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13120065 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19050 PRUNERIDGE AVE CONTRACTOR:DPR SKANSKA,A JOINT PERMIT NO: 13120065 VENTURE OWNER'S NAME: CAMPUS HOLDINGS INC 1450 VETERANS BLVD DATE ISSUED:01/09/2014 OWNER'S PHONE: 4089961010 REDWOOD CITY,CA 94063 PHONE NO:(650)474-1450 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALEI icense Class_ Lic.# 9 66 Zo 1 APPLE- INSTALL 12 TEMPORARY CONSTRUCTION d TRAILERS FOR SUBCONTRACTORS Contractor �PZ Date I ��'�`� 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: 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 rIerformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$100000 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:31606033.00 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 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 1.80 DAY M L T CALLED INSPECTION. indemnifyand 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 per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: t of fu b3 Dale All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I 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 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(Scc.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 Codc,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 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 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S etions 25505,25533,and 5534. Section 3700 of the Labor Code,for the performance of the work for which this 0,09. u lio agent: Date:L__9—l-1 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 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 Dale CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION Ud 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1�f (408)777-3228• FAX(408)777-3333•bu1IdindCa),cupertino.org CUPERTINa ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION I DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS K 1050 M I WE K APN �I 0 to L 3 OWNERNAME � 1��I�`Ghc �7td�CAV�L ,c PHONja o m ��v E-BAIL STREETADDRESs, 1"UTELOOP MCS 36- ZTK 111,(E �E��O CA 9 FAx CONTACT NAMEt4we mus PHONEE-MAIL �IllSe .��►^� STREETADDRESsI�O� Q�uT �l�f CITY,STATE„ZIP FAX C on' mt-iD, CA QS t ❑ OwNER ❑ OWNER-BOH.= ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR,AUNT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME JO640 LICENSENUMBER LICENSE TYPE BUS.LIC COMPANY NAME nrJ� Co�rsT ,�alri) E pl�ntn.Jo•toQaw�K�prSltaK�ul.caw� FAX STREET ADDRESSj-l� U�,�, .,L l p� rD CITY`,STATE,ZIP /�{ O G PHONES_4 ,-`u ARCHTTEMENGTNEERNAME LICENSE NUMBER BUS.LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 17-y- C-W7r ti`+CT(5Q 41.E 1- svgz , c"R atj EXISTING USE PROPOSED USE CONSTR-TYPE #STORIES USE TYPE OCC. SQ.fir. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL ARTA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA RFMODELAREA PORCH AREA. DECKAREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING ONUS: 1S A SECOND UNrr ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? [:]NO PRE-APPLICATION [I YES IF YES,PROVIDE COPY OF ISTHEBLDGAN DYESRECEIVED hP�9x T+:h'�:0��i=” PLANNING APPL# ❑NO PLAIQNING APPROVAL LEITER EICHLER HOME? ❑NO " ,14�.,'y` ,s`z.r By my signature below,I certify to each of the following: I am the property owner or authorize age o act on the property owner's behalf. I have read this V V application and the information I have provided is correct. I have read the Description of Work and fverify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construe ' ' c representatives of Cupertino to enter the tificd property for inspection purposes. Signature of Ap re • ,, 3, to 13 SUPPL NTAL INFORMATION REQUIRED _" PLANCHECKTYPE „a RO[TIING'SLII New SFD Or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ❑ oV1 R THE l OTDyTER C7 sun nlnG PLAI1 RE�7h�v permit for new building. ] EXPRE ❑.'Pi axN¢qGsLAN RE."EIV` r _Commercial Bldgs: Provide a colnpletcd Hazardous Materials Disclosure annDnRn ❑` Pt BLrc"1`'oxlcs form if any Hazardous Materials are being used as part of this project. L 3s LARCE ❑S FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to naAaoRi m ❑ s rrAnys�N��R�isTRTcr,• submittal of Building Permit application. 4 'ENIVIRONATEN`TAL'HEALTH Bld,&App_201].doe revised 06121111 CITY OF CUPERTINO IIFEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19050 pruneridge aveDATE: 12/0912013 REVIEWED BY: Mendez APN: BP!#: G "VALUATION: $100,000 *PERMIT TYPE: Building_Permit PLANCHECKTYPE: Tenant Improvement PRIMARYCommercial PENTAMATION USE: Building PERMIT TYPE: 1 GENCOM WORK [qMLq- install 12 construction trailers for subcontractors SCOPE Alt- Xtech,Plan Check _ Plirrnb.Plus Check Elec.Plan Check rM1-fecli.Permid lour: plumb, permil Fee; l lex, permit Fee: Or}rer Meeh,Insp. Orlker Plumb Imp. Other Elec.Insp. ,M1:Iech. Insp.Fee- plurn0. hap. Fee: Elec.Insp,Fee: NOTE:This estimate does not include fees due to other Departments(Le.`Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). 77rese ees are based on the prelindna in ormation,available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 Efr' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F12 # Temporary Structures Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $5,004.00 ITEMPSTR PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tin:; ,ldinli istralive Fee: Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0,00 Select a Non-Residential Travel Docuinexntatioi? Fees: Building or Structure A Strong Motion Fee: IBSEISAOCO $21.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $25.00 $5,004.00 _ TOTAL IiEE:� $5,029.00 Revised: 10/01/2013