14030073M
0
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD
CONTRACTOR: DEVCON PERMIT NO: 14030073
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC
690 GIBRALTAR DR DATE ISSUED: 03/20/2014
OWNER'S PHONE: 4088624575
MILPITAS, CA 95035 PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
q
License Class Lie. # 1
APPLE T.1, FOR SOUTH SIDE FOR OFFICES AND
RESEARCH
i-,o y>,�}�„ r �; r i
Contractor l/t'N W r I r tJ� a
Poi
AND DEVELOPMENT PURPOSES (9562 S.F.)
I hereby affirm that I am licensed under the provisions of Chapter 9
REV # 2 - RELOCATE (E) FREE STANDING LIGHT POLE IN
(commencing with Section 7000) of Division 3 of the Business & Professions
REAR PARKING AREA- ISSD 5/28/2014
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: $1200000
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 1 have read this application and state that the above information is
PERMIT. IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAY 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
I80 DAYS FROM VAST 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: Date:
with all non -point source regulations p t e u ertino Municipal Code, Section
9.18.
'
0
RE -ROOFS:
Signatur Date
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
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 (See.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
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 Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sect• 25533 add 25534.
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
ns 155 _
�.
l.)-&
Owner or authorized ag4;�y Date
permit is issued.
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_
CITY OF CUPERTINO
Fm_§ FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10300 BUBB RD
DATE: 05/23/2014
REVIEWED BY: MELISSA
APN: 357 20 020
BP#: 14030073
`VALUATION: Iso
"PERMITTYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
hours Plan Check, Hourly
$278.00 iSTPLNCK
PENTAMATION 1 GENRE
PERMIT TYPE:
WORK
REV # 2 - RELOCATE E FREE STANDING LIGHT POLE IN REAR PARKING AREA
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.). Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'1 info.
FEE ITEMS (Pete ReJolwion 11-053 Eff ,1%l3)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly
Only? 0 Yes (j) No
$0.00
hours Plan Check, Hourly
$278.00 iSTPLNCK
Suppl. PC Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:) Reg.
0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
E)
Work Without Permit? 0 Yes) 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
$278.00
TOTAL FEE:
1 $278.00
Revised: 04/01/2014
CONSTRUCTION PERMIT APPLICATION
v
COMMLINITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENLIE • CLIPERTINO, CA 95014-3255
CUPERTINO 1 (408) 777-3228 • FAX (408) 777-3333 • buildingpiauperrino.org r�}
❑ NEW CONSTRUCTION [:1ADDITION El ALTERATION
ALTERATION / TI 1��`�iiiYiill DEFERRED ORIGINAL PERMIT # ! f 0
PROJECT ADDRESS
)l I L12 rA .
J
7"'k`� - U - I) Z-0OWNER
NAME
PH NE t
E-MAIL o//)
STREET ADDRESS
1T ' IP
FAX
CONTACT NAMEh�hV ,-V y 111 PH NE
6&"�r� CM vi -ow
ovSTREET ADDRESS 1
T ,S ATE, IP FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Nh I ry
LICENSFf NUMBER
LICEN TY
BUS. L]
COMPANY NAME J,
y�
E-MAIL1
FAX
w
V
,
U)na
STREET ADDRESS (Ot"I'IPOV
DE.r
.I ,NATE ZI 1`J
23
PHONE
ARCHITECT/ENGINEER NAME }I J
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
I IY,
-MAIL
FAX
v I
I ) ki-
ET D
ST SS
CITY TE, ZIP ..
CA
P-.
DESCRIPTION OF WORK
ry
EXISTINGUSE
PROPOSED USE CONSTR.
TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
//////l/
V
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKORCH AREA
/P
GARAGE AREA: DETACH
E] ATTACH
IN
# DWELLING ITS
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEING ADDED? E]NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEI VED BY;
T TAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
I
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 beha f I have read this
application and the information I have provided is correct. I have read the Descripti �of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to uild g co s ruction. I authoriz repr e at. eslof Ct ertin to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: �� Date: t fS23 A
SUPPLEMENTA NFORMATION QUIRED
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
FAI
f' tom
1
\A
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD
CONTRACTOR: DEVCON PERMIT NO: 14030073
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC
690 GIBRALTAR DR DATE ISSUED: 03/20/2014
OWNER'S PHONE: 4088624575
MILPITAS, CA 95035 PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
1�1� ' ,
License Class �% Lic. # l!/
APPLE T.I. FOR SOUTH SIDE FOR OFFICES AND
RESEARCH AND DEVELOPMENT PURPOSES (9562 S.F.)
Contractors Date
REV # I - ADD CDA PIPING TO LAB & STRUCTURAL
I hereby affirm that I am licensed under the provisions of Chapter 9
UPGRADES (E) FRAMING - ISSUED 5/7/14
(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: $1200000
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 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 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
Igo DAYS LED 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 comp]
V: Date:
with all non -point source regulations per the Cupertino Municipal Code, Se ion
9.18.
rl }
511
RE -ROOFS:
Signature Date
All roofs shall b ected prior to any roofing material being installed. If roof is
installed without first obtaining an inspection, 1 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).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 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 255 5, 25533, . rd 25_ 4.
Section 3700 of the Labor Code, for the performance of the work for which this
L
Owner or authorized agen . 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, 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
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
UPERTINO (408) 777-3228 • FAX (408) 777-3333 • building5)--cupertino.org
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PROJECT ADDRESS i C` C) J�)Ujo
APN# - _ O��/
7
V�
OV✓NER NAMEt �-, P -
E-MAIL - r R
I T
STREET ADDRESS , ' n ��
�iPH
CITY, STATE, ZIP
FAX
CONTACT NAME {
E E-r4ALL
t
C%Jh t
STREET ADDRESS ` 6r a
S ATE,• IP
or-
ns
FAX
13 OWNER 11 OWNER -BUILDER ❑ OWNER AGENT �ON'TRACTOR 1-1CONTRACTORAGENT ❑ ARCHITECT ENGINEER 11 ❑ DEVELOPER ❑ TENANT
CONTRA OR AM 0 V�
LICENSE NUMB
LICENSE TY
BUS. LIC #
COMP NAME Od
E-MAIL
FAX
j/
SIRE -.ADDR5S
C TY STATE, ZIP C f Nl 9
ARCHITECT NGINEER NA E
LICENSE NUMBER
BUS. LIC #
YI
COMPANY NAME \ n ,rte
V
E-tvk[LV j _
e
FAX
XAC1 �v (YJ
GTYY
STREET ADDRESS p
0
SSSTATE, ZIP,
p
J C
HOh
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR
TYPE
4 STORIES
USE TYPE OCC. SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMO DEL AREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: U DETACH
❑ ATTACH
k DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? NO
ADDITION? ❑NO
PRE -APPLICATION [3YES IF YES, PROVIDE COPY OF
IS THE BLDG AN E]YES
CEIVED TOTAL VALUATION:
PLANNING APPL 9 ❑ NO PLANNING APPROVAL LETTER
EICHLER HONIE?
v
By my signature below, I certify to each of the following: I am the property owner or aut agent to act on the property owner's behalf. I have read this
application and the information I have provide is correct. I hav read the De iption of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating bui ing o st ction. I aut rizi re7 eniatives of Cupertino to enter the above -identified prop rty for inspection purposes.
i r� .
Date: y�},�- J l
Signature of Applicant/Agent: D5
SUPPLEMENTA INTFORMATION QUIRED
rI nl� cHEcr� TiPE
_ ,'JiouTLNc s%iP
YT*
❑ ".OVER
D
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
TTJriTER
' t HE CO� r
BTJII DING PLAN REVIEW
permit for new building.
❑ _EXPRESS -
A❑ P.tANN1NGPLAIIREV1Ews
Commercial Bldgs: Provide Hazardous Materials Disclosure
qf,1^.`'�
a completed
form if any Hazardous Materials are being used as part of this project.
ARD
woRlcs r ---h
Copy of Planning Approval Letter or Meeting with Planning prior to
_
❑ � DIAJOR�-+' � s'"°--��
i� SAI\ITAR�' SE}i�ERDISTRICT
submittal of Building Permit application.
�'.•',�� '� :.-u � � •. ':� a ' -
� * EIVVIROl�T4ENTAi;"HEAL1 H
BldgApp_2011.doc revised 06/21/11
om
CITY OF CLTPERTINO
EM -N FEE ESTIMATOR - BUILDING DIVISION
igADDRESS: 10300 BUBB RD
FEE
DATE: 05/07/2014
REVIEWED BY: MELISSA
APN: 357 20 020
BP#: 14030073
`VALUATION: Iso
*PERMIT TYPE: Building Permit
-0.01
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial BuildingT
USE:
PME Plan Check:
$0.00
PENTAMATION 1GENCOM
PERMIT TYPE: A
WORK
REV # 1 -ADD CDA PIPING TO LAB & STRUCTURAL UPGRADES E FRAMING - ISSUED 5/7/14
SCOPE
0.0
1 hrs
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 preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E�: 7f %,1!13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No
$0.00
2 hours Plan Check, Hourly
$278.00 1STPLNCK
Suppl. PC Fee: (j) Reg. ® OTT
-0.01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
SuppL Insp. Fee:(D Reg. Q OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure
Strom Motion Fee:
$0.00
Select an Administrative Item
Bldt,)Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$278.00
TOTAL. FEE:
$278.00
Revised: 04/01/2014
9-1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD
CONTRACTOR: DEVCON
PERMIT NO: 14030073
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC
690 GIBRALTAR DR
DATE ISSUED: 03/20/2014
OWNER'S PHONE: 4088624575
MILPITAS, CA 95035
PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class*'V_? Lic. # L/ 1 ��
APPLE T.I. FOR SOUTH SIDE FOR OFFICES AND
RESEARCH
Contractor W—c *e_ '�2 . L�
AND DEVELOPMENT PURPOSES (9562 S.F.)
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: $1200000
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 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 O 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 DAY FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,9r
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 -pont source ulations per the Cu rtino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Dat
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:
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
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)
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
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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti ns 2 05, 33, and 34
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Datei.�l—�
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, 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
n NFW ('(INSTT2r1("
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org
f Tf1N 71 ADT)/TION VAT TFRATT(1N /TT inI RFVTCT(11J/1lRFRRRT7n
Oxy
CIR Tr:TXT AT DT:AAA TTN
PROJECT ADDRESS + O !],• OO j �'� ^ �%
✓V
APN 4 3 C
1 �E-MAIL
OWNERNAME
`f/ r oeS
N .���V 5
e,
Q
STREET ADDRESS I /�
Vel'
TY, STAT ZI A cis 0
FAX
I+^
CONTACT NAME '{„ tA
PHONE
E-MAIL,
(2)Ma yr
STREET ADDRESS 0:<) 66Va�W- Dmac.
ti ATE IP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRAC R A��
LICE N
LI N YPE
BUS. LIC
COMPANY NAME
E-MAIL
FAX
ann o e co co
STREET ADDRESSCITY,
STATE, ZIP
_D,0JP 015>0 oo,
PHO - 2'
4n
ARCHITECT/ENGINEERNAM W`_-
��// ))
u�mACOMPANY
LICENSE NUMBER -
BUS. LIC#
NAME �(�n
`/Y 1(✓
E-MAIL W` O� N' r
•N6� ' 1 W rn
FAX
STRE T ADDR �y�� •
7I
C Y, T TE, ZIP
PHO
DESCRIPTION OF WORK 1 ro ` irA/
C4aM 1AA1 t -10
101 Z .
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
G
,..
1
/
USE
TYPE
OCC.
SQ.FT.
VALUATION($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
WO
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA DETACH
E]ATTACH
# DWELLING UNITS:
ISA SECOND UNIT ❑YES
SECONDSTORY E]YES
BEING ADDED? ❑ NO
ADDITION? []NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEI ' BY:
TOTAL VALUATION:
PLANNING APPL N ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
000
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
By
application and the information I have provided is correct. I have read the cri ^ n of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin t bui mg nstruction. I aut�jire es t iv s of Cupertino to enter the above- petty for inspection purposes.
2identit7edrrpr
Signature of Applicant/Agent: Date:
SUPPLEMENTAV INFORMATION ' `lUIRED
PLAN CHECK TYPE -
- ROUTING SLIP
❑ ovER-THE-COUNTER
BUILDING PLANRENTEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS _
PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
FIRE DEPT 4 /74z JR'
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY §EWER DISTRICT
submittal of Building Permit application.
.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21111
L
CITY OF CLIPERTINO
FM -7' FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10300 BUBB RD
TYPE OF
CONSTR.
DATE: 03/11/2014
REVIEWED BY: MELISSA
APN: 357 20 020
BP#: 116.3*VALUATION:
1$1,200,000
*PERMIT TYPE: Building Permit
II-B,III-B,IV,V-B
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1BTIPLNCK
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
APPLE T.I. FOR SOUTH SIDE FOR OFFICES AND RESEARCH AND DEVELOPMENT PURPOSES
SCOPE
PME Plan Check:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE 1D
B (Tenant Improvements)
II-B,III-B,IV,V-B
9,562
$2,603.36
1BTIPLNCK
$6,230.36
1BTIINSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$6,230.36
Suppl. Insp. Fee:Q Reg.
Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
9,562
$2,603.36
$0.00
$6,230.36
MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY Q Yes ) No ELEC, HOURLY 0 Yes Q No
F E]
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 preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Pee Resolulion 11-053 Ef 7i1%13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,603.36
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Feer Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$6,230.36
Suppl. Insp. Fee:Q Reg.
Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
7
0
E)
Work Without Permit? 0 Yes ) No
$0.00
Advanced Planning Fee:
$0.00
Select a 1Von-Residential
Building or Structure
E)
0
i
_
Strom Motion Fee:
IBSEISMICO
$252.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$48.00
SUBTOTALS:
$9,133.72
$0.00
TOTAL FEE:
F $9,133.72
Revised: 01/15/2014
CUPERTINO
PURPOSE
HAZARDOUS MATERIALS CHECKLIST
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
To minimize possible delays that would result for the Fire Department plan review, please complete the
following checklist to determine if an additional level of Hazardous Materials plan review will be
required.
MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING?
PLEASE MARK YOUR ANSWER WITH AN `X' IN THE YES OR NO BOX ON THE SIDE
BELOW.
YES
NO
1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases,
hazardous materials, etc.
2. Battery back-up rooms or racks.
3. Propane tanks.
4. Gasoline stations with underground tanks.
5. Installation or replacement above ground or underground storage of liquid petroleum
products, liquefied petroleum gases, compressed natural gas, explosives or other
regulated hazardous materials.
6. Gas rooms for dentist, doctors or veterinarians.
7. Generators with back-up diesel or other fuels.
8. Large refrigeration systems.
9. Fuel cell systems.
10. Commercial pool systems.
11. Chemical Storage areas.�c�
12. Flammable liquid storage.
13. Compressed Gases.
14. Dry cleaners.
15. Print Shops.
16. Auto Repair and Auto Body Shops.
17. Research and Development.
LIZ
For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa
Clara County Fire Department, at (408) 378-4010.
HasMat 2011.doc revised 03/07/11
CUPERTINO
PURPOSE
HAZARDOUS MATERIALS CHECKLIST
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ing(a)cupertino.org
To minimize possible delays that would result for the Fire Department plan review, please complete the
following checklist to determine if an additional level of Hazardous Materials plan review will be
required.
MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING?
PLEASE MARK YOUR ANSWER WITH AN 'X' IN THE YES OR NO BOX ON THE SIDE
BELOW.
YES
NO
1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases,
hazardous materials, etc.
2. Battery back-up rooms or racks.
3. Propane tanks.
4. Gasoline stations with underground tanks.
5. Installation or replacement above ground or underground storage of liquid petroleum
products, liquefied petroleum gases, compressed natural gas, explosives or other
regulated hazardous materials.
6. Gas rooms for dentist, doctors or veterinarians.
7. Generators with back-up diesel or other fuels.
8. Large refrigeration systems.
9. Fuel cell systems.
10. Commercial pool systems.
11. Chemical Storage areas.
�(
12. Flammable liquid storage.
�C
13. Compressed Gases.
�C
14. Dry cleaners.
7C
15. Print Shops.
7C
16. Auto Repair and Auto Body Shops.
9C
17. Research and Development.
For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa
Clara County Fire Department, at (408) 378-4010.
HasMat 2011.doc revised 03/07/11
ELECTRICAL
Cord Reels
Automatic Retracting Electric Cord Reels HUBBELL
■ Steel construction
Durable, high-performance reels ensure safe and
effective wire management. UL Listed and CSA mmmmmmmmmmobdrw
Certified.
COMMERCIAL
Compact size. Mount on ceiling, wall, or bench.
INDUSTRIAL
Extra -sturdy, with positive latch mechanism and
corrosion -resistant, powder -coated finish. Mount on
ceiling, wall, or bench.
WEATHERPROOF
Withstand abusive environments. UL Type 4X rating t
allows use outside; hose -down resistant. Rotate
3400 on pivot base. No. 1TRC3
STATIC DISCHARGE
Operate in hazardous environments.
No. 7 TRCS
WUVp DevMsKefl m
f
Cord
Gauge/
3
r.i,rwasu
e
NEMA Plug
�s rr
H
0
Mfr.
Industrial -Grade Retractable Co I
RTB Series, 60OV/30A Slip Ring Rating
Designed for continuous -duty indoor or outdoor appli-
cations. Feature 12 -position guide arm and ratchet MA
lockout to provide versatility. 6 -ft, feeder cord makes ►L 9
installation easy. Durable steel construction with yellow C
powder -coated finish. Heavy-duty, formed steel stand `
with mounting holes for ceiling, wall, or floor. Rated for BY
indoor or outdoor use, including wet locations. -� 13V788
14 No. 13V191
Description/ Cord Gauge/ Cord Max. NEMA NEMA Plug w H D Item $
Special Features Length (ft.) Conductor Type Voltage Amps Connector Config. Color (in.) (in.) (in.) No. Each
Blunt Ends 25 1613 SO 125 10 Yellow 7.75 13.83 12 13V188 505.50
Blunt Ends 35 16/3 SO 125 10 Yellow 7.75 13.83 12 13V189 625.00
Blunt Ends 50 16/3 SO 125 10 - - Yellow 7.75 13.83 12 13V190 695.00
(2)-15A Duplex 25 16/3 SJ 125 10 5-15R 5-15P Yellow 7.75 13.83 12 13V191 689.50
(2)-15A Duplex 35 16/3 Si 125 10 5-15R 5-15P Yellow 7.75 13.83 12 13V192 736.50
(2)-15A Duplex 50 16/3 SJ 125 10 5-15R 5-15P Yellow 7.75 13.83 12 13V193 818.50
(2)-15A Duplex 50 14/3 SJ 125 15 5-15R 5-15P Yellow 7.75 13.83 12 13V194 r 834.50
`\y Single Plug 25 12/3 SJ 125 20 5-20P Yellow 7.75 13.83 12 13V195 835.00
Single Plug 50 12/3 SJ 125 20 5-20P Yellow 7.75 13.83 12 13V196 906.00
Duplex GFC1 25 12/3 SJ 125 20 5-20R 5-20P Yellow 7.75 13.83 12 13V197 977.50
Pivot Base for RTB & RTF Series Reels 7 1 6 13V202 / 234.00
Take COST out of managing inventory with grraingercom/keepstock 1-800-GRAINGER 501
Cord
Gauge/
Cord
Max.
NEMA
NEMA Plug
W
H
0
Mfr.
Item $
Description/Special Features
Length (ft.)
Conductor
Type Voltage
Amps
Connector
Config.
Color (in.)
(in.)
(in.)
Model
No. Each
Commercial
Triple Tap
40
12/3
SJTW
125
15
5-15R
5-15P
Black 11.75
15.51
5.26
HBLC40123T7
1TRC3 / 403.25
Wire Leads
25
1613
SJT
125
10
-
5-15P
Yellow 9.5
11.38
4.11
HBLC25163
1TRC4 1 246.00
Includes HBL5969VBLK Connector
25
16/3
SJT
125
10
5-15R
5-15P
Yellow 9.5
11.38
4.11
HBLC25163C
1TRC5 246.00
IncludesAuto Shut Off Nonmetallic Incandescent Hand Lamp
25
16/3
SJT
125
0.6
-
5-15P
Yellow 9.5
11.38
4.11
HBLC25163AIN
1TRC6 278.50
Metallic Incandescent Hand Lamp and Receptacle
25
14/3
SJT
125
13
5-15R
5-15P
Yellow 9.5
11.38
4.11
HBLC25143IN
1TRC7 W 347.75
Fluorescent Hand Lamp and Receptacle
40
16/3
SJT
120
10
5-15R
5-15P
White 9.5
11.38
4.11
HBLC40163FL
1TRC8 306.25
Auto Shut Off Fluorescent Hand Lamp
40
18/2
SJTOW
120
0.3
-
5-15P
White 9.5
11.38
4.11
HBLC40182AFL
1TRC9 340.50
hrdasbUl
Includes Cord End HBL5269C Connector
45
12/3
SJEO
125
15
5-15R
5-15P
Yellow 12.38
13
9.75
HBL45123C
1TRA7 V 1,294.00
Includes Portable Duplex Outlet Box
45
12/3
SJEO
125
15
5-15R
5-15P
Yellow 12.38
13
9.75
HBL45123R
3KT77 V 1,236.00
Includes Cord End HBL5369C Connector
45
1213
SJEO
125
20
5-20R
5-20P
Yellow 12.38
13
9.75
HBL45123C20
1TRA8 V 1,425.00
Includes Portable Duplex Outlet Box
45
12/3
SJEO
125
20
5-20R
5-20P
Yellow 12.38
13
9.75
HBL45123R20
1TRA9 V 1,569.00
Includes Cord End HBL2313 Connector
45
12/3
SJEO
125
20
L5 -20R
5-20P
Yellow 12.38
13
9.75
HBL45123TL20
1TRB1 V 1,425.00
Includes Cord End HBL2313 Connector
45
12/3
SJEO
125
20
L5 -20R
5-20P
White 12.38
13
9.75
HBL45123TL20W
1TR82 / 1,425.00
Includes Incandescent Hand Lamp
50
16/3
SJEO
125
0.8
-
5-15P
Yellow 12.38
13
9.75
HBL50163IN
1TRB3 f 1,256.00
Pivot Base
-
-
-
-
-
-
-
Black
-
HBL340PB
1TRB4 V 198.50
1
14'Cord Reel
50
14/3
SOW -A
600
15
-
-
Yellow 13.75
16.25
12.19
HBL501431W
1TRB51 1,787.00
16' Cord Reel
50
12/4
SOW -A
600
16
-
-
Yellow 15.75
18.25
14.19
HBL501242W
1TRB6 ( 1,981.00
16' Cord Reel
50
10/3
SOW -A
600
25
-
-
Yellow 15.75
18.25
14.19
HBL501032W
1TRB7 V 2,001.00
16' Cord Reel
50
10/4
SOW -A
600
20
-
-
Yellow 15,75
18.25
14.19
HBL501042W
1TRB8 V 2,167.00
14' Pivot Base
-
-
-
-
-
-
-
Yellow -
-
-
HBL14PB
1TRC2 V 149.10
$tatie DkCharge
Single 3hi Steel Cable
50
-
-
-
-
Yellow 8.62
8.81
3.35
HBL50SD
1TRB9 V 557.50
Dual (Y) 3h2' Steel Cable
50
-
-
-
-
-
-
Yellow 8.62
8.81
3.35
HBL50YSD
1TRC1 / 702.00
Recommended replacement lamp., No. 1PGU6.
Industrial -Grade Retractable Co I
RTB Series, 60OV/30A Slip Ring Rating
Designed for continuous -duty indoor or outdoor appli-
cations. Feature 12 -position guide arm and ratchet MA
lockout to provide versatility. 6 -ft, feeder cord makes ►L 9
installation easy. Durable steel construction with yellow C
powder -coated finish. Heavy-duty, formed steel stand `
with mounting holes for ceiling, wall, or floor. Rated for BY
indoor or outdoor use, including wet locations. -� 13V788
14 No. 13V191
Description/ Cord Gauge/ Cord Max. NEMA NEMA Plug w H D Item $
Special Features Length (ft.) Conductor Type Voltage Amps Connector Config. Color (in.) (in.) (in.) No. Each
Blunt Ends 25 1613 SO 125 10 Yellow 7.75 13.83 12 13V188 505.50
Blunt Ends 35 16/3 SO 125 10 Yellow 7.75 13.83 12 13V189 625.00
Blunt Ends 50 16/3 SO 125 10 - - Yellow 7.75 13.83 12 13V190 695.00
(2)-15A Duplex 25 16/3 SJ 125 10 5-15R 5-15P Yellow 7.75 13.83 12 13V191 689.50
(2)-15A Duplex 35 16/3 Si 125 10 5-15R 5-15P Yellow 7.75 13.83 12 13V192 736.50
(2)-15A Duplex 50 16/3 SJ 125 10 5-15R 5-15P Yellow 7.75 13.83 12 13V193 818.50
(2)-15A Duplex 50 14/3 SJ 125 15 5-15R 5-15P Yellow 7.75 13.83 12 13V194 r 834.50
`\y Single Plug 25 12/3 SJ 125 20 5-20P Yellow 7.75 13.83 12 13V195 835.00
Single Plug 50 12/3 SJ 125 20 5-20P Yellow 7.75 13.83 12 13V196 906.00
Duplex GFC1 25 12/3 SJ 125 20 5-20R 5-20P Yellow 7.75 13.83 12 13V197 977.50
Pivot Base for RTB & RTF Series Reels 7 1 6 13V202 / 234.00
Take COST out of managing inventory with grraingercom/keepstock 1-800-GRAINGER 501