B-2017-1323 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1323
10100 N TANTAU AVE CUPERTINO,CA 95014-2540(316 19 062) NOVO
CONSTRUCTION INC
MENLO PARK,CA
94025
OWNER'S NAME: PR CUPERTINO GATEWAY LLC DATE ISSUED:08/10/2017
OWNER'S PHONE: PHONE NO:(650)701-1500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class l3 Lic.#791022
Contractor NOVO CONSTRUCTION INC Date 02/28/2019 X BLDG _ELECT _PLUMB
MECH_RESIDENTIAL X COMMERCIAL
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. JOB DESCRIPTION:
APPLE TANTAU 7B-1ST FLOOR;T.I.-EXPANSION OF R&D SPACE
I hereby affirm under penalty of perjury one of the following two declarations: INCLUDING NEW FINISHES,MECHANICAL AND ELECTRICAL
1. I have and will maintain a certificate of consentto self-insure for Worker's WORK(4380 SF)
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. o REV#1:ADD PONY WALLS TO MOUNT ELECTRICAL WIRE MOLD;
2. I have and will maintain Worker's Compensation Insurance,as provided for by ADD SHADE FRAMING DETAIL;ADD CDA&VAC DROPS-ISSUED
Section 3700 of the Labor Code,for the performance of the work for which this 12-11-2017
permit is issued. - --
Sq.Ft Floor Area: Valuation:$630000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 19 062 A(Tenant Improveinents),B(Tenant Improvements)
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,costs,and expenses which •
may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally,,the applicant understands and will,comply with all non-point WITHIN 180 DAYS OFPERMIT ISSUANCE OR
source regulations per1the Cupertino Municipal'Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 12-11-20107 Issued by:Jasmine Archbold
•
Date:08/10/2017
OWNER-BUILDER DECLARATION "'
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be,inspected prior to any roofing material being installed.If a roof is
t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to removeall new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,a's owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec,7044,Business&Professions Code). Date: 12-11-20107
I hereby affirtmunder penalty of perjury one of the following three declarations:
i. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation„as provided for by Section 3700 of the Labor Code,for the
performance of th'e work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25505,25533,and 25534.
be deemed revoked. / / ^
Owner or authorized agent ( �✓
APPLICANT CERTIFICATION Date:12-11-20107
I certify that I'have read this application and state that the above information is CONSTRUCTION LENDING'AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's'Name
to save indemnify and keep harmless'the City of Cupertino against liabilities, ,
judgments,costs;and expenses which may accrue against said City in Lender's Address
consequence,of the granting of this permit. Additionally,the applicant understands
and will comply'With all non-point sdurce regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 12-11-20107 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1323
10100 N TANTAU AVE CUPERTINO, CA 95014-2540 (316 19 062) NOVO
CONSTRUCTION INC
MENLO PARK, CA
94025
OWNER'S NAME: FOUR SQUARE PROPERTIES DATE ISSUED: 08/10/2017 I
OWNER'S PHONE: PHONE NO: (650) 701-1500
License Class 3 Lic. #Z91022
Contractor NOVO CONSTRUCTION INC bate 02/28/2019
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:
1. 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
illimformance of the work for which this permit is issued.
I
have and will maintain Worker's Compensation Insurance, as provided for by
j, Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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, costs, and expenses which
may accrue against said City in consequence of the 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.
Date 8/10/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
APPLE TANTAU 713- 1ST FLOOR; T.I. - EXPANSION OF R & D SPACE
INCLUDING NEW FINISHES, MECHANICAL AND ELECTRICAL
WORK (4380 SF)
Sq. Ft Floor Area: I Valuation: $630000.00
APN Number: Occupancy Type:
316 19 062 B (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Jasmine Archbold
RE -ROOFS:'.
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
sale (Sec. 7044, Business & Professions Code)
z. I, as owner of the properly am exclusively contracting with licensed Signature ofApl
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/10/2017
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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
performance of the work for which this permit is issued.
2. 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
permit is issued.
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, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION 1
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, costs, and expenses which may accrue against said City in
consequence of the 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.
Signature Date 8/1012017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25!5K3, and 25534.
ner a thorized agent: �,�
t0
CONSTRUCTION LENDINGAGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec.'3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed