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14100071 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR:DEVCON PERMIT NO: 14100071 CONSTRUCTION INC OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 10/13/2014 OWNER'S PHONE: 4088624575 MILPITAS,CA 95035 PHONE NO:(408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL 0 S1Y APPLE TENANT IMPROVEMENT TO CREATE NEW LAB License Class Liicc.# M—(�1�1(��}}) (171 SQ >n,�NContractoVfthDate FT). 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. 1 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$75000 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 91 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 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 `j��NA�7��W granting of this permit. Additionally,the applicant understands and will comply Issued by: �/ Date: 7 with all non-point source regulations p the Cupertino Municipal Code,Section 9.18. 0RE-ROOFS: Signatur Date I I 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 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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). 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 thChapter 9.12 and have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,SecA""Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent. Dat 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,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 1 certify that I 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 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 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 (408) 777-3228- FAX (408)777-3333- building aDcupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS Io, D ,n�r �` APN# . OWNER NAME ,/�I /� /YJ 4f` (�Ir�JpGD P Olv -MAIL C/ pie �w 5 h STREET ADDRESSCITY STT ,ZJP 50 14 CONTACT NAME P(;'1It PHON cwmo� ` D 11L STREET ADDRESS '�;1AVItgr Yt` TA ,ZI C/ �"V�� FAX (�n el ❑ OWNER 13OW'N'ER-BUILDER 13OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM&�,J 1 _^ LICENSE NUMBE!F LICENSETY BUS.LIC# COMPANY NAME^,,, �ml E-MAIL vJ FAX STREET ADDRESS w CITY,STATE,ZIP PH ARCHrrECTIENGINEER NAME LICENSE NUMBER BUS.LIC# I � COMPANY NAME ` ^' )vt n� ` 1DCA)� FAX STREET ADDRESS V V� `00 CITY, co`ST'ATE,ZIP a,^ 1^ f C A gJ51 PHONFj DESCRIPTION OF WORKob tstyo 0A C e EXISTINGL'SE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA //1 / 5 OO BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA / 7/ PORCH AREA DECK AREA TOTAL DECK/PORCH.AREA GARAGE AREA: DETACH ❑.ATTACH k DWELLING UNITS: IS A SECOND UNIT EYES SECOND STORY ❑YES BEING ADDED? ENO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECE D BY TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑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 r ad this application and the information I have provided is correct. I have read the script' of ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relati t buildi c s c ' n. I authorize re e enta v s of pert, o to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ate:10-12) 1 SUPPLEMENTAL FORMATION REQU RED "PLANcffECkTYPE : RovTli,cSLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THcouivTERBvunmcPLANxEVIEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESS ' ��'+PLANNII\G PLAN REVIEW^ _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �l] sTaNnARD. - DPUBLrcveoRxs , form if any Hazardous Materials are being used as part of this project. ❑ LARGE PIItEDEPr _Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR:—' ❑ SANITARY SEWERDISTRICT` submittal of Building Permit application. 11 ENVIRONMENTAL HEALTH BldgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10300 BUBB ROAD DATE: 10/13/2014 REVIEWED BY: SEAN APN: BP#: 'VALUATION: 1$75,000 "PERMIT TYPE: Building Permit PLAN C ECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 B T� WORK APPLE TENANT IMPROVEMENT TO CREATE NEW LAB 171 SQ FT). SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE 1D BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,111-B,IV,V-B 171 $2,097.00 IBTIPLNCK $588.00 IBTIINSP TOTALS: 171 $2,097.00 $588.00 MECH,HOURLY Q Yes (D No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No F, Ll Ll 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 prelimina information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS(Eee Resolution 11-053 Eff, 7;'1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,097.00 Select a Misc Bldg/Structure Suppl. PC Fee: (j) Reg. 0 OT 0j0hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $588.00 Suppl. Insp. Feer Reg. Q OT rs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes (j) No $0.00 E) Advanced Planning?Fee: $0.00 Select a Non-Residential G Building or Structure i Strony,Motion Fee: IBSEISMICO $21.00 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $2,709.00 $0.00 TOTAL FEE: $2,709.00 Revised: 08/20/2014