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13070139 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19333 VALLCO PKWY CONTRACTOR:DEVCON PERMIT NO: 13070139 CONSTRUCTION INC OWNER'S NAME: CAMPUS HOLDING INC 690 GIBRALTAR DR DATE ISSUED:07/23/2013 OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL EI License Class AE5 Lic.# L 1 d(o 6 APPLE-T.I.TO RECONFIGURE(E)OFFICE AREA TO CREATE 4(N)OFFICE SPACES& 1 (N)OPEN OFFICE Contractor Div czy% w C- Date 23 AREA(INCLUDING PARTITIONS,DOORS,CEILINGS& 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$250000 1 have and will maintain Worker's Compensation Insurance,as provided for by i Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31620076.00 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 FRO T LED 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 Z granting of this permit. Additionally,the ap licant understands and will comply Issued Date: with all non-point source ERulations a Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 23 13 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 Cupert' Muni ' e,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections ,255 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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,1 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 d\ Is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION h� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M CUPERTINO (408)777-3228• FAX(408)777-3333• building(a�cupertino.org J ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 7APN ALL� �vVy k -3 ' i 2 OWNERNAME PHONE l��r ��AppLE1true 0'IO 1O E-MAIL STREET ADDRESS CITY, STATE7IP Ir /`�� I�O , I r 01q q0 0, FAX CONTACT NAME ¢Ne�yg t�-�+PJINSa�' PHONE V,(0(0Co.(o�l�f E-MAIL �4JJ1. l"•" �bb,e-robi,n��t a ,t�.u• STREGTADDRESS .r 33CITY,STATE, ZIP U rz-r1 c+' y7q. p OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �/'�v I� t n w r LICENSE NUMBER Ir^� LICENSE TYPE BUS.LIC#2qqr 1vr_ COMPANY NAME f" E-MAIL `Y/, FAX I \V 'MVCal.1 Gt4S-TR.UC,n0r.J IrJG iryv„n �v ✓t-c7ovtS�• CarY� '{00.21vL.2, �Z STREET ADDRESS � „-71-6,a 1-6✓ l..i(-- CITY,STATE,ZIP A ;t S � �25 PHONE Lt_. .qq2. 2W ARCHITECT/ENGINEER NA AMLV FO LICENSE NUMBER 01�. �^ J BUS.LIC#1V COMPANY NAME _�D{L04'LS I E-MAIL d FAX STREET ADDRESS CITY,STATE,ZIP �� IU (A PHONE Ill � ��j•\p DESCRIPTION OF WORK G I --( C work- � ��I C-1IlC� / Jr� �rQ4Vv `` c l I d1 t.1/ FYGG5 Ci(i iIir w�✓ h G(ak exivtj p EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES © (1� �(�( �� USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG h NEW FLOOR C'I�`"`-/� DEMO JL TOTAL c /}, Q AREA 2081 S� AREA AREA ' NET AREA �8,-15.1 (_L L.9- /f 68-7 ,2�o BATHROOM Ll KITCHEN OTHER T'P s�� REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 0 4 b 0 []ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY OYES BEING ADDED? �NO ADDITION? •f g�N0 PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES E TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? 5LNO - ,25,p bOp -Ii By my signature below,1 certify to each of the following: I am the property owner or authorized agent to act on perty owner's behalf. I e read this application and the information I have provided i correct. l have a Description of Work and verify it is accurate. I agree to comply with all a �licable local ordinances and state laws relating to b I onstructi ut orize representatives of Cupertino to enter the above-identife property for inspection purposes. Signature of Applicant/Agent: Date: 7 2 SUPPLEMENT LINFORMATIONREQUIRED PLAN CHECK TYPE ROUTING SLIP _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. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 19333 VALLCO PKWY DATE: 07/23/2013 REVIEWED BY: MELISSA APN: 316 20 076 BP#: ;j Q�70 f 3 '7 *VALUATION: 1$250,000 ;P!'ERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 B TI WORK APPLE -T.I. TO RECONFIGURE E OFFICE AREA TO CREATE 4 N OFFICE SPACES & 1 N SCOPE OPEN OFFICE AREA (INCLUDING PARTITIONS, DOORS, CEILINGS & MECH & ELECTRICAL) OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,III-B,IV,V-B 2,087 $2,182.24 1BTIPLNCK $1,835.82 1BTIINSP TOTALS: 2,087 $2,182.24 $1,835.82 MECH,HOURLY Yes (F) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No ,11,1ech. Pion Check Phunb. Plan Check Elec.Plan Check Ftech. Permit Fee: Phamb.Permit Fee: Eer.. Permit Fee: Other;llech.Insp. Other Plumb Insp. Other Elec.Insp. Li illech. Insp. Fee. Plumb. Insp. Fee: Elec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). TheseLees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff..* 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,182.24 Select a Mise Bldg/Structure Suppl.PC Fee: Q Reg. O OT 0.0 1 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,835.82 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: -FT $0.00 Construction .Tela-: Administrative Fee: 0 Work Without Permit? C) Yes C) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential O Travel Documentation Fees: Building or Structure 0, Strong Motion Fee: IBSEISMICO $52.50 Select an Administrative Item Bldy Stds Commission Fee: 1BCBSC $10.00 SUBTOTALS: $4,080.56 $0.00 TOTAL FEE: 1 $4,080.56 Revised: 07101/2013 Building Department City Of Cupertino 10300 Torre Avenue V , 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: q 9411.Co PERMIT# OWNER'S NAME: PHONE# Lib • q42,PJ2l0 GENERAL CONTRACTOR: �,,� 1 �, BUSINESS LICENSE# 1000 ADDRESS: G% at M. CITY/ZIPCODE: i I c*J- q5035 *Our municipal code Lrequires 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: %/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 12EOVvoo a E �c Excavation Fencing Flooring / Carpeting Linoleum/Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contr or Sig ture Date