141101420
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD
CONTRACTOR: DEVCON
PERMIT NO: 141 10142
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC
690 GIBRALTAR DR
DATE ISSUED: 11/25/2014
OWNER'S PHONE: 6502084081
MILPITAS, CA 95035
PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
G� I
License Class Lic.tl� l l
COMM. T.I ADD WALL IN PREPARATION FOR NEW
PREFAB
�O A I
Contractor Dat6 1�' �./ ' ��
CHAMBERS
_
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 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: $210000
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: 35720020.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EV SAF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITH 180 DAYS _F PiRMIT 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 DALY�,,:.FROM LAST -CALLED INSPECTION.
ndemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
%r.
ev
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per e C rtino Municipal Code, Section
y
9.18.
RE -ROOFS:
Signature ate
All roofs shall be inspected prior to any rooting 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
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. 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
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 1
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 25 25533, a 2_ 4.
Section 3700 of the Labor Code, for the performance of the work for which this
-
Owner or authorized ager 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 1 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD
CONTRACTOR: DEVCON
PERMIT NO: 14110142
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC
690 GIBRALTAR DR
DATE ISSUED: 11/25,12014
OWNER'S PHONE: 6502084081
MILPITAS, CA 95035
PHONE NO: (408)942-8200
j LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 0
�g 1 �0
COMM. T.I ADD WALL IN PREPARATION FOR NEW
License Class Lic. # 519
PREFAB CHAMBERS
Contractor te
�eIrn� :W(Cb i2 1 �(6 a,
DEF # 1 - DETAILS/SPECS FOR RF CHAMBERS 12/18/14
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 Bill force and effect.
I 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: $210000
performance of the work for which this permit is issued.
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: 35720020.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that t 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 ERMIT 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 +?c6i LAST CALLED INSPECTION.
indemnify Cupertino judgments,
:µ W.._..
.t�e..:.
nr nswhich mayagainst dconsequence of
granof [hsPermit. Additionally the applicant understands willcomply
� d� a
with all no omt source regulati p the Cupertino Municipal Code, Section
9.18.
Imo} p,
RE -ROOFS:
Signatu a ate L V
l
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:
1 hereby affirm that l 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)
I, 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
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 w ' he Cupertino nicipal 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 Sept ns 25505a2tnid,275534.
Owuer or authorized ag ut: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, 1
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
1 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 1 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
ARCHITECT'S DECLARATION
indemnify, and keep harmless the City of Cupertino against liabilities, judgments,
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 BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD
CONTRACTOR: DEVCON
PERMIT NO: 14110142
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC
690 GIBRALTAR DR
DATE ISSUED: 11/25/2014
OWNER'S PHONE: 6502084081
MILPITAS, CA 95035
PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL E]
License Class Lic. #�y�7�
COMM. T.1 ADD WALL IN PREPARATION FOR NEW
PREFAB
�yl� 2— `IIEE�
CHAMBERS
Contractor 1/�YL��7ite
REV # 2 RECONFIGURE SIZE OF CHAMBER & REMOVE
I hereby affirm that I am licensed under the provisions of Chapter 9
ACOUSTICAL CEILING - ISSUED 2/2/15
(commenting 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 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: $210000
erformance of the work for which this permit is issued.
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: 35720020.00
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 DAYS IT 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
I AYS F 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
granting of this permit. Additionally, the applicant understands and will comply
Date: /
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date !/ i
All roofs shall b ' pA�pnorany 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:
1 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
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)
I, 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(x) 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 Munici I de, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, cti ns 255, 25533 a 53 .
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dater
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, l
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, l 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD
CONTRACTOR: DEVCON
PERMIT NO: 14110142
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC
690 GIBRALTAR DR
DATE ISSUED: 11/25/2014
OWNER'S PHONE: 6502084081
MILPITAS, CA 95035
PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
I �n
COMM. T.I ADD WALL IN PREPARATION FOR NEW
License Class Lic. # I�1
PREFAB CHAMBERS
0G -
REVISION #1: ADD LAB SINK WITH ASSOCIATED
Contracto l Y ate
AUY� IbIJY l�
REVISION #1: ADD LAB SINK WITH ASSOCIATED PLUMBING. - ISSUED
I hereby affirm that I am licensed under the provisions of Chapter 9
2/2/15
(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 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: $210000
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: 35720020.00
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. T 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: } W' '7 Date: 67-1-5
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.
41-40RE-ROOFS:
Signatur Date2:� rj
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, T 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)
I, 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
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(x) 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 MChapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
'2553
the Health & Safety CoiT010"Da(e
Section 3700 of the Labor Code, for the performance of the work for which thi
Owner
permit is issued.
or authorized a•
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, T
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, 1 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD
CONTRACTOR: DEVCON
PERMIT NO: 14110142
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC
690 GIBRALTAR DR
DATE ISSUED: 11/25/2014
OWNER'S PHONE: 6502084081
MILPITAS, CA 95035
PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class �� 'leyCOMM.
Lic. #
T.I ADD WALL IN PREPARATION FOR NEW
PREFAB CHAMBERS
_
n `rn (�
Contractor �/�/vwY) \', � �1� Date (�
DEF # 2 - DETAILS/SPECS FOR RF CHAMBER #2. ISSUED
I hereby affirm that I am licensed under the provisions of Chapter 9
2/9/15.
(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 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: $210000
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: 35720020.00
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
ofrect. 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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: , 1 Date:
with all non-point source regulations t Cupertino Municipal Code, Section
9.18.
\
RE-ROOFS:
Signature, Date-u
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 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 1 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, Sectio s 25505 5533,an 5
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agen ate: 1. �'
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION
ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
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PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: LJDETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
.ry
BEING ADDED? IRITO
ADDITION? 0700
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APPL #;24MPLANNING APPROVAL LETTER
IS THE BLDG AN E] YESRECEIV
EICHLER HOME?0
BYE
TOTAL VALUATION:
”
l
By my signature below, I certify to each ofthe following: I am the property owner or authorized 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 D Scr pti of ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to uildin con c ion. I authorize rep se ti es of u ino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: I Date:
SUPPLEMENTAL F140PMATION REQUI D
"
PLAn CIiCCK, C PE ,
'
" ROUTING SLI
OV>;RTIE-COUNTER
BUILDING PI ANRTVIEW
— 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 p
❑"YiAIdNThGkLANREVIEW%
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑tsTANDARD::�"
❑ PUBLICwoics �"
_
form if any Hazardous Materials are being used as part of this project.
EJ, LARbU
k I„RE DEP I
_ Copy of Planning Approval Letter or Meeting with Planning prior to
r
❑ MAJOR t
SAl�ITATiX SEWERDISII2ICT
submittal of Building Permit application.
❑-”.Env'tRoni�ii;NTAiHEaLTx'=.°``',
BldgApp_2011.doc revised 06/21/11
V)
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISIOD
ow
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aQcucertino.org
❑ NEW CONSTRUCTION ❑ ADDITION
ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT N
PROIECTADDRESS 11)3()o ()o t] , `JOU V61
APN4 3�5, -Lo 6 -LO
OWNER NAME p
•
PHONEC O I
EMAIL ap p -con
STREET ADDRESS `
� � n I t Loop
CITY, STATED, ZIP /�, �„Q ImoIM / ' Q� O ff(
I�+V��'/�1
FAX
CONTACT NAME {��,/(e,
PHONE C�Q
E -MAI ,
M 16"A
STREET ADDRESS tJ
CITY, STATE, ZIP 'n d
FAX
13 OWNER OWNER -BUILDER OWT`ER AGENT IK40NTPACTOR 13 CONFrRACT0RAGENT❑ARc=T El ENGINEER❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEA�� w A'� r ,�,• Q 1 v wr�
LICENSE NUMBER ON I(n�%
V/,�
LICENSE TYPE /1 �
tS
BUS. LIC k'
�Vv/
COMPANY NAME L1C�Y� �` 1 t
Y 1 C0MJ-
E-MAIL-uGJ-(dr 6kM'1C elm eJc an-cohsi16.
FAX
STREET ADDRESS
*CWp
CITY, STATE, ZIP . A; 1 n 1.}� (I / i� 1 S�
'
PHONE n�
80
a r
N
I�
VI'
ARCH3TECTIENGINEERNAMEceS+ `{ tA11Y�L
LICENSENUMBER
BUS LIC4
VSD Co,
COMPANY NAME �vvVt���lt V� F�t�M
E-MAILsrd►��11� de�cvn-con
FAX
STREET ADDRESS f _/j� j� C VraA "/
lJ
CITY, STATE, ZIP tj t I 1 t�S IC1 '• S 1�2�
- Q�jy1
PHONE . O qr1 �J
L CJ
DESCRIPTION OF WORK
f
EXISTING USE
PROPOSED USE CONSTR
TYPE
I STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EX.ISTG
NEW FLOOR
DEMO
TOTAL
AREA
_
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: LJ DETACH
❑ ATTACH
0 DWELLING UNITS:
IS A SECOND UNIT E] YES
SECONDSTORY ❑YES
BEING ADDED? ❑NO
ADDITION? []NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIV Y
TOTAL V UATION:
PLANNING APPL x ❑ No PLANNING APPROVAL LEITER
EICHLER HOME? ❑ NO
By my signature below, I certify to each ofthe following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I h ve provided is corre ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to wilding construe thorize representatives of Cupertino to enter the above 'I property for inspection purposes.
Signature of Applicant/Agent: Date: iZ V� lo
SUPPLEME L INFORMATION REQUIRED
PLAN CHi �ri�E,,,, .. ,:�.
�` , , ROUTING SLIP
❑ OVER TAE 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 , ,
❑t PLaN7QG�PLAN REVIEW t
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
❑ POBLiewORK
_
form if any Hazardous Materials are being used as part of this project.
❑
,F1R DEP
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑� MAJOR
"
❑ SANITARY SE\;'SR DISTTtICT �
submittal of Building Permit application.
❑ ENVIRON114ENTALIiEALTII '
BldgApp_201 1. doc revised 06/21/11
)Kg f
cc)",
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDI I
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION
❑ ALTERATION J TI REVISION / DEFERRED ORIGINAL PERMIT 4, V f / L' / / Z—
PROJECT ADDRESS 0 OBJ � l -
APN N 3L5.- � � �T e
OWNER NAME y ,
PIj01
/ '
EMAIL &K
�C,(�
STREET ADDRESS l ,^
CITY T TE, Z /JI G {� I
FARC
CONTACT NAME
-
VV 'V6 If� P I J
II
E-MAIL 1 n V- n^I^Onf^��
e C/VWi�
/
STREETADDRESS /j O► ` Lr VW,
�/ '
CITY STA E, Z
CA_
�25
FARC
11 OWNER ❑ OWNER --BUILDER ❑ OIAWERAG_�E(NT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 1 /1 IV(� /� i ^ pl jj p
v l� j"r
LICENSE NUMBER Gf / ��
LICENSE TYPE �
BUS. LI O
w` �5
COMPANY NAME
E-MAIL VV�4n9
Crn
'�Pii ��� -amt Ci ir
FAX
STREET ADD I �Q1
ITY' TAT ZIP D
PHON ^ �,�
ARCHITE ENGINE R N 2E
LICENSE NUMBER
BUS. LIC k
` U
C 0 M P A\4Y NA,teV
E-MAIL ham`
FAX
STREET S
DESCRIPTION OF WORK
Y ��-f-[/
Ao%16, ch_
EXISTENG USE
PROPOSED USE CONSTR.
TYPE
H STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
lV
`
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCHAREA
DECK AREA
TOTALDECK/PORCH AREA
GARAGE AREA: LJ DETACH
❑ ATTACH
DWELLING Ul`7r5:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLAN!ffNGAPPL'A ❑NO PLANT'D,G APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑1,10
)�,E�EJ,Af,E]j dry t h�
i Y y ' wp s
,J,y'
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized 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 scri n o cork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws Tela g bui ing struction. I autho ze re r ent es upertino to enter the above-i((d��e??ntified roperty for inspection purposes.
SignatureofApplicant/AgenI. Date: `�` y(T- ��
T
SUPPLEMENT REFORMATION QUIRED
f� ��� �"r pa.l,sa r 5 I ti,1411"
1 'NrWA' '�/�+m� �'>.✓., '`+,-
U� ER TAE COTEA a gyp,
7iUII DAG PL �T� RES tE?X
New SFD or Multifamily dwellings: Apply for demolition permit for�'uiraa�r��0,y
Y PP Y P
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
�'4f if�2�i�'ar+xsy
k�%�r�vIAG1ANti>FtEw', �'I
C_1LiBL)CwAsr
_ Commercial B]dgProvide a completed Hazardous Materials Disclosures
smAd•n �a r ��-
i ' rtw��,
P P Js:
form y if an Hazardous Materials are being used as art of this project.
01111"L`s2i'�Jfl1��71,r
'
_ of Planning Approval Letter or Meeting with Planning Prior to
IsCoPY a �: a1
uSJO +� f '
�K u
S } RY SEV1 I R DTSTRSCT
submittal of Building Permit application.
1`r ti
s
��u>:
BldgApp_201 1. doc revised 06/21/11
CUPERTINO
CONSTRUCTION PERMIT AP Pim
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950
(408) 777-3228 • FAX (408) 777-3333 • building(o)cupertino.org
NEW CONSTRUCTION ❑ ADDITION El ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS 0/Zh
FAPN 9
OWNER NAME
PHO.E-MAIL. I V, MAV, / A
`L
STREET ADDRESSCIT
,STATE IP FAX
J2 01 En I
CONTACT NAME y A f C, ,� ^� n
r, �j
PHO. `�
E-MAIL i
STREET DD
i IDV,
C T , ST TE, IP��J���
FAX
D OWNER ❑ OWNTR-BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENr ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CON'iRACTORNA VI �/j Q � ' ^ �/n
/
LICE, SENTM4BER N
`!
LICENSE TYPE
BUS. LIC Q
/^� �'^
COMPANY NAME �V� /�� �/ ,
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINE RN LICENSE NUMBER
BUS. LIC O
COMPANY NAME • 1/� ` E-MAIL v
AX
STREET ADDRESS CirY STATE�ZI�/f
PHONE
1409)
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE
CONSTR. TYPE
k STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
`
BATHROOM
KITCHEN OTHER
RF -MODEL AREA TREMODELAREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
DWELLING UNrrS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? E]NO
ADDITION? NO
PRE -APPLICATION ❑S'FS IF YES, PROVIDE COPY OF
LEITER
IS THE BLDG AN ❑YES
EICHLER HONIE?
TOTAL VALUATION:
PLANNING APPLI El NO PLANNING APPROVAL
❑NO
By my signature below, I certify to each of the following: I am the property owner or authorized 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 Descri tion of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cc ruction. I authori re en t e Cu ertino to enter the ab ve-ide((nttifiie�d property for inspection purposes.
Signature of Applicant/Agent: Date: ��
SUPPLEMENTAL WFORNLATION PEQT
New SFD or Multifamily dwellings: Apply for demolition permit for
existing buildin.gs . Demolition permit is required prior to issuance of building
i at R T t a R k
ELrI DING PL fit E+
pen -nit for new building
_ Commercial completed Provide a Bldgs: leted Hazardous Materials Disclosure
� p
form if any Hazardous Materials are being g used as part of this project.
.�'�r�x�`'
t t,
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
J
}zs9xYrtc�ztC�+
rt
�tl
k'W.k
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
N-700 FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10300 bubb rd
DATE: 11/25/2014
REVIEWED BY: Mendez
PC FEE ID
APN:
BP#: /
`VALUATION: 1$210,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1BTIPLNCK
PENTAMATION 1B Tl
PERMIT TYPE:
wORK
comm. t.i add wall in preparation for new prefab chambers
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
2,217
$2,276.68
1BTIPLNCK
$2,051.48
1BT11ATSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,051.48
Suppl. Insp. Fee:Q Reg.
Q OT
0,0
Ll
$0.00
PME Unit Fee:
$0.00
TOTALS:
F 2,217
1 $2,276.68
1
$2,051.48
MEC'H, HOURLY
0 Yes
0 No
PLUMB, HOURLY
0 Yes
(F) No
ELEC, HOURLY
Q Yes
(j) No
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,051.48
Suppl. Insp. Fee:Q Reg.
Q OT
0,0
Ll
$0.00
PME Unit Fee:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt otr) Thnco fooc aro hacod an tho nroliminary infnrmatinn avai/ahlo and are an1v an estimate_ Cnntart the Dent fnr addn'l info_
FEE ITEMS (Fee Resolution 11-053 Cff 7/1/13)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee:
$2,276.68
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,051.48
Suppl. Insp. Fee:Q Reg.
Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
i
Strong Motion Fee:
IBSE1SM1CO
$58.80
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$9.00
;SUBTOTALS;
$4,395.961
$0.001
TOTAL FEE:
1 $4,395.96
Revised: 10/01/2014
CITY OF CUPERTINO
FM_711 FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Ge. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are haled on the nreliminary information available and are onlv an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
ADDRESS: 10300 BUBB RD
DATE: 02/0212015
REVIEWED BY: MELISSA
Plan Check Fee: Hourly Only? C) Yes 0 No
APN: 357 20 020
BP#: 14110142
`VALUATION: Iso
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PME Plan Check:
PENTAMATION 1GENCO i
PERMIT TYPE:
WORK
REV # 2 RECONFIGURE SIZE OF CHAMBER & REMOVE ACOUSTICAL CEILING - ISSUED 2/2/15
SCOPE
Suppl. Insp. Fee:O Reg. Q OTQ.0
NOTE: This estimate does not include fees due to other Departments (Ge. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are haled on the nreliminary information available and are onlv an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
111 IN lill
Will I
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? C) Yes 0 No
$0.00
2 hours Plan Check, Hourly
$286.00 1STPLNCK
Suppl. PC Fee: 0 Reg. O OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (Ge. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are haled on the nreliminary information available and are onlv an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? C) Yes 0 No
$0.00
2 hours Plan Check, Hourly
$286.00 1STPLNCK
Suppl. PC Fee: 0 Reg. O OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. Q OTQ.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
�..�)JlS1`FlfC'CIUFt 1�71`:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning, Fee:
$0.00
Select a Non -Residential 0
Building or Structure
i
1I ,n c/'
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg, Stds Commission Fee:
$0.00
Vtt0 ALS:
$0.00
$286.00 T6TA>L FE)�
$286.00
Revised: 01/06/2015
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
IN
NOTE: This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimates Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Elf' 711.%13)
ADDRESS: 10300 Bubb Road
DATE: 0210912015
REVIEWED BY: Sean
APN:
BP#:
*VALUATION: Iso Ll
..................
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
0.0
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
Deferred Submittal #2: Details/specs for small RF Chamber.
SCOPE
IN
NOTE: This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimates Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Elf' 711.%13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$286.00
Deferred Submittal
1DEFSUBM
Suppl. PC Fee: (F) Reg. 0 OT
0.0
1 hrs
NOTE: This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimates Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Elf' 711.%13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$286.00
Deferred Submittal
1DEFSUBM
Suppl. PC Fee: (F) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. 0 OT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
�,OS'l,s('7tz`XYUY,r 7a7 .
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0 �
it1.�14 t. l��Cf('PI/,"£Cr"J�(d(r Cell �`CC'.S'.
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
$i T(TAI.;:
$0.00
$286.00
TATAL FES:
$286.00
Revised: 01/06/2015
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUft'�I
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(o,cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI b� REVISION / DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS +C) -3M -8k)b �i '
APN k 3S-1 20 6-20
OWNER NAME • 4PHONI b So- E-MAIL r'� �d1 porn
STREET ADDRESS O 1/- ,, � rtk rt CITY, STATE, ZIP C` V, /S lq 01501%f
/
1
FAX
CONTACT NAME E-MAIL
l
STREET ADDRESS ke 10 Gibroatvr
CITY, STATE, ZIP H C11 95C35
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OHRdER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME pr h ► q; �- O n @./lvp
4n(��/Vl�u �tl/�
Tl I
LICENSE NUMBER O► q 1 �"Z
) II %
LICENSE TYPE ^ BUS. LIC >:
ri U/(J
CC) �1
COMPANYNAME I�V�YI
E-MAIL
-1 -
FAX
0 Yy orf -evo o s). o
STREET ADDRESS q -f � t -PY
CITY, STATE, ZIP H•I `to c CA Q
PHONE 510
ARCHITECTIENGRKEER NAME S '"e C'�� r V -w ` e
, ``Cr LO
V�QJ
LICENSE NUMBER-
BUS. LIC K � � O, Q
(Q()
�...}`'.�
COMPANY NAME ^{-�` I �OJ
l
E-MAILS �V Coy)_
O Y1 `
FAX
STREET ADDRESSct n 9
l
CITY, STATE, ZIP S
li
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE
CONSTR. TYPE d STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
�
mm
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN OTHER
REMODEL AREA
REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ ATTACH
I DWELLING UNITS: IS A SECOND UNIT ❑ 1 BS SECONDSTORY ❑ YFS
BErNG ADDED? ANO ADDITION? ❑NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APPL 9 ❑NO PLANNING APPROVAL LEITER
IS THE BLDG AN ❑YES
EICHLER HOME? ❑ NO
RECEIVE Y - - s
'
TOTAL VA,�,4TIONt
-, J%�
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I provided is correct. I h e ead the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati to lding construction. I(- uth ze representatives of Cupertino to enter the above- �dtentif ed property for inspection purposes.
Signature Applicant/Agent: Date �ZLZ
of :
SUPPLEMENtffL INFORMATION REQUIREDr'La1v
cxECI<Xir>
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OVER THE-COUI�T�R
BUU,DIAG,PLAI\Ii);�'TEW
permit for new building.
�xrttESS
❑� PLAiyAaAGPL i5 RtvtFry
`puBl
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
Cl IcwoRxs
_
form if any Hazardous Materials are being used as part of this project.
❑ �'r
_ Copy of Planning Approval Letter or Meeting with Planning prior to
L4RL
.rt DJ rr r
submittal of Building Permit application.
r AZ4IOI2,
AnIT�RX$EIiERDI$TRICT k
❑ ENYIRONMENTAL }IEALTW
B1dgApp_2011.doc revised 06/21/1 /
1-0
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10300 Bubb Road
DATE: 12/2212014
REVIEWED BY: Sean
UNITS
APN:
BP#:
'VALUATION: Iso
PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY S,FD or Duplex
USE:
#
PENTAMATION 1RPFIX
PERMIT TYPE: A
WORK
Revision #1: Add lab sink and associated and plumbing.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Fixture or Trap
1BPFIXTURE
1
#
$10
PME Unit Fee:
$10.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? Yes) No
$0.00
TOTALS:
Travel Documentation Fee: ITR9 vDOC
$10.00
Strong Motion Fee:
Plumb. Plan Check 0.0 hrs $0.00
Plumb. Permit Fee: IPPERA4IT
Other Plumb Insp. 0.0 hrs $48.00 -
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 based on the Dreliminary information available and are only an estimate. Contact the Devt for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft 7,11!13)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$10.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? Yes) No
$0.00
Travel Documentation Fee: ITR9 vDOC
$48.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS-.
$151.00
$0.00 TOTAL FEET,
$151.00
Revised: 10/01/2014
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
1)ictrir1_ otr_) Theco fovc aro hacod an tho nroliminary infnrmatinn availahle anti aro nniv an estimate. Cnntact tho Dent for addn'l infn_
FEE ITEMS (Fee Resoluliun 11-033 Efl: 7/1,113)
ADDRESS: 10300 BUBB RD
DATE: 12/03/2014
REVIEWED BY: MELISSA
APN: 357 20 020
BP#: 14110142
`VALUATION: Iso
.................................
'"PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building7
USE:
Suppl. PC Fee: Q Reg. Q OT
PENTAMATION 1 GENCOM�
PERMIT TYPE:
WORK
12/3/14 - DEF # 1 - DETAILS/SPECS FOR RF CHAMBERS
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
1)ictrir1_ otr_) Theco fovc aro hacod an tho nroliminary infnrmatinn availahle anti aro nniv an estimate. Cnntact tho Dent for addn'l infn_
FEE ITEMS (Fee Resoluliun 11-033 Efl: 7/1,113)
FEE FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$286.00
Deferred Submittal
IDEFSUDM
Suppl. PC Fee: Q Reg. Q OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.• Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
T77
Work Without Permit? Q Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$286.00
TOTAL FEE;
$286.00
Revised: 10/01/2014
/Building Department
City Of Cupertino
10300 Tone Avenue.
Cupertino, CA 9501.4-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: Uk:�bR
PERMIT #
OWNER'S NAME:40b'��•
��
?) }
GENERAL CONTRACTOR: l ego3
,PHONE,#
BUSINESS LICENSE #
ADDRESS: i V^6?in
CITY/ZIPCODE: M ► I -Q- .
*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
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Ro vvoco)
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
col q\(tel 111 Lot
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
)F� v Kr6 kl:�"\
(J
Roofing
Septic Tank
Sheet Metal
Sheet Rock
g0 y)v � `�
--,
2–q 2—
Tile
u
Owner / Contr,*tor Signature
Iz-o1-1
Date