15060002CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
16 RESULTS WAY
CONTRACTOR: NOVO CONSTRUCTION
PERMIT NO: 15060002
OWNER'S NAME: OVK PERIMETER SQUARE RETAIL LLC ET
1460 O'BRIEN DR
DATE ISSUED: 07/30/2015
OWNER'S PHONE:: 6507841440
MENLO PARK, CA 94025
PHONE NO: (650)701-1500
LICgNSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
Z
APPLE - 2ND FLR - NON STRUCTURAL - RECONFIGURE &
License Class_ Lie. # DZ
REMODEL 9650 S.F. OFFICE SPACE
Contractor N (71i Gi GUv�Sk�u t.�1 Date
I hereby affirm that 1 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:
I have and will maintij'in 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: $700000
performance of the work for which this permit is issued.
have and will maint4in 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.
APN Number: 35720041.16
Occupancy Type:
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 cornply with all city and county ordinances and state laws relating
WITHIN=DgPPERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enterupon
the above mentioned property for inspection purposes. (We) agree to save
180 DACALLED INSPECT ON.
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
sue Date: !)
with all non-point so ce regulations per the Cupertino Municipal Code, Section
9.18.
RE-ROOFS:
Signature Date 3 1
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-BU ER 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: iHealth
& 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, Sectionj 2,ffo5, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
?
Owner or authorized agent: Date:
permit is issued.
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
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
CUPERT[NO
❑ NEW C014STRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228• FAX (408) 777-3333 • buildingQcupertino.org l
❑ ADDITION ,ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROIECf ADDRESS 1 Iles FSS Cv 7
APN f! si-- 7O I
U W ( LYj ,rI v
mu
OWNER NAME P1� Inc. PH0NE
5('
M
E-AIL�� U2M0.Y Q ie • LD n
STREET ADDRESSCITY
2 j v, _� i k Let
STATE, ZIP FAX
�v e-fin0, Cq C, C) lLJ
CONTACT NAME r lQ Q
�-(�i ►'1'C�s
PHONE E-MAIL
(oSo -3 � v "43 toZ`i c�;e►-ro� r�u�pcc�✓,S-t+�Ucti-nvl.
STREET ADDRESS
�`itvD
CITY, STATE, ZIP
CITY, Mevllo PUra�, C�4.GIt-{U2
FAX
❑ OWNER ❑ 1OWNER-BUILDER ❑ O'AWERAGEN-r >QONTRACTOR ❑ CON'TRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
La�-t F=ie%:Us Gw ConShv , -�1 IL) -2_
3
COMPANY NAME
NOS D cr�,nsi��fii or I
E-MAIL
�f' leer o� ho�Oc.�rrir�xfi� •
FAX
STREET ADDRESS
II-l�b 'f3�►� pr.
CITY, STATE, ZIP
Menlo Fear'!` CA 9Lf0 2S
PHONE
So-3eL, b2-4
ARCHITECT/ENGNEFRNAME LICENSE NUMBER
BUS, LIC k
COMPANY NAME -1. '
�IVL�IOS �YC}-�� �L�rE
E-MAIL
S �G�iQ ca) S"�VC��O S• wrT�l
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
o ar 0,+e, y8�d
aVA L-rarncisc0 CA 941 CS
�ilS— � 32- 53bS
DESCRIPTION OF WORK
SC one- p ove 0-\It-cn-4 i -t> lr\ C, r— Y2VnCvJo i00 11lC J CA i IIew
inter��• �UvtifiionS doors .x-�,,,� �i 1 -,`inn niSl�l�s UI -,c1 ire �i�r- I�r, vvvcmen
l� O�Cri Ce GIVER �� ��D+ WOr LC.� 'jl'QC 1-ErrlWal, Gr- ILfr� GG lS SU�if1�1�ILUW ��,5 I
EXISTING USE
PROPOSED USE CONSTR
TYPE
4 STORIES
vp
.D
r_)_
USE
TYPE JCC.
SQ.FT.
VALUATION (S)
EJGSTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA����U�
Q _
BATHROOM
KITCHEN
OTHER
REMODEL AREA
TREMODFL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKiPORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
k DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEING ADDED' E] NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PRO\'IDE COPY OF
PLANKENG APPL 9 ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME:' ❑ NO
C IVED.BY - -.
TOTAL VALUATION:
j C oO O . D
By my signature below, I certify to each of the following: I am the property owner or author ed agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work 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 property for inspection purposes,
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
-"
PL HCHECKT_TER ,
ItOIiTII�G_SLIP,
Y 5 °
❑ BTJIIDINGPLANREVIEi
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
for building.
OVER THECOUIvTER
eF
-
❑
permit new
ExPRFCg h �F�c
P.IaIQ1\LTSGp0 NREViEW ,
a�
Y� F nf– ^Y
x.�
1 'i .y-tea'–�3�"`
❑""—
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
CQ sTariDnRD
ti
.�PUBIav,oRxs
form if any Hazardous Materials are being used as part of this project.
z L 4RG$ s❑
FIRL DE>'T g x
NMI
_ Copy of Planning Approval Letter or Meeting with Planning prior to
Ll MAatix��,�
8 vTrARYSEwER Is RIez
submittal of Building Permit application.
� � �
z
�`•,-•",
—r- _
r �::�N��ss
"*,_- '':, -�-.
.-❑tEAT'VITtOh'MENTAI_FIEALTAL'" -
BldgApp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
119
ADDRESS: 16 RESULTS WAY
DATE: 06/01/2015
REVIEWED BY: PAUL
PC FEE ID
APN: 357 20 041
BP#:
*VALUATION: 1$700,000
FPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1BTIPLNCK
PENTAMATION 1B TI
PERMIT TYPE:
WORK
APPLE - 2ND FLR - NON STRUCTURAL - RECONFIGURE & REMODEL 9650 S.F. OFFICE SPACE
SCOPE
PME Plan Check:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,111-B,IV,V-B
9,650
$2,686.54
1BTIPLNCK
$6,454.95
IBTIINSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$6,454.95
Suppl. Insp. Feee. Reg.
0 OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
9,650
$2,686.54
$0.00
$6,454.95
MECH, H , RLY 0 Yes 0 No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes 0 No
jvu,tr inns esumare goes not incruae fees aue to orner ueparrmenrs (i.e. rrannrng, ruouc trouts, rrre, aunuary newer Ursrrrcr, moor
n;ct►irt ote 1 Thoco fooc ara hacod nn tho nroliminanv infnrmatian availah/o and aro nnly an octimato_ rnntart thv Dont far addn'I info_
FEE ITEMS (Fee Resolution 11-053 Eff 7/1,73)
FEE
QTY/FEE
MISC ITEMS
Plan Check fee:
$2,686.54
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fie: Q Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$6,454.95
Suppl. Insp. Feee. Reg.
0 OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning? Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Strong Motion Fee:
IBSEISMICO
$196.00
Select an Administrative /tern
Bldg Stds Commission Fee: 1BCBSC
$28.00
SUBTOTALS:
$9,365.49
$0.00
TOTAL FEE:
1 $9,365.49
Revised: 05/07/2015
Building Department
Cite Uf Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-31<K
Fax: 408- 77-> 33
JOB ADPt7RrSS-, 1PERS 11ti
VHQNF
GENERAL CONTRACTOR: , yo ���� C.'c�c� E B' �STNFSS l JCFNSF = ®_
ADDRESS: 14(.0 6tA" X2._ (t'li4' Zli'CODE:t Pty
*Our municipal code requires all businesses working in the cit-
y to have a Citi of Cupertino business license,
NO BUII DING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND A.L.I., SUBCO T1L-kCTORS HAVE OBTAINED A CITY Of C.UPERTI O
BUSINESS LICENSE.
I am not using any subcontractors: -------
Signature Date
Please deck applicable subcontractors and complete the following information:
✓ ' SVBCONTRACTOR
( BUSINESS NAME
i BUSINESS LICENSE
Cabinets & Millwork
Cement Finishing
Eliectrical
t
p Euavatlon
s Fencing
j Flooring/ Carpeting
_
i
Li'
oleum ./ Food
Glass/ Glazing
Heating
l
f
lnWlation
Landscaping
Lathing
M sonry
Painting r' Wallpaper
� E
Paving
Plastering
Pl.trnbing
# Roofing
Septic Tank
Sheet Metal
L
Sheet Rock
Tile
Ps 2=1ej 14,._
-' Owner i Contractor Signature Date