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13100102 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20401 STEVENS CREEK BLVD CONTRACTOR:NOVO CONSTRUCTION PERMIT NO: 13100102 OWNER'S NAME: WDV PROPERTIES 1460 O'BRIEN DR DATE ISSUED:10/15/2013 OWNER'S PHONE: 7078884367 MENLO PARK,CA 94025 PHONE NO:(650)701-1500 IFLICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class P Lic.# 7 ldLZ APPLE-T.I.-(N)EXHAUST DUCT FOR THERMAL CHAMBER,OUTLET RECEPTACLES FOR LAB BENCHES Contractor�(/`(� C�►.tl'7�'lrr'.T l b�Date U �J l3 & I hereby affirm that I am licensed under the provisions of Chapter 9 INSTALL(N)CARD READER AT(E)DOOR (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:$5000 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:31626090.20401 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.l agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS O 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 D +D 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Da �U with all non-point source regul s er the Cupertino Municipal Code,Section 9.18. G IJ /7 RE-ROOFS: Signature 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 I hereby affirm that I 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) 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(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 I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections fi3,3.and 25534. Section 3700 of the Labor Code,for the performance of the work for which this r permit is issued. Owner or authorized agent: Date: �o 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 ONSTRUCTION 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 constnrction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indcmnify 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 v CONSTRUCTION PERMIT APPLICATION �o COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building[c@cupertino.org CUPERT11140 ❑Nl-W CONSTRUCTION ❑ ADDMON ALTERATION/TT ❑ REVTSION/DEFERRED ORIGINAL.PERMIT# PROJECT ADDRESSzQ /) ' 7 o 3 - 2 (y O 0/ OWNER NAMEC� ONE Q E-MAIL P T 1 f 7o B Itf4� STREET ADDRESSCITY, STATE,LIP FAX 2Z0 SJrJNY lyc&? CO\TACT NAMEPHON E-MAIL /J �S ICD Al.CDM STREET ADDRESS CITY,STATE, ZIP FAX 9 2AIb sr s CH 17!5113 ❑ONTTER ❑ ONNER-BUIIDER ❑ OWNER AGENT ❑ COWRACIoR ❑CONTRACTOR AGENT X ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONRACTORNAME LICENSUMBER LICENSE TYPE BUS.LIC �Y EN -71162Z COMPANY NAME E-NIAIL pp FAX S OIJ Lt /Uo CSTiLtJ T CC1/Yr S I REF L'ADDRESS C1�T1;STATE ZIP O 2 S G�N I &W -'`� N(a0 11-K� i-1 7 ARCHITEC'I%ENGR4F,lER NA.VIE LICENSE NUNIBER BUS.LIC# 4lss 1."tJC COMPANY NAME. E-MAIL FAX S1RI:E:1'ADDRESS CITY,STATE,ZIP PHONE et SU DESCRIPTION OF WORK T' 4 r Ck Apo, n Gr— Lms 1t n icij C NST-AL.�Lc� Sreuc:rjz- liXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES N' V- Q i7 USE TYPE, OCC. SQ.FT. VALUATION($) EXIS'rG NEFLOOR DEMO IJ TOTAL 6^ AREA AREA ART A NEC AREA > 260 #a 5 600 3%rIIROOM KITCHEN OTHER RLMODEr.AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DPCK,PORCI-1 AREA GARAGE AREA: LJDEfACH []ATTACH #DWELMNO UNITS: IS A SECOND UNIT YES SECOND STORY ❑YES BEING ADDED? [:]NO ADDITION? []NO _ _ PRE-APPLICATION []YES IF YES,PROVIDE.COPY OF IS T111 BLDG AN ❑YES RE(;,tVL4�4'—. 7 �'"�� TOTAL VAL PIANNINGAPPLtf []NO PLANNING APPROVAL LETTER EICHLER HOME? NO 4 ' By my signature below,I certify to each ofthe following; I am the property Owrfror authorized agent to a n perty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constructs - I augkorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicanUAgent: Date: 161 /3 SUPPLEMENTAL INFORMATION REQUIRED PI:AN CHLCk TYPE 11UII11.\G SLIP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building (rVFR=1I[E c trlrua rx r r,aN rtt;vrE:Nr permit for new building. ❑ EXPRESS ❑ Pr.nN-NING PLAN RV.VTF V Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STA:YDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as pari of this project. ❑ LARGE "rrrtr DI irr Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 4L>alrx ysNITAxY SF:wsRDISI'xrcT C] FIN-ORON.. NTAL IIEALTIr BldgApp_3011.doC reviseel06121/I1 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20401 STEVENS CREEK BLVD DATE: 10/15/2013 REVIEWED BY: melissa APN: 316 26 090. 20 Y 01 BP#: "VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 B T� WORK APPLE -T.I. - N EXHAUST DUCT FOR THERMAL CHAMBER OUTLET RECEPTACLES FOR LAB SCOPE BENCHES & INSTALL (N) CARD READER AT(E) DOOR OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,111-B,IV,V-B 200 $2,036.00 IBTIPLNCK $571.00 IBTIINSP TOTALS: 200 $2,036.00 $571.00 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY 0 Yes Q No ELEC,HOURLY 0 Yes Q No ;bfecli. Pico ck ;nn. ( 'crn >icck fret x% ,vfec,h. Pl� Plumb. Permit l' lilac. Permit Pepe: Other Aleeh.Insp. Other Plumb Insp Other filer. Insp. Alech. Insp. Fere: Plumb. Insp. Pee: 1aer. Insp. Fire: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are onlV an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolulion 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,036.00 Select a Misc Bldg/Structure Suppl. PC Fee: 0 Reg. 0 OT TO.OThrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $571.00 Suppl. Insp. Fee:Q Reg. 0 OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee: 0 Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 T nivel Documentation Fens: I Building or Structure 0 i Strong; Motion Fee: IBSEISABCO $1.05 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $2,609.05 $0.00 TOTAL FEE: $2,609.05 Revised: 10/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 15TE VCN,S' CA, X- 8-V/L:-VA ft. 0 PERMIT# 1 0 OWNER'S NAME: fs rfL ' PHONE# GENERAL CONTRACTOR: V -M,; T-1 b BUSINESS LICENSE# ADDRESS: 1%Q CITY/ZIPCODE: A . V . *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring I Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile f- --2 �o 11 Y 1, 13 ner/ ractor Signature Date d Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 405-777-3228 C U PERTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: YC�� K �r -jf.ilAte,. !? PERMIT# 1 � &&S OWNER'S NAME: PHONE P GENERAL CONTRACTOR:A/ 'I/ F?. r ti.; fi 1[i. BUSINESS LICENSE 4' ADDRESS: 1�) f)' � b�Z j.-r CITY/ZIPCODE: 'Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any, subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAi\ZE BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/ WaIlpaper Pavim, y Plastering Plumbing Roofing Septic Tank Sheet Metal (.��`I'e 142 e44 Sheet Rock Tile A _6N1 ner./Contractor Signature Date HAZARDOUS MATERIALS CHECKLIST COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building o cupertino.org PURPOSE To minimize possible delays that would result for the Fire Department plan review, please complete the following checklist to determine if an additional level of Hazardous Materials plan review will be required. MARK 'YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING? PLEASE MARK YOUR ANSWER WITH AN 'X' IN THE YES OR NO BOX ON THE SIDE YES NO BELOW. 1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases, hazardous materials, etc. 2. Battery back-up rooms or racks. 3. Propane tanks. 4. Gasoline stations with underground tanks. 5. Installation or replacement above ground or underground storage of liquid petroleum products, liquefied petroleum gases, compressed natural gas, explosives or other ✓ regulated hazardous materials. 6. Gas rooms for dentist, doctors or veterinarians. 7. Generators with back-up diesel or other fuels. 8. Large refrigeration systems. V/ 9. Fuel cell systems. 10. Commercial pool systems. 11. Chemical Storage areas. 12. Flammable liquid storage. 13. Compressed Gases. 14. Dry cleaners. 15. Print Shops. 16. Auto Repair and Auto Body Shops. 17. Research and Development. For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa Clara County Fire Department, at (408) 378-4010. HasMar 2011.doc revised 03/07/11