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15110127Fa CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10411 BUBB RD CONTRACTOR: SC BUILDERS INC PERMIT NO: 15110127 OWNER'S NAME: M WEST PROPCO II LLC 910 THOMPSON PL DATE ISSUED: 11/18/2015 OWNER'S PHONE: SUNNYVALE, CA 94085 PHONE NO: (408)328-0688 a'9P LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL TENANT IMPROVEMENT (14,816 SF); INSTALL 2 (N) License Class Lic. # .* '7U -1)9U SKYLIGHTS; RELOCATE FRONT DOOR "APPLE" I Contractor 3 5C. Sal, �W +2S SDC.. Date* 41 1 I $d r 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:' 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: $900000 performance of the work for which this permit is issued. II 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: 35720010.10411 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 WITFIIN 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: DCM&ate: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signaturem Date Ar 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. ❑ 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 j 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 ofithe 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(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, 255M3, and 25534. 1 Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agenDate: id I 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 perfdimance 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 1 CUPERTINO. CONSTRUCTION PERMIT APPLICATION CCMi10UNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - build! noClcuoertlno.orcl �KXTW CONSTRUCTION ❑ ADDI1ION . ❑ r`=:2-ATION / TI ❑ n-MION / DEFERPED ORIGIN e.L PERIMFr T PRorCr ADDRESS I 'S =.PIR I O LI A � _ 19I OWNER NAIf^ PHONE= = I✓ AsL STREET ADDRESS C-ITY, STATE, ZIP I FAX CO v T. CT N.tivE PHOIis �t NLSR I$a�BARA-.t��$�t6tS1L1 QA l 1 S*k yA M��i� .G. STn--: ADDRESS CITY, STATE, Z1P FA -X l �I 13 t -W Looe C v Gr% "(314 0111 ER ❑. OR 1vT_P.-3UII DER ❑ 0\ ^ `2 AC=IGt CO S RAC OR ❑ COh7R4CTOR?.GT-r ❑ ARC=, --CT D8\ =LOPS ❑ iENF.hT CONT7LACiORNAI10E LICENSENUI'SER I LiCTS": I BUS. LIC 0 CO]✓3ATvYNAT E•NSIL I FAX t�>�RSG ast"�Srr a,�U� J nlC., C*•�1 STREET ADDRESS CITY, STATE, ZIP PrT01 t I �,�sot P1.ncs� Svorv 1%Le CA °I4c,9I, �sb • w^ -, .AR C91 -Z irNONFF-KNA]✓,E LI CEN S' KUlsER BLTS. LIC R % (C-OC`� G 1.10 J • ,P c l 1 COMPANY NJ C- E•M R_L FAX ►C,n A ZC. IrTle1<.T LSAT r_c6-1 STP.EETADDRESS qv 1j.apoSra-w= CITY, STATE, ZIP 50.743 GA G%,Sl 13 I PHONE DESCRIPTION OF WORK J�r10 Z'1: ?,Sri VC, a]; -;I Ct'5 A4D 12@`•• I L *)C J .. -i1 Ara IL L1 i4 ECA STsOC4 1..14 1 A� P7EG1i11i1GFll. . E>:ISTING USE PROPOSED USE CO"" -'7' TYPE r STORIs �YLv 1 G�;�)G� 1�` • Q ( USE TYPE OCC. SQ.FT. p VALUATION (S) rG AREA I.'EW FLOOR /9.=A DEMO AREA TOTAL N.zrAREA VC,oc"©Or4 Of 1e't �1' � ��O�V " BATHROOM KITC:`MFN OTHER REMODEL AI EA REMODEL AREA REMODEL AREA PORCii /AREA DECK. TOTAL DECY-TORCH AREA G.! --LAGS AREA: ❑ ATTACT I nDRTLLIGU IS: IS ASECOND UNIT OYES S£CONDSTORY ❑M BEING ADDED? ONO ADDITION? ❑NO PRE -eons iCAT10N ❑17=S IF 1'S, PROVIDE COPY OF IS THE BLDG ALN' ❑ 7:S - i:t I ,33__"s ;; V ; _ `._' ":=-''_-��-,� ` �.- _'--.', TOTAL \%y1.UATION; PLANINMGAPPL: ONO PLA.T7�ZNGAPPROVALLcT2R EICHLERROMIE? 0NO �.. "`"-�; �t�� �� - q b By my signage below, I certify to each of the fel l o -wing: I am the p er-y oN;mtr or au' hor!zed agent to act on t p opefty wAmer's behalf. I have read this application -arid the i, uermation I ha\ e provided is cor, ve t escriptionof ZVork and verij itis 2ccLra:e: I=agree to comply �;ith'z11 €ppliczb!e lo��l ` ordinances and state !pws relating o buil c ns` c ' n. I a nth r; rep: sentatives Df Cupertino to enter the above -identified Propertyfor inspection purposes. _.Sigriatu,eOfADD] icant/?gent:_..-.- ._. -._., _.,_ .. .._ -.. (- = �� SU�PLE?`r�NT�L I?�rOR1<�A1 O>\i REQUIRED= arm New C 1 tl r 1 nv New „FD or uhifami.y d-welli_ us:. Apply for demolition p =' it for Y. 0\�RTI COL�iTER _. �J BIIIIDI�GPL3NRrTSEVr xy; i na , i o I r c eXsti_.� bti]d.D�(s). De nolition pennit 's _Pqused prior to is-ua Ice of btadi g Fm per it for new buil_am°RINE •� M-177200 ss, �•4w� - © PZ k ��1�1irE�L� yx\\ — �1 Q , -T d Haz �a 1- Disclosure Commercial b_d_s: ProV_de a co.._plete �ardo,us A__�eria � L K z4��aRDr t 4 I�Iacv oR�cs � _ fon if any Hazardous Materials are being used as part of this project. � V Copy of Planning Approval Leser or Meeting with Planning prior to _ submittal of Building Pe_nnit application. ri �NL470R � � � �TEa�iYSER�n�ISTRICT � � Bldg�pp-201 1. doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10411 Bubb Rd DATE: 11/18/2015 REVIEWED BY: Phuong APN: 357-20-010 BP#: "VALUATION: 1$900,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building, PENTAMATION 1 B TI USE: PERMIT TYPE: WORK Tenant improvement (14,816 SF • Install 2 N skylights; Relocate front door "Apple" SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,III-B,IV,V-B 14,816 $2,968.38 1BTIPLNCK $8,397.15 1BTII7VSP I TOTALS: 14,816 $2,968.38 °' $8,397.15 ,feeh. Pion Check Pharr;b. Plcarr Check I lec..Plan C7rech Fleck Permit Fee: Pixrnli. 1`ermit hee: i lec-Per'mii Fee: OzherA/ech.lirsp. Other Phar>blrsl;. Otl?c>r..li;`,, fnsp. Afech. h -un. Fr Mull1b. Lzsn. Fee: frlec. hrcp. Fee: I NOTE: This estimate does not include fees due to other Departments fl e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.). Thesefees are based on the prefiWdna information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS Lee Resolution .1.1-053 .F, . 7/1/13) FEE QTY/FEE MISC I EMS Plan Check Fee: $2,968.38 2 # Skylight $862.00 1SKYL<10SF <=10 s.f. Suppl. PC Fee: (D Reg. 0 OT FO.OThrs $0.00 PME Plan Check: $0.00 Permit Fee: $8,397.15 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (. `nf�}tructinn Tax: -Fi r1G1ministralive few: 10 Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i D,av:;l Documentation.Fees Strong Motion Fee: IBSEISMICO $252.00 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $36.001 w ¢ SUBTQTALS :`%$11,653.53 $862.00 TOTAL FEE $12,515.53 Revised: 10101/2015