B-2016-1273 (2)CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1273
10100 N TANTAU AVE CUPERTINO, CA 95014-2540 (316 19 062)
(NOV 0
CONSTRUCTION INC)
MENLO PARK, CA 94025
OWNER'S NAME: PR CUPERTINO GATEWAY LLC
DATE ISSUED: 01/28/2016
OWNER'S PHONE: 415-385-4474
PHONE NO: 650-394-5449
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lie. #,Zg=
Contractor ( NOVO CONSTRUCTION INC ) Date 01/28/2016
X BLDG —ELECT _PLUMB
MECH RESEDENTIALX COMMERCIAL
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.
JOB DESCRIPTION:
APPLE - T,I. PREP FOR SOUTH EAST CORNER (3670 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations:
r, 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.
2. I have and will maintain Worker's Compensation Insurance, as provided for
. U_ 0 by Section 3700 of the Labor Code, for the performance of the work for which
Sq. Ft Floor Area: 3670
Valuation: $10000,00
✓ this permit is issued,
APPLICANT CERTIFICATION
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
APN Number:
occupancy Type:
ordinances and state laws relating to building construction, and hereby
316 19 062
V-B
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, costs, and
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City In consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulatiov per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9,18.
Issued by: MELISSA
Signature Date 01/28/2016
Date: 01/28/2016
OWNER -BUILDER, DECLARATION
R Fit
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall, be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without fast obtaining an inspection, I agree to remove all new materials for
1. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sce.7044, Business & Professions Cade)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 01/28/2016
contractors to construct the project (Sec,7044, Business & Professions Code),
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. I have and will maintain a Certificate of Consent to self-insum for Worker's
Compensation, as provided for by Section 3700 of the Labor Cade, 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
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to became subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safely Code, Sections 25505 533, and 25534,
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized agen '
be deemed revoked.
Date: 01/28/2016
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above Information Is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is Issued (Sec, 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall he used as public records,
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 01l2812016
CUPERTINO'
CONSTRUCTION PERMIT APPLICATION
CC)NtlJiUNIT'P DEVEL"OPA4ENT DEPARTMENT BUILDING DIVISICId
D300 TORRE AVENUE -CUP FRTINO, CA 9501 "--3255
(408) 77-3228 FAX (4D6) 777-"s333 buildin0(dcuoeriir10.oro _ 20 1 b
LJ x� w CONSTRUCTION U ADDI1I0N . `Ll 4J_TERATI0?t / T I L REvis!CN i DEF_R1L D OP lomAL PBRI,ASi
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PR-.SPP_CATION ❑)r- Y=S, PROPuOE CoPY OF I IS THE BLDG AN ❑,a ) h A - " — TOTAL VA. UATON: —^_—
l'u-NNNG�PIL9 DNO PL/.'T�GAF. RO\'ALL_Ti_ SICK=?OMM? mT
By my signature below, I r. riy to each of the fellowinz: Ian the proper!), oN nu or sutbori _ _ t to set on the property owner's behalf. I have rezd this
app!ieetien and the information I hove provided is correct, I have read the Description of-W01-k snd ) erij� it is xec�ste. I atu, ee to comply, ',;;th all eoplicsde local
ermnances and state ISHs relating to beiiding cons,rv^ o I euihor' represerh_.;ves of Cupertino to enter the above-i �`i-�ed ,-o/p-.ry for rose^^tion purposes.
SirnatveofApp)iceDt/.±.rent Date' CI L lam_
S UPYL._EM FN 1AJ_ INr ORM_q TION_RQTJ=D .
New SFD or ?r4ultiia<a±ily dv,!-Ilings: Apply for donoiNon pa:-,+'t for
axisti" bUlidlnE(s). Dem.olitioz penit is reeulred Drioe to icsti mac. of building
D.-it for new building.
_ Commercial Bides: Provide a ao-pleted Hazz dvus Materials Disclosure
fora if -sty Hs:aado- ss Maieri al €e SeiDg used as . a,-t of the rroject.
Copy of Planning Approval Leer or Mectina c ;th ?!=;_,g prior to
submittal of BuildLag Pe -, it appheation.
1. doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
JAFADDRESS: 10100 N TANTAU AVE
DATE: 01/28/2016
REVIEWED BY: MELISSA
APN:
BP#:
"VALUATION:
$10,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? 0 Yes (E)No
PENTAMATION
PERMIT TYPE: 1TIPRE
WORK
APPLE - T.I. PREP FOR SOUTH EAST CORNER 3670 S.F.
SCOPE
VoP1P. i'1oPl 12GLi
PlffiJNb. C'lf'��
%eG. Plan
ti ]Y:- l'e9'm;3 HC'<±:
Phopb PcJ?Pdtl i'Kt?:
�Pf. l omk l`a['.
Ci:hrr .9f,ch. hasp
orht: flhtwh Inca
C dw/ bhr. Trip. ET
,nett. lrrsp. F,.x'.
Flur>Jb, Imp, Fte:
I:%e¢ ln:q,- fee:
NOTE: This estimate does not include fees due to other Departments (i.e, Planning, Public Works, Fire, Sanitary Sewer District' School
District. etc.). These fees are based on the oreltminmv information available and m'e on1v an estimate. Contact the Dept for addn'l into.
FEE ITEMS (Fed Rerolpltort 11-053 Eff 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$417.00
Tenant Improvement Prep
177PREP
Suppl. PC Fee: (F) Reg. O OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
7-7
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: i13coNsm XT
77
$0.00
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
A
1i aeeCl osu<ezJataPi�>n} ids:
Strom Motion Fee: IBSENVIC0
$2.80
Select an Administrative Item
Rj1iX Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$3.80
$417.00
'DOTAL p`1V~ :
$420.80
Revised: 01/01/2016
SANTA CAR- COUNTY
CCldinCL NUV,�EEF�
14700 irJ 0119her..--
(40E) 378-4010 (phone) _ ROY 37&9342 jaw) P_ IJIT wul+ aEa I 2r2(
PL411 CHECK No.
PLAN REVIEW COMMENTS
SCOPE OF ` C)RK: 6r
Existing fire Sprinkler P& -5o alarm SyStems Shall be moci led as ntowsSid', Submit 3 112 of drp\0'In_5 -
pf}�RO completed pei rnit apphcmion &✓ fees to the Santa Una County Fire Dept, in approval prior to al iering
�(y 1 system, CFC 001.4
f L All portions of the building snalI be'd'iihin 75 feet of a no winguiAa ha
A;10-BC. CFC906 -ving a m1nIMLm rating of 2-
Commercial cooking e0uipment shall be provided vviih a Class K portable, f ire Extingulsh ET to Gated R'lthin
30 feet of the eq+! ip nd in he path of exit travel. CFC 904
CF6 Egress doors shall 1001
(� rcqulretlghtgrasping,t
G permit ed when readily
WHEN BUIL DENG IS
(L%
C'flynl
le from the Egress side-Nvkhout special LnoR'lcd8e or eitoit & shall nor
SOT iW 1STing Of the Wrist to operate. Key operated looking devices ere
locked and signed i i�15 DOOR TO RE2 . "- N UNLOC:�D
C OS.Ii9
Means of egress Shall be illuminated at -N-nes ,00 minute back up where 2 or more exits are
required. CBC 1006.3 to 49
Ex - s shall be m ked by illuminated exit signs, Signs e PnIlMeLed at all times and have S'0 nt nute=.
of emergency backup po•a'e;, CBC iDl1
Contractor shall field verify the integrity of existing rated cOn St, uC /ESSeinbiics and restore or repair a
necessary, Penetrations in rated walls/cedings shall be protected by listed sire rated assemblies (dar;per;,
doors, caulking, fire stopping, etc,) CFC 703
Tenant shall provide a labeled emergency access
x• CFC 506 k ' for placem EP.t In the building emeigcn Cy cCCesS key
./, SccFi
A .^ N4uC,rf �� �L'�7`O � �'r�r.0 �lkF` l i /"i ✓i1CC�C
,•��i 9✓r1 �0 fry- 9.0,-I`nt W, 4/,k/^t ,\II S'.?ni I' JYi,1k Al-
t
TT is plan Check does not permit he use, storage or diSC'ens:ng Of hazardous miter Isis, Operations Or waste.
Tenant shall provide a Coy„ pleted HH11S to tp he flo de erle`acnazarous nata
t`s hdf'rtic
Sp eclallst-.oi rc'v le'n'
and comment. A CLOSURE PERMIT Is required prior i0 tci min aiing the storage of hazardous materials
at a penmll-ed Storage faclll, Demolition of any fa nitylsterage- area that previously stood hazardous
r S-S ail not be approved prior w ohiahhg a CLOSURE PERMIT,
to isSLe b+iildinv gLb2ci to C.
�. - ] 0rnPliance. ,,vith above ifcros.
JURIS
PL: C S I-dE'JJ P.J "Js SP./Q°. L
CONST. DESCPJP.
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