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13020034y CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 5 INFINITE LOOP FLR 3 CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 13020034 OWNER'S NAME: CAMPUS HOLDINGS INC 1460 O'BRIEN DR DATE ISSUED: 09/192013 OWNER'S PHONE: 6503398338 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. # APPLE - SOUTHWEST PORTION OF 3RD FLR (6464 SF). x Contractor / Y W6 o.vr �z c. IJ d � / Date �° i �' IP ..1. TO 50MPLETE OFFICE & LAB SPACES, A j� I hereby affirm that I am licensed under the provisio is of ►apter 9 CIDjFFRENCE ROOMS &BREAK ROOMS. (E) MEP'S & (commencing with Section 7000) of Division 3 of the Business & Professions FIRE __MJ .--., Code and that my license is in full force and effect. / " I hereby affirm under penalty of perjury one of the following two declarations: REVISION #I- RECONFIGURE (2) ROOMS, AND REMOVAL OF (1) I have and will maintain a certificate of consent to self -insure for Worker's ROOM Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $1000000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 31602109.FLR3 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 180 DAYS ROM LAST CALLED INSPEVTIO N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the q J / 6 '++pp /1 Issued by: Date: ! y/ granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cu " o Municipal Code, Section 9.18. Signature Date / 1 4/AA, 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. ❑ OA'NER-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) 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 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 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 .hapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 2 3, an 553 Section 3700 of the Labor Code, for the performance of the work for which this is issued. �- Owner or authorized agent: Date: i cA permit 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 CITY OF CUPERTINO rm_� FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 5 INFINITE LOOP DATE: 10/24/2013 REVIEWED BY: MENDEZ APN: BP#: 13020034 *VALUATION: 1$40,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: Suppl. PC Fee: (DReg. 0 OTFo PENTAMATION PERMIT TYPE: WORK REVISION #1- RECONFIGURE 2 ROOMS AND REMOVAL OF 1 ROOM SCOPE NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta ). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 711113) 1 f.�t ,. �r i.. , fi . -,13 = t rtrr:, L _ _ `!._ C. �a�•e i� Plan Check Fee: o!bc t/ , .. E3_L_ Lj Suppl. PC Fee: (DReg. 0 OTFo i NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta ). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (DReg. 0 OTFo 7 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.`onswlw ioo 1'ox: 0 Work Without Permit? © Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 licnc1 I)Gttt�r.c°;;tuf;oer i ;.,�_ Strong Motion Fee: IBSEISAHCO $8.40 F-1-1 # $834.00 Revisions IREVCONITI Tenant Improvement Bldy Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $10.40 $834.00 TOTAL FEE: $844.40 Revised: 10/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 5 INFINITE LOOP FLR 3 CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 13020034 OWNER'S NAME: CAMPUS HOLDINGS INC 1460 O'BRIEN DR DATE ISSUED: 09/19/2013 OWNER'S PHONE: 6503398338 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class__ Lic. # %GJ fid 2 Z APPLE - SOUTHWEST PORTION OF 3RD FLR (6464 SF). CpN�!/�o�./ INTERIOR T.I. TO COMPLETE OFFICE & LAB SPACES, Contractor —1.0 Date ! 3 ADD I hereby affirm that t am licensed under the provisioiis of 4hapter 9 CONFERENCE ROOMS & BREAK ROOMS. (E) MEP'S & (commencing with Section 7000) of Division 3 of the Business & Professions FIRE 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: $1000000 performance of the work for which this permit is issued. 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: 31602109.FLR3 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 0 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 OM 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 f ,� / ? granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulatio er the ertino Municipal Code, Section 9.I8. 9//qh-K RE -ROOFS: Signatu 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 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. 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(x) 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 de, C apter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 2553 - 5 4 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: ate: 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 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 RM -5 FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 5 INFINITE LOOP 3RD FLR DATE: 02/07/2013 REVIEWED BY: MELISSA PC FEE ID APN: 316 02 109 BP#: 'VALUATION: j$1,000,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: $4,890.70 PENTAMATION 1B TI PERMIT TYPE: WORK APPLE - SOUTHWEST PORTION OF 3RD FLR. INTERIOR T.I. TO COMPLETE OFFICE & LAB SCOPE SPACES, ADD CONFERENCE ROOMS & BREAK ROOMS. (E) MEP'S & FIRE SYSTEMS WILL BE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 6,464 $2,337.20 IBTIPLNCK $4,890.70 IBTIINSP Permit Fee: $4,890.70 Suppl. Insp. Fee -.0 Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'nnslr7rCtion Tcr.r: Adirjh isil"Qilvc f'ov: 0 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: 6,464 $2,337.20 71-urei 1}mvrrrcri'uFiix; Fc;:'". $4,890.70 Strong Motion Fee: IBSEISMICO MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes (E)No ELEC HOURLY 0 Yes- Q No MISC ITEMS Plan Check Fee: $2,337.20 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs Yi El $0.00 Permit Fee: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'I info. FEE ITEMS (Fee Resolution 1I-053 Eff.' 7/I/I2) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,337.20 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,890.70 Suppl. Insp. Fee -.0 Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'nnslr7rCtion Tcr.r: Adirjh isil"Qilvc f'ov: 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure 0 71-urei 1}mvrrrcri'uFiix; Fc;:'". Strong Motion Fee: IBSEISMICO $210.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $40.00 SUBTOTALS: $7,477.901 $0.00 TOTAL FEE: $7,477.90 k' , . Revised: 01/01/2013