13060186 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20705 VALLEY GREEN DR CONTRACTOR:NOVO CONSTRUCTION PERMIT NO: 13060186
OWNER'S NAME: CAMPUS HOLDING INC 1460 O'BRIEN DR DATE ISSUED:08/01/2013
MENLO PARK,CA 94025 PHONE NO:(650)701-1500
OWNER'S PHONE: 4088629799
❑
JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
APPLE-T.I.TO RECONFIGURE(E)OFFICE AREA ON IST
License Class Lie.# / o Z- &2ND FLRS,INCLUDING ABOVE T-BAR DUCT WORK&
Contractor yo V0 X11 44V Date 1 / LIGHTING FIXTURES.REPLACE SINKS&DRAINS IN(E)
I hereby affirm that I am licensed under the provision s o 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 Valuation:$750000
performance of the work for which this permit is issued. Sq.Ft Floor Area:
'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 APN Number:32610046.00 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 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 FROM L ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, //_3
costs,and expenses which may accrue against said City in consequence of the Issued b Date:
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.
j 1 � RE-ROOFS:
Signatur_ -- . Date / /7 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 Date:
Signature of Applicant:
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)
HAZARDOUS MATERIALS DISCLOSURE
1,as owner of the property,am exclusively contracting with licensed contractors to
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 Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25$33, d 2 34. ;
I have and will maintain Worker's Compensation Insurance,as provided for by r
Z 12
Section 3700 of the Labor Code,for the performance of the work for which this // Date. i'
Owner or authorized agent i-
permit.is issued. '"''
777
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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.
I
Signature Date
I
I
_ CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20705 VALLEY GREEN DR DATE: 06/24/2013 REVIEWED BY: MELISSA
APN: 326 10 046 BP#: �- EVALUATION: 1$750,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 B T�
WORK T.I. TO RECONFIGURE E OFFICE AREA ON 1ST & 2ND FLRS INCLUDING ABOVE T-BAR DUCT
SCOPE WORK& LIGHTING FIXTURES. REPLACE SINKS & DRAINS IN (E) BREAK ROOM
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-13,111-13,IV,V-B 42,638 $4,510.12 IBTIPLNCK $16,016.77 IBTIINSP
TOTALS: 42,638 $4,510.12 $16,016.77
MECH,HOURLY 0 Yes ' (D No PLUMB,HOURLY 0 Yes 'E) No ELEC,HOURLY' ® Yes Q No
tA46:3).Plura Check P/rumb, Plcm Check EYec.PhIII C'hcek
1<fech.Perr)ril Fee: Plumb, Pernil Fee: Elec. Permit Fee:
Ofher rilech, 71,1sp. Oilier Phrrvab hasp. Ll Oilier Flee.Rup. Li
Aleck,111sp, F=e: I Plumb. hap, Fee: Flee.My.Fee:
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 7/1/122 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $4,510.12 Select a Misc Bldg/Structure
Suppl.PC Fee: (D Reg. () OT 0,0 hrs $0.00 or Element of a Building
i
PME Plan Check: $0.00
Permit Fee: $16,016.77
Suppl. Insp.Feer Reg. Q OT 10701 hrs $0.00
PME Unit Feer $0.00
PME Permit Fee: $0.00
Consiruciion Tax:
Administrative.Fee: 0
Work Without Permit? Yes E) No $0.00 E
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Doctunentcrlion Fees,: Building or Structure 0
i
Strong Motion Fee: 1BSEISMICO $157.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $30.00
SUBTOTALS: 20,7114.391 $0.00 TOTAL FEE: $20,714.39
s� Revised: 04/29/2013