12110121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20401 STEVENS CREEK BLVD CONTRACTOR:NOVO CONSTRUCTION PERMIT NO:12110121
OWNER'S NAME: WDV PROPERTIES 1460 O'BRIEN DR DATE ISSUED:11/27/2012
OWNER'S PHONE: 4082887833 MENLO PARK,CA 94025 PHONE NO:(650)701-1500
❑ LICENSED CONTRACTOR'S DECLARATION r—
BUILDING PERMIT INFO: BLDG ELECT PLUMB '
License Class Lic.# 2_ ���' � ?
MECH RESIDENTIAL COMMERCIAL s
Contractor 444 ,` Date 4
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APPLE-COMMERCIAL OFFICE TENANT IMPROVEMENT
(commencing with Section 7000)of Division 3 of the Business&Professions TO
Code and that my license is in full force and effect. (2)BREAK ROOMS AND ADDITION OF(3)SECURITY DOORS
(500 SQFT)
I hereby affirm under penalty of perjury one of the following two declarations: �p�`S1G � �A U/u/J�
I have and will maintain a certificate of consent to self-insure for Worker's � f2
Compensation,as provided for by Section 3700 of the Labor Code,for the U/�/� /� /O7 rZC/�; G�/�CEJ -21 OdV
performance of the work for which this permit is issued.
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
permit is issued. Sq.Ft Floor Area: Valuation:$50000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:31626090.20401 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. f ,� 180 DAYS FROM LAST CALLED INSPECTION.
SignatureDate %f Issued by: Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
1
become subject to the Worker's Compensation provisions of the Labor Code,I must
Ower o� razed agent:
forthwith comply with such provisions or this permit shall be deemed revoked. � �i° �,-�
Date: 1x10
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ARCHITECT'S DECLARATION
Signature Date I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
WIA
DDRESS: 20401 Stevens Creek Blvd DATE: 01/09/2013 REVIEWED BY: Sean
PN: BP#: 12110121 *VALUATION: $20,000
PE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: PERMIT TYPE:
WORK Revision#1: Add 1 roof top condensing unit and interior fan coil.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $67
TOTALS: $67.00
Mech.Plan Check 10,61hrs $0.00
Mech.Permit Fee: IMPERMITpi
ari,';"ee.
Other Mech.Insp. 0.0 hrs
!c= bi. <,1.0:
NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $67.00
PME Permit Fee: $45.00
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Blda Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $202.00 $0.00 TOTAL FEET $202.00
Revised: 10/01/2012
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20401 STEVENS CREEK BLVD CONTRACTOR:NOVO CONSTRUCTION PERMIT NO:12110121
OWNER'S NAME: WDV PROPERTIES 1460 O'BRIEN DR DATE ISSUED:11/27/2012
OWNER'S PHONE: 4082887833 MENLO PARK,CA 94025 PHONE NO:(650)701-1500
C3 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB
License Class 7!� Lic.#
MECII RESIDENTIAL COMMERCIAL
Contractor ' Date '7 �
I hereby affirm that I am license under the provisions of Chapter 9 JOB DESCRIPTION:APPLE-COMMERCIAL OFFICE TENANT IMPROVEMENT
(commencing with Section 7000)of Division 3 of the Business&Professions TO
Code and (500,that my license is in full force and effect. ( BREAK
ROOMS AND ADDITION OF(3)SECURITY DOORS
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.
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
permit is issued. Sq.Ft Floor Area: Valuation:$50000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:31626090.20401 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature
Date ' z Issued by: "" _.____ Dates
� .�-��� _ -
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
performancewoCalifornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and of the
rn Worker's Compensation Insurance,as provided for by
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authoriz agl!: : 1 Z
�� Date-
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
7MFEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20401 Stevens Creek Blvd DATE: 11/20/2012 REVIEWED BY: Sean
APN: BP#: �-- VALUATION: 1$50,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION rTrl
USE Commercial Building PERMIT TYPE: 1` "
WORK Office tenant improvement to 2 break rooms and addition of 3 security doors 500 s ft . {, `
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID s BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-B,III-B,IV,V-B 500 ( $1,959.80 IBTIPLNCK $674.14 IBTIINSP
TOTALS: 500 $1,959.80 1 $674.14
MECH,`HOURLY 0 Yes (F) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY'' ® Yes F)No
1. .,
El
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 E . 7/1112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,959.80 Select a Misc Bldg/Structure
Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $674.14
Suppl. Insp.FeelD Reg. 0 OT p p hrs $0.00
PME Unit Fee: $0.00
PN/1E Permit Fee: $0.00
0
Work Without Permit? 0 Yes (F) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential
rti a 'a > r : rr ... {:' "5, Building or Structure
i
Strong Motion Fee: 1BSEISMICO $10.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $2.00
SUBTOTALS:I $2,646.44 $0.00 TOTAL FEE: 1 $2,646.44
Revised: 10/01/2012
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingPcupertino.org
CUP.ERTINO �
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT
PROJECT ADDRESS „ _ APN#
OWNERNAME PHONE/ E MAII, ��yy
STREET ADDRESS CITY, STATE, FAX
CONTACT NAME jP PHONE E-MAIL
STREET ADDRESS (� „\ CITY,STQ,TE,QIP , FAX
P oc
❑OWNER ❑ OWNER-BUH.DER ❑ OWNER AGENT t^`'0�CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# '&B p
COMPANY NAME - - E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE _
ARCHITECT/ENGINEER NAME PLICENSE NUMBER BUS.LIC#
fl
COMPANY, E-MAIL FAX
STREET ADDRESS CITY,STATEZIP PHONE
)
DESCRIPTION OF WORK
CElyl L -af, 17f
EXISTING USE PROPOSED USE CONSTR TYPE I #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
r
c'-1
BATHROOM KITCHEN OTHER
REMODEL AREA - REMODEL AREA REMODEL AREA -
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
[]ATTACH
- -
#DWELLING UNITS: IS ASECOND UNIT ❑YES SECONDSTORY []YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION.❑YES IF YES,PROVIDE COPY OF - IS THE BLDG AN ❑YES RECEIVED BY: - TOT 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 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 constructik. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Agent: � a 9�4L Date: 1
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE TINGSLIP
sr
New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. El LARGE ❑ FTRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. MAJOR SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2 0 11.do c revised 06/21/11
UNREASONABLE HARDSHIP E:EMPTION FORM
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•buildinci( cuper6no.org
For Tenant Improvements where the Cost of Construction does not exceed $128,410.90)
SITE ADDRESS APN BP#
2 b vIR4Ai2D
CITY CA ZIP TOTAL CONSTRUCTION COST A $...5a..0o..........................
DESCRIPTION OF WORK: C) CNMISSIONEV
�,� j° &fes` 1$1� GmBE Ores?VP e.
W11 ollowing is a list o casts to pro! a cess features in order to comply 100%with the current State Title-24 Disable Access 5tandards.(All
costs to be documented by actual bids or other information accepted by the Bui ding Official.
Accessible Features Complies with If not,rest required upgrades in order for Cost to make feature
current standards? features to fuIIX comply? full accessible?
1.Path of travel to accessible entrance. Wo O^ _ $ 1��
2.Cost of providing a primary entrance. (Including but t
not limited to,thresholds,landings,door hardware, �e�GJ $
max.doorpull.-etc.) 1
3.Cast of providing the primary path of travel to the
spec area of alteration,structural repair,or $
addition.
4.Cost of providing accessible restroom facilities. 6® POOR I'-�Le%'1 TDILET
tv
5.Cost of providing an accessible drinking fountain. (if $
required or if a drinking fountain is provided.) �C
5.Cost of providing accessible public telephones(if $
provided)
7.Cost of providing other accessible features,including t MILLWW i�"T*VCtessiev 1
but not limited to,parking,storage,alarms etc. ni $ 9 )2
TOTAL COST OF ACCESS FEATURES(B): $ Q 2� �ypp
Has the same tenant performed work in the l ` Calculate(B 1 A)x 100% %
same tenants ace within the last three ears? ® >�
Description of access features to be provided:
2-
TOTAL COST OF {{ PERCENTAGE (20%minimum „
PROPOSED UPGRADE $ I, � Zed expenditure is required) %Z�-�� �
ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify that the agovp noted information is true and correct. ,p .
Name(print): W1 0 Signature: [ t�e-�. _ Date:
Firm address: 1'U9 �p; �.Q14•2NO9 �ile:�e�7�� Phone 2116"' I n
--------------------- FOR DEPARTMENT USE ONLY - --------------- ---------- ---
❑ The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 11348.2.1.
p The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR-Title 24
(Regulation for the Accommodation of the Disabled)pursuant to 2010 CBC Section 11346.2:1.
COMMENTS:
p �-
Building Official Designee(print): 5E= ��!G�>' � Signature: if Date: Z/"
HardshipExempdonForm 2011.doc revised 02/25/17
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CIdFERT[NO (408)777-3228•FAX(408)777-3333• buildin cu ertino.or
[:]NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN#
OWNERNAME f)fjon PHONE E-MAIL
e r
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
P ,� -6?0-
STREET ADDRESS4 CITY,STATE,ZIP FAX
MfAA0 FA' F–IC CA !1407-5
❑OWNER ❑ OWNER-BuJLDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL % FAX
6 EllsAfbJZX-19LV le-N60 Ca-45ER
STREET ADDRESS CITY,STATE,ItZIP 5.1IIP PHONE 0' 1
ARCHITECT/ENGINEER NAME LICENSE NUMBER SS 5.J BUS.LIC#
COMPANY NAME ,� S E-MAIL ► FAX
STREET ADDRESS % Af, CITY,STATE,ZIP PHONE
so�f- CA 511
DESCRIPTION OF WORK
,�
ll,
rio o lull' c)R
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
� I ` USE TYPE OCC. SQ.FT. VALUATION(S)
EAM-_ATG FLOOR AREADEMO TOTAL
4033,
( AREA '0 [ `fid
BATHROOM KITCHEN OTHER _...
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: LIDETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVEDY: TOT VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO
000
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 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 constructiok I authorize representatives of Cupertino to enter the abov -identified property for inspection purposes.
Signature of Applicant/Agent Date: ,7(:5 /z—
SUPPLEMENTAL INFORMATION REQUIRED PLAIN CHECK TYPE ROUTING SLIP
W9
_New SFD or Multifamily dwellings: Apply for demolition permit for 11ovER-THE COUNTER W1 BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building f
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide 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 06/21/11