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13100068CITY O)E SCUP E)18' INO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: DEVCON PERMIT NO: 13100068 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED: 10/09/2013 OWNER'S PHONE: 4085909579 MILPITAS, CA 95035 PHONE NO: (408)942-8200 Ed LICENSED CONT'RACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL r] COMMERCIAL ❑ ,, _ � APPLE- IST FLOOR- INSTALLATION ®]F (2) CHAMBERS License Class Lic. # ?19nIT�� TO INCLUDE M,]E Contractor Date—i DEFERRED #I-INSTA1L1LATiON OF FREQUENCY I hereby affirm that I am licensed under the provisions of Chapter 9 CHAMBER WITH STRUCTURAL CA]L,O'S - ISSUED 12/18/13 (commencing with Section 7000) of Division 3 of the Business &c 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: 1 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: $500000 performance of the work for which this permit is issued. I h. a and will maintain Worker's Compensation Insurance, as provided for by tion 3700 of the Labor Code, for the performance of the work for which this APN Number 31622017.00 Occupancy Type: Permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is D )PjERMffT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating W17�� R80 ���� ® �����, ]I��>LTA��IE ®� 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 DAY CALLED INSPECTION. ECTION. 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. Additional , the applicant understands and will comply ➢Date: with all non- 'nt source regulatio s er the Cupertino Municipal Code, Section 9.18.K) RE -ROOFS: Signature Date �4All 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 DER DEC ARATION -BUT Signature of Applicant: Date: 1 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 &c 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.I2 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 Cu rt M 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 IHealth &i Safety Code, Sections 25 5 55 d 25534. Owner or authorized agent: Date: permit is issued. I/ 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 AGENCX 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 1 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 I CITY OF CUP EI[ TINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: DEVCON PERMIT NO: 13100068 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED: 10/09/2013 OWNER'S PHONE: 4085909579 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL COMMERCIAL ERS APPLE- IST FLOOR- INSTALLATION OF (2) CHAMBERS License Class (-Tt- CA, Lic. # TO � INCLUDE M'E Contractor�Ca� < Date � e92.s� C,�tSi�' I hereby affirm that I am licensed under the provisions of Chapter 9 10/24/13 DEFERRED #2 SECOND RF CHAMBER- ISSD 1/9/2014 (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: $500000 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: 31622017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is R'][']Ci D PERMIT )Ci XPMS IEF WORK ES NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating �� TEIN �� ���� ®� PERMIT ISSUANCE ®� 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 �D 1lF Iii[ (LAST CALLED ffNSP ECTEON. 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: Date: / with all non -point s2Wrc3egulOons per the unicipal Code, Section 9.18. nature to B 9 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 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. 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections ;32 , and 25534. Q er or authorized agent: ate: 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, 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. 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 cCUP E][8TINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: DEVCON PERMIT NO: 13100068 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED: 10/09/2013 OWNER'S PHONE: 4085909579 MILPITAS, CA 95035 PHONE NO. (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COIF MERCIAL License Class_ Lic. 4 APPLE- IST FLOOR- INSTALLATION OF (2) CHAMBERS t��� j( TO � Contractor ����1 Date INCLUDE M,lE 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: $500000 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: 31622017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT ][gjyj[]jT ]EXPIRES Ili+ WORK 1« NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating ����D]O���®��jE��� ����IAN�IE ®� to building construction, and hereby authorize representatives ofthis city to enterupon the above mentioned property for inspection purposes. (We) agree to save 180 QDM ILAST CALIL]EDD llPE T 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 Date: granting of this permit. Additionally, the applicant understands and will comply Issued by: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature I Date/, / J Q 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 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). 1 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(a) should I store or handle hazardous 1 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 upertino Municipal Code, Chapter 9.12 and 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 the Health & Safety Code, Section 0 , 533, and 25534. Owner or authorized agent: Date: permit is issued. 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, [ CONSTRUCTION L1ENDi[NG 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 perfonnance 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 1 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 d-11TrTR7 ?AU� i"Tr TTM7MTMrrr1Trk\T?n 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 nreliminary information available and are onlv an estimate Contact the Dent foraddn'1 info. FEE ITEMS (Fee Resolution 11-053 Eif 711/13) 11..1L 11 A \U/ L' V.. U Y AidiiX, 11 1U N \U/ FEE ESTIMATOR - BUILDING IDIVIRON ILI ADDRESS: 10500 N DE ANZA BLVD DATE: 101151203 R1EVE EWED ICY: MELISSA Mich. Permit Fite: APN: 316 22 017 B?#: "VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PR)<MARY Commercial Building Phemh. htsp. Fee: PENTAMATION 1GENCOM USE: Permit Fee: PERMIT TYPE: wORK DEFERRED # 1 - INSTALLATION OF FREQUENCY CHAMBER WITH STRUCTURAL CALC'S SCOPE $0.00 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 nreliminary information available and are onlv an estimate Contact the Dent foraddn'1 info. FEE ITEMS (Fee Resolution 11-053 Eif 711/13) tech. Plan Check Plumb, Flim Check ,J Elec. Plan Check Mich. Permit Fite: Plumb. Permit Fee: Elec. Permit Fee: Other htech. Insp.Ll I Other Plumb Insp. C Other Elec, Insp. Me& Insp. Fee Phemh. htsp. Fee: Elec. Insp. Fee: 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 nreliminary information available and are onlv an estimate Contact the Dent foraddn'1 info. FEE ITEMS (Fee Resolution 11-053 Eif 711/13) FEE Q"ll'YN ElE MIISC )<T EMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. C OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 # Deferred Submittal $278.00 IDEFSUBM Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conswuction .Tax: Adin inistr-ative .Fee: Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 01 7-2 Travel Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $278.00 TOTAL FEE: $278.00 Revised: 10101/2013 *f1Tr.mccT ir't TrI ."Tr T1MTr1TfTrn TrUTAn OCCUPANCY TYPE: L.Jl ll ll 'LPIU M" R ll1V IXy FEE ESTIMATOR - BUILDING DIVISION I.M. ADDRESS: 10500 n de ansa blvd DATE: 10/09/2013 RIEYdEW1EdD BY: MENDEZ PC ]FEE IID APN: 1BP#: _31A_14 9 *VALUATION: 1$500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building Oilier Glec. Insp. . PENTAMATION 16 TI 'TYPE: USE: Elee. Insp. Fee: PERMIT WORK{ apple- 1 st floor- installation of 2 chambers E M SCOPE I Permit Fee: Hourly Only? 0 Yes Q No OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.ff. PC FEES PC ]FEE IID BP ]FEES ]BP ]FEE IID B (Tenant Improvements) II-B,111-B,IV,V-B 0 $0.00 Oilier Glec. Insp. . $0.00 Plumb. Insp. ree: Elee. Insp. Fee: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Feer Reg. 0 OT 0;0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY ® Yes Q No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes 6) No L1ech, Plan Check Phunh., Plan Check Elec. Plan (,'heck :Meeh. Permit F'ee.' 11m.h. Permit Fee. Floc. Permit Fee: C)tluj• b9ech. Insp. 01/jo• Phamb Insp. Oilier Glec. Insp. . Alech. Insp. Fee: Plumb. Insp. ree: Elee. Insp. Fee: 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 nreliminary information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 a.. 7/1/13) ]FEE QTY/FEE MISC ITEMS Plan Check Fee: Dourly Only? () Yes (j) No $0.00 [= hours $278.00 Plan Check, Hourly 1STPLNCx Suppl. PC Fee: (D Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Feer Reg. 0 OT 0;0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ConsIvuetion Tax: ,I dtninisirative Fee: 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 � d Tilavel Documentation Fees: Strome Motion Fee: IBSEISMICO $105.00 F-5—.-07 hrs $695.00 Inspections 1STINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $20.00 SUBTOTALS: $125.00 $973.00 TOTALFEE: $1,098.00 Revised: 10101/2013 enlrrm'97 rfT.mrf'IITTT MA IPt MI M%r.re . NOTE: This estimate does not include fees due to other (Departments (Le. Planning, Public Works, Fire, Sanitary Sewer (District, School District. etc ). These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn I info. FEE ITEMS (Fee Resolution 11-053 E . 711/13) M-11" U \ly 1P tl. tU Y IC.1N 1 ll 1 ] �lY FEE ESTIMATOR — BUILDING DIWSIGN Phan& Plan Ojeck ADDRESS: 10500 N DE A►NZA BLV® DATE: 10/24/2013 REVIEWED BY: SEAN 1.", ch. Permit Fee, APN: BP#: z Aqd6 5r*VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex J 7?ERMRT PENTAMATION 1GENRES USE: TYPE: WORK DEFERRED SUBMITTAL 42: SECOND RF CHAMBER. SCOPE hrs NOTE: This estimate does not include fees due to other (Departments (Le. Planning, Public Works, Fire, Sanitary Sewer (District, School District. etc ). These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn I info. FEE ITEMS (Fee Resolution 11-053 E . 711/13) Llech. flan Check Phan& Plan Ojeck Elea. Plan (:heck 1.", ch. Permit Fee, Plurnh. Pe a it Fee: G1ec. Permir Fee: Other Afech. Insp. Oilier Plurnh Insp.Ell I Other Flue. lnsp, ;llech, InyE Fee Plumh. hasp. Fee: Dec. Imp. Fee: NOTE: This estimate does not include fees due to other (Departments (Le. Planning, Public Works, Fire, Sanitary Sewer (District, School District. etc ). These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn I info. FEE ITEMS (Fee Resolution 11-053 E . 711/13) EEE QTY/EEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. OT 10.0 1 hrs $0.00 PME Plan Check: $0.00 1 # Deferred Submittal $278.001 IDEFSUBM Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT Q Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cons1ruclion Tax: Ad'rninistrative.Fee. Work Without Permit? 0 Yes 0 No $0.00 Advanced P}anningjge $0.00 Select a Non -Residential Building or Structure 7iM,el Docianentation lyres: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS; $0.00 $278.00 TOTAL. FEE: $278.00 Revised: 10/01/2013