priz 13 TENAN"r CONTRACTOR NAME LIC'FNSF NIiNBf:R 791 022 LICIiNSF'FYPF B H"S LIC' ' 23891 CONIPANY NAME Novo Construction Rhorn@novoconstrljction.com FAX STREE'FADDRESS 1460 O'Brien Drive CIIY_STATE,ZIP Menlo Park, CA III ION p '650-705-1617 ARCHITEC,7F.NGINFF.R NANIE Ken Hayes LICENSE NUMBER C-15562 BtiS LIC H C'OMPANYNAME Hayes Group E-MAIL Asumanth gthehayesgroup.coni 1A1 STREET ADDRESS 2657 Spring Street CITY,STA - A1E.''ZI`' Redwood City, CA 11HONF" DESCRIPTION OF WORK Removal of existing cubical. Installation of new bench style work stations. If Gv' F 2 FL EXISTING USE PROPOSED USE CONSTR TYPE I STORIES 3V 5 USE TYPO OCC, I S(Z,FT. VALUATION ($) FXISTG AREA NFW FLUOR AREAAREA DENIO TOTAL NETARPA3(y3 BATHROOM KITCHEN OTHER REMODL'L AREA REMODEI. AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE. AREA DE"TACH ATTACH N DWELLING UNITS- IS A SECONDIINI'r YF.S SECOND STORY ES BEING ADDED? [3 NO ADDITION? [3NO PRE -APPLICATION ❑ YES IF YES. PROVIDE COPY OF IS THE BLDG AN TOTAL VALUATION - PLANNING APPI.. c E3 NO PL:INNING APPROVAL LETTER F.ICHLER HOME? ONO S�ocLo , m� By my signature below, I certify to each of the following: t am the property owner or authoriz agen act on the pro ty owner's behalf- 10 ve read this application and the information I have provided is correct. I have read the Description of Work an F. I agree to comply with all applicable local ordinances and state laws relating to building construction. 1-p0horize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ 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 Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dg1lpp-2011.doc revised 062L 11 I.CC14f CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION baADDRESS: 10100 N TANTAU AVE DATE: 09/10/2015 REVIEWED BY: MELISSA PC FEE ID l APN: BP#: *'VALUATION: 1$68,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 1BTIPLNCK PENTAMATION 113 TI PERMIT TYPE: WORK APPLE - T.I. 2ND FLR - RECONFIGUREIREMODEL E AREA (3,143 S.F. SCOPE Suppl. Insp. Fee:Q Reg. Q OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 3,143 $2,384.24 1BTIPLNCK $2,776.96 1BTIINSP Permit Fee: $2,776.96 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C oasirt"'l iov 1OX" �,lilliylisla`CrffI'C 0 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: 3,143 $2,384.24 $2,776.96 Strong Motion Fee: IBSEISMICO MECH, H(RL' ®YesNo PLUMB, HOURLY Q Yes Q No ELEC, HOURLY' Yes i Na.. I'lall C i,e: k . q1" (W,("r i� Li I NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt. ote )_ Theco fooc oro hacod nn tho nroliminary infnrmatinn availahle and ore anly an estimate_ Camaet the Aent far addn'l info_ FEE ITEMS (Fee Resolution 11-053 Elf' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,384.24 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,776.96 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C oasirt"'l iov 1OX" �,lilliylisla`CrffI'C 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced. Planning Fee: $0.00 Select a Non -Residential Building or Structure � Strong Motion Fee: IBSEISMICO $19.04 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $3.00 SUBTOTALS: F$5,183.24 $0.00 TOTALFE $5,183.24 Revised: 07/02/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ICI GAG�,% PERMIT #a ` a G 1 OWNER'S NAME: (u ,- ;ho AJw.�'fLLC PHONE # Af0 g -86Z-479? GENERAL CONTRA TOR: 4/p✓J Cray 4t a BUSINESS LICENSE # ADDRESS: 14 6 G' rr CITY/ZIPCODE: YOZ S *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL, OR FINAL, OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 4 61 /b r / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical r "" E` e -c } - i L Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper /t/� tX rl a w► lam►' �/a� Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Gw n eeVed ,�r+-e ►�► S �p� Sheet Rock Tile 4 61 /b r / Contractor Signature Date