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14070017: CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10080 N WOLFE RD STE SW3-350 CONTRACTOR:APPLIED PERMIT NO: 140700 t7 CONSTRUCTION TECH OWNER'S NAME: 1&G DIRECT REAL ESTATE LP 1230 OAKMEAD PKWY DATE ISSUED:07/07/2014 OWN'ER'S PHONE: 4089828433 SUNNYVALE,CA 94085 PHONE NO:(408)252-9990 s ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] �--I -� SUITE 350: INSTALLATION (3)SERVER RACKS WITH(1) License Class Lie.# COOLING MODULE. Contractor rr,.J6tte f I hereby affirm that 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$30450 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 1 APN Number:31620086.3350 Occupancy Type: permit is issue 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 18 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 FR ST 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 /y granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: / with all non-point source re la ions per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date u 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 al I new materials for inspection. ❑ O R-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 die 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. 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 Cupertin unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25" and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 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,1 CONSTRUC ON 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 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ,[1 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 D/ !7 CUPERTINO (408)777-3228 • FAX(408)777-3333• buildinp(c�cupertino.org Iq✓ G ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIG[NAL PERMIT# PROJECT ADDRESS 10080 N. Wolfe Rd SW3 Suite 350 APN1 OWNER NAM ,'-, P if� &MAIL 8) 982-8433 mgoudeauxOriverrockreg.com STREET ADDRESS IOOBO N. Wolfe Rd SW3-301A CITY sT�JATE, IP, FAX Cu erZtino, CA 95014 CONTACT NAME Jerry Komp "'Wh-8 5 8-4 9 9 8 EjkompOact-gc.com STREET ADDRESS CITY,STATE, ZIP FAX 1230 Oakmead Prkwy Suite 216 Sunnyvale, CA 94085 ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CON'TRACTORNrE LICENSE NUMBER -730642 LICENSE TYPE BUS.LIC# 22815 Stephen D. Mason B COMPANY NAME E-MAIL FAX MAS Applied Construction Technology smason@act-gc.com STREET ADDRESS CITY,STATE,ZIP 1230 Oakmead Prkwy Suite 216 Sunnyvale, CA 94085 U 'E 328-8400 ARCHITECT ENGINEER NAAMt�E LICENSE NUMBER BUS.LIC# Kevin T. O'Keete 5-4192 COMPANY NAME E-MAIL FAX Universal Structural Engineers ktokeefe®UniversalStructuralEngineers.com STREET ADDRESS CITY,STATE,ZIP PHONE 1660 S. Amphlett Blvd, Suite 250 San Mateo, CA 94402 650-312-9233 DESCRIPTION OF WORK ( EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS ASECOND UNIT []YES SECONDSTORY AYES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVE Y: OTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO r� By my signature below,I certify to each of the following: I am the property owner or authorized agent to acct on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of W ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi o io ze representatives of Cupertino to enter the above-identifiedpro erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEN ATI- REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD Or Multi 'Ily dw ings: ply for demolition permit for OVER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). emoliY pe Is required prior to issuance of building permit for new building. EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs:. ovide 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 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10080 N.Wolfe Rd , Suite 350 DATE: 07/07/2014 REVIEWED BY: Sean APN: BP#: �QD� VALUAT[ON: $30,450 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building PENTAMATION FURN/AC USE: PERMIT TYPE: A wORK Suite 350: Installation 3 server racks with 1 cooling module SCOPE Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: 1MPERMIT Other Mech. Insp. 0.0 hrs $47.00 07twr Pb,rnh �r�,,. 7- �,�:, Li ( ' 77th'. ?r.';� I. 1 t.. r.tti� ;1,; 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 prelimina information available and are only an estimate- Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7'11"13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Mechanical Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $139.00 IMCRAA Cooling Unit PME Plan Check: $0.00 Permit Fee: Hourly Only? ©Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 ( ,)t?N(t'uc'lion r cti Administrative Fee: 1ADM/N $44.00 Work Without Permit? 0 Yes 0 No $0.00 G Advanced Planning,Fee: $0.00 fours Inspections Travel Documentation Fee: 1TRA VDOC ✓ $47.00 $278.00 1STINSP Inspection, Hourly Strong Motion Fee: 1BSEISMICO $6.39 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 ' :.>::::. $ TOTAL FEE: $ $146.39 47.00 563.39 �' Revised: 07/01/2014