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14030151V" I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10100 N TANTAU AVE I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 14030151 1 OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC 11460 O'BRIEN DR I DATE ISSUED: 06/04/2014 1 OWNER'S PHONE: 4089748821 `D"`" LICFNSED CONTRACTOR'S DECLARATION License Class Lic. # 1( 1 D d a Contractor "Vo Coerl4 IC4AA Date % S 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. 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. 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 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date "_� ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will raintain 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. 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 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 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. APPLICANT CERTIFICATION I certify that 1 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, costs, and expenses which may accrue against said City in consequence of the 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. Sign Date MENLO PARK, CA 94025 LPHONE NO: (650)701 -1500 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL APPLE -405 SQ FT COMM .T.1 TO INCLUDE ROOFTOP EQUIPMENT REVISION #2-REVISE ROOF TOP DUCT WORK- ISSD OTC 4/1/2015 Sq. Ft Floor Area: , Valuation: $1005000 APN Number: 3161906 1. 10100 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D OF PERMIT ISSUANCE OR 180 DAYtPRIQ, AST CALLED INSPECTION. Issued by: Date: RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health & Safety Code, Sections 2550 , 25533, an 25534. Owner or authorized agent: Date: �r CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 CUPERTINO (408) 777 -3228 - FAX (408) 777 -3333 - building a cupertino.org APN 7BP #: DATE: S PROJECT $ LEVEL 14030151 a VALUATION: lev , ace SITE 10100 N Tantau . OWNER'S NAME: PHONE #: 4018 - -7133. y 73 Cup rtino Gateway Partners LLC FAX #: MAILING ADDRESS (if different from site address): 550 Montgomery Street, Suite 200, San Francisco, California 94111 CONTRACTOR: PHONE #: ¢ S 0— 9/7 0 - 5 oa Novo Constriction FAX #: CONTACT: PHONE #: &50 - GQa /040 Nathan Dudiay FAX #: TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND AMOUNT (1% VALUATION 1t (BLDBONDS] CODE ❑� CHECK El CASH BOND OF BOND: 5K min-10K max) $, ,,. 'j 1000 EDITION: TCO EXPIRATION DATE (6 MONTHS MAX): r n O,5 FEE: $2$6.00/IIIO TOTAL FEE: $ [1 TEMPOCC] USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT ❑ APPROVED Ojos Signature: ........... .............. ............................... I er ❑ APPROVED El APPROVED WITH CONDITIONS- Signature: .......................... ............................... Date:...................... OTHER DEPARTMENT / AGENCY APPROVALS: Planning Signature :....................... .............................. Date:........................ ❑ APPROVED El APPROVED WITH CONDITIONS- Ti—re Signature:.. .............. Date:..Q. ❑ APPROVED APPROVED WITH CONDITIONS` ❑ APPROVED ❑ APPROVED WITH CONDITIONS - Signature: ........... .............. ............................... Date:...................... er ❑ APPROVED El APPROVED WITH CONDITIONS- Signature: .......................... ............................... Date:...................... "CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Te Certificate of Occupancy expires, the total amount of the bond m y be fo ited and the non - compliance may result in an a ction. Owner Contractor Signature ......... .... Date: 911...14 Signature: .......... ................................. Date: This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and approved for the specific area of the ing specified above to provide a reasonable degree of safety to the occupants from fire and similar emer encie ,,//�� //�� ,' / / �,/� Building Official:.. ............ .... .......f.T..i�.."i/ ... SW�7Q7.t/. "... A l7.-ZJat - : DEPARTMENT ACTION f After defermination, copies to: 1) applicant, 2) permit file TempOccFonn_2011doc revised 717114 A CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10100 N TANTAU AVE I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 14030151 1 OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC 1 1460O'BRIEN DR ] DATE ISSUED: 06/04/2014 1 OWNER'S PHONE: 4089748821 1 MENLO PARK, CA 94025 1 PHONE NO: (650)701 -1500 L'9" � ' LICENSED CONTRACTOR'S DECLARATION License Class __ Lic. # AA '' (� Contractor /w f-b C-ort 4Y —JI'.A Date 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. 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. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comp) ::—' with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature_-,y.r" Date ❑ OWNER - BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). 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 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 permit is issued. 1 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 ofexemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ APPLE -405 SQ FT COMM .T.1 TO INCLUDE ROOFTOP EQUIPMENT REV #1 - REVISION TO INCLUDE A SNORKLE VENTILATION - ISSUED 1113114 Sq. Ft Floor Area: Valuation: $1005000 APN Number: 31619061.10100 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS ALLED INSPECTION. Date: RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health &Safety Code, Sections 25505 25533, ,pnd 25534. ) Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profession W CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10100 N TANTAU AVE I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 14030151 OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC 11460 O'BRIEN DR I DATE ISSUED: 06/04/2014 1 OWNER'S PHONE: 4089748821 1 MENLO PARK, CA 94025 1 PHONE NO: (650)701 -1500 ' ❑ LICENSED CONTRACTOR'S DECLARATION License Class G� Lic. # 0 as Contractor (J-Vc- o✓I Date 1 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: t 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations he Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 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 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. APPLICANT CERTIFICATION 1 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL ❑ APPLE- 405 SQ FT COMM .T.1 TO INCLUDE ROOFTOP EQUIPMENT Sq. Ft Floor Area: Valuation: $1000000 APN Number: 31619061.10100 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PE SSUANCE OR 180 DAYS ALLED INSPECTION. Date: RE- ROOFS: 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. Signature of Appl icant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous 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 the Health & Safety Code, Sections 25505, 2 33, and 25534. ./ Owner or authorized agent: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingl�cupe(tlno org In ❑ NEW CONS TRIJCHON ❑ ADDITION ❑ AL FRATION H M RtiVlSION , DL l RRED ORIGINAL ITRMI f u 140301 51 PRO,F(,- ADDRESS 10100 N Tantau, Cupertino, CA 95014 OvkNERNrA "FApple Inc. 777 1 5-385-4474 gallen @apple.com SIREEI ADDRLSS I Infinent Loop CITY, S AF_"'Cupertino, CA, 95014 CONFA( I NAM' Nathan Dudley PHONE650- 690 -1660 E- "AII, ndudley @novoconstructior sERL:" y1)DI(I:SS1460 O'Brien Drive `IrY,sTAfF. "''Menlo Park, CA, 94025 ❑ OWNER ❑ OWNER- DE.II.DER ❑ OWNFRAGFNT ❑ (ON'ERACTUR ❑('ON "FRA('IORAGENT ■ ARCHIT'E( "I ❑ ENCIINFER ❑ DFVIA,OPER ❑ 11-NAM CONTRACTOR NAME Nathan Dudley LICENSE MAIM R 791 022 LICFNSE TYPE B BUS I-K I/ 23891 CO "APANYN` "" Novo Construction F- "AP, ndudley @novoconstruction.con F^` STRG.FT A °DRI.SS 1460 O'Brien Drive ` "' "� "F, "'Menlo Park, CA, 94025 ''HON1 :650- 690 -1660 ARCHJILCTTNGINFER NAvlk Sherry Chaumpluke LICLNSL' NC MHE?R [it IS LICp COMPANY NANIFACCO Engineered Systems E. 11O."P, schaumpluke @accoes.com EAx STRELT ,A D D R FSS 1133 Aladdin Avenue ('IIY, SEA FE, ""San Leandro, California, 9 PE' ° "F 510- 346 -4328 DESCRIPTION OF 1VORK Addition of a new snorkel in dry lab. EXISTING USE Lab /off PROPOSED USE Lab /off CONSTR TYPE IT 1 4 STORIES 1 USH TYPE OCC, SQ_FT_ VALUATION,%) EXISTG AREA 400 NEW PE.00R ARE^ 400 UEMO AREA 0 TOTAL. NET -ARFA Lab/office ��� BATHROOM KITCHEN OTHER REMODEI AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DF('K /PORCH ARLA GARAGE AREA DETACII I ATTACH I � DIVFI I ING UNrTS IS A SECOND UNIT YES SE(.ONDSTORY ❑YES BEING ADDED? NO ADDITION? NO PRE: APPLICATION [IY'ES IF YES- PROVIDE ('OPA' OF IS THE BLDG AN ❑ YES E . VED BY. r$(JTAL VALUATION_ PLANNING APPL11 ❑NO PLANNINGAPPROVAL LETTER EICHLER HOME° ❑NO Yf �o By my Signature below, I certify to each of the following I am the property owner or authorized ageot4 act on the property owner's behalf. I have read this application and the information I have provided is correel. I have read the Description of Wort. and verify it Is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction- 1 authorize representatives of Cupertino to enter the above - identified propertN for inspection purposes Signature of Applicant /Agent: Date St IPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER - THE - COUNTER ❑ BUILDING PLAN REVIEW New SIT) or Multifamily dwellings: Apply for demolition permit for 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 l lazardOHS Materials Disclosure ANDARD El PUBLIC WORKS form if anN 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 Bldg App 2011.doc revised 06'21 11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(a)-cupertino.org CUPERTINO QC ❑ NEW CONSTRUCTION [:1 ADDITION ❑ ALTERATION/TI Z REVISION /DEFERRED ORIGINAL PERMIT # / t% '0 319 151 PROJECT ADDRESS D APN # a /,0 U �/N � OWNERNAME �, III t PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL �v s Wo � c � GS a 1 3�iG- s�►� STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEFR NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � f 1 � AeV, v+'l EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH E] 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 RECEI VED BY - TOTAL PLANNING APPL # E] NO PLANNING APPROVAL LETTER EICHLER HOME? []NO ' it 44'', By my signature below, I certify to each of the following: I am the property owner or authorized agent to act o owner's behalf. I have read this application and the information I have provided is correct. I ave 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 construe ' I uthor' epresentatives of Cupertino to enter the above -i ent' led property for inspection purposes. Signature of Applicant/Agent: Date: l �S SUPPLEMENTAL INFORMATION REQUIRED �.r xd' ROUTING SLIP ❑ 'OVER THE COUNTER ❑ BUH DING REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition perTnit is required prior to issuance of buildin g ti a PLAN t for new building. uit ❑ EXPRESS O > "'' „ ❑ NNING PLANrREVIEW permit ,PI Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ©sTA.�AIiD , ', ❑ "PUSLICwoRi x _ form if any Hazardous Materials are being used as part of this project. :LARGE a ❑ FIRTy _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ � nRY sEiinlsTiucr ±` submittal of Building Permit application. :MAJOR ❑.' ENViRONMENTAL r - IEALTH . t'.'. B1dgApp_2011.doc revised 06 121 1II TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 CUPERTINO (408) 777 -3228 - FAX (408) 777 -3333 - building a cupertino.org APN 7BP #: DATE: S PROJECT $ LEVEL 14030151 a VALUATION: lev , ace SITE 10100 N Tantau . OWNER'S NAME: PHONE #: 4018 - -7133. y 73 Cup rtino Gateway Partners LLC FAX #: MAILING ADDRESS (if different from site address): 550 Montgomery Street, Suite 200, San Francisco, California 94111 CONTRACTOR: PHONE #: ¢ S 0— 9/7 0 - 5 oa Novo Constriction FAX #: CONTACT: PHONE #: &50 - GQa /040 Nathan Dudiay FAX #: TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND AMOUNT (1% VALUATION 1t (BLDBONDS] CODE ❑� CHECK El CASH BOND OF BOND: 5K min-10K max) $, ,,. 'j 1000 EDITION: TCO EXPIRATION DATE (6 MONTHS MAX): r n O,5 FEE: $2$6.00/IIIO TOTAL FEE: $ [1 TEMPOCC] USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT ❑ APPROVED Ojos Signature: ........... .............. ............................... I er ❑ APPROVED El APPROVED WITH CONDITIONS- Signature: .......................... ............................... Date:...................... OTHER DEPARTMENT / AGENCY APPROVALS: Planning Signature :....................... .............................. Date:........................ ❑ APPROVED El APPROVED WITH CONDITIONS- Ti—re Signature:.. .............. Date:..Q. ❑ APPROVED APPROVED WITH CONDITIONS` ❑ APPROVED ❑ APPROVED WITH CONDITIONS - Signature: ........... .............. ............................... Date:...................... er ❑ APPROVED El APPROVED WITH CONDITIONS- Signature: .......................... ............................... Date:...................... "CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Te Certificate of Occupancy expires, the total amount of the bond m y be fo ited and the non - compliance may result in an a ction. Owner Contractor Signature ......... .... Date: 911...14 Signature: .......... ................................. Date: This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and approved for the specific area of the ing specified above to provide a reasonable degree of safety to the occupants from fire and similar emer encie ,,//�� //�� ,' / / �,/� Building Official:.. ............ .... .......f.T..i�.."i/ ... SW�7Q7.t/. "... A l7.-ZJat - : DEPARTMENT ACTION f After defermination, copies to: 1) applicant, 2) permit file TempOccFonn_2011doc revised 717114 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildlng(d)cupertino org y V ❑ NEW CONSLRUCTION ❑ ADD[ PION VALTERATION /'fl ❑ REVISION I DEFERRED ORIGINAL PERMIT u PROJEC' I ADDRESS 7-7, I U/(• 1 V OWNER NAME. P ONE' E-NIAIL C SIREC "rADDRF.SS 5.50 CITY. SIATE.ZIP 'Sty FAX St' liK Zds ISCO CONTACT NAME 5 PHON Yos 6,56 - 7oto E -MAIL, x . cv Pd c y4. co S "FREEr ADDRESS Y Ai CITY, STATE, ZIP Sigm ro3e, CA 7.51Z& FAX ❑ OA4NER ❑ OWNER- BIALDE'R ❑ OWNERAGENT ❑ (ON TRACTOR ❑ CONTRACTOgR AGENT ARCHITECT ❑ ENGINFFR ❑ DEVELOPER ❑ TEN.ANT CON "rRACIORNAME� I.ICENSF NUMBER '%{ /OJ•Z LICENSE TYPE BUS I.l�a COMPANY' NAME E -MAIL FAX • s I RF.r. r ADDRESS CI "I'Y. SPATE, ZIP HObN v I D O C m ,,A t o G CGTO lGbb AR( HITFCT- ENGINEER NAME LICE SF NUMBER BUS LIC x 5 r� COnIPANY NAME L -.NI AIL F AN y STREET ADDRESS CITY, STArEJ�IP s 15121. PH( NE v* - I T S N :rbl5t, CA 5G boo DESCRIPTION OP WORK zwde T IAJC4&pt^a 5 s roc- ,IJ t EXISTEN ' tISE PROPOSED USE. CONSTR TYPE h STORIES � ot � IV1� USE TYPE OC'C SQ.Ft. N'ALl'AiION(S) ExIsTO NEW FLOOR DEMO TOTAL IRF.A 5:i- ARFA AREA n! N1;FAREA Y67 G �� (� BATHROOM KITCHEN OTHER REMODEL AREA REMODEI. AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA (IARAOE AREA DFTA('H ATPACH I _.._ _ . . n DWELI ING UNIIS IS.A SECOND UNIT ❑YES SECOND STORY' ❑YES BEINCADDED? NO ADDITION? ❑NO PRE -APPI IC:\TION OYES IF YES. PROVIDE COPY OF IS "I t E BLDG AN ❑ YES RECEIVE Y: TOTAL VALIJ Al'ION. PLANNING APPI_ N F] NO PLANNING APPROVAL EF.TTER EICHLER HOME? ❑ NO BN m)' signature below, I certify to each of the following I am the property owner or authorized a nt to < to propert, owner's behalf I have read this application and the information I have provided is correct. I have rea he Description of Work and - y It is accurate_ I agree to comph with all applicable local ordinances and state laws relating to building construction. I nze presentativcs of Cupertino to enter the above -i +ntified proper[, for Dlsp ction purposes. Signature of Applicanb'Agen( Date SUPPLEMENTAL INFORMATION REQUIRED eLANCxecKTVeE Rou NGSLIP ❑ OVER- THE - COUNTER BUILDING PLAN REVIEW New SI' ) Or Multllamlly dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit t(/T new building. ❑ EXPRESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUB WORKS form i f any Hazardous Materials are being used as part of this project, El 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 Bldg.lpp 2011.doc revised 06 21, 11 FrO CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 1AADDRESS: 10100 n tantau pi DATE: 03/31/2015 REVIEWED BY: Mendez PC FEE ID APN: BP #: "VALUATION: $0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION 1E TI PERMIT TYPE: WORK REVISION #2- REVISE ROOF TOP DUCT WORK- ISSD OTC 4/112015 SCOPE PME Plan Check: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID E (Tenant Improvements) II- B,III- B,IV,V -B 0 $0.00 $0.00 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee :Q Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 TOTALS: 0 $0.00 $0.00 $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Di.ctrirt_ otc )_ Thece feoc are hacod an the nreliminary information available and are only an estimates Contact the Dent for addn R info. FEE ITEMS (F(,e Resolution 11 -053 Ef ..' 7/1 /13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee :Q Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 G Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non- Residential Building or Structure Strong Motion Fee: $0.00 F 0.5 hrs $45.00 Admin. /Clerical Fee IADMIN Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $45.00 TOTAL FEE: $45.00 Revised: 02/14/2015 Fm_ff CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10100 n. tantau ave DATE: 09/10/2014 REVIEWED BY: larrys APN: BP #: VALUATION: 1$5,000 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: PENTAMATION 1CMAP 7 PERMIT TYPE: WORK revision to include a snorkle ventilations stem. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY /FEE QTY UNITS BP FEES Ventilation System 1 BREMVENS 1 # $107 PME Unit Fee: $107.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes Q No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $107.00 Strong Motion Fee: 1BSEISMICO 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 preliminar information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7`1 13) Mech. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: 1MPERMIT Other Mech. Insp. 0.0 hrs $48.00 QTY /FEE Ll 7__ 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 preliminar information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7`1 13) FEE QTY /FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $107.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes Q No $0.00 A Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICO $1.40 Select an Administrative Item Bldt,; Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $250.40 $0.00 TOTAL FEE: $250.40 Revised: 08/20/2014 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10100 n tantau ave TYPE OF CONSTR. DATE: 03/26/2014 REVIEWED BY: Mendez PC FEE 1D APN: BP #: 3OI II- B,III- B,IV,V -B `VALUATION: j$1,000,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 1 hrs $0.00 PME Plan Check: PENTAMATION 113 TI PERMIT TYPE: WORK apple 405 sg ft comm .t.i to include rooftop equipment SCOPE $703.74 Suppl. Insp. Fee:Q Reg. © OT 0,0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE 1D BP FEES BP FEE ID B (Tenant Improvements) II- B,III- B,IV,V -B 405 $2,046.22 IBTIPLNCK $703.74 IBTIINSP 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $703.74 Suppl. Insp. Fee:Q Reg. © OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 405 $2,046.22 $703.74 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY Q Yes (F) No ELEC, HOURLY Q Yes Q No 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 preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FEE ITEMS Fee Resolution 11 -053 Efi. ?i� FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,046.22 Select a Misc Bldg /Structure or Element of a Building Suppl. PC Fee: (j) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $703.74 Suppl. Insp. Fee:Q Reg. © OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 G Work Without Permit? 0 Yes (`) No $0.00 Advanced Planning F,ee: $0.00 Select a Non - Residential Building or Structure 0 Strong Motion Fee: IBSEISMICO $210.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $40.00 SUBTOTALS: $2,999.96 $0.00 TOTAL FEE: 1 $2,999.96 Revised: 01/15/2014 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: D/ 00 A/. ; i BUSINESS NAME PERMIT # 1'/0 O 1 S OWNER'S NAME: rtt7 q I,r,�J PHONE # 0- V70- 150! GENERAL CONTRACTOR: NOW cw4ytl& M BUSINESS LICENSE # ADDRESS: ROD ,?;eM A CA q410aS. 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 Please check applicable subcontractors and complete the following information: Date r/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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 / Contractor Signature Date CONTRACTOR /S0BCK���R LIST 0uUdiugDopo/imcw Ci|y0[[upo1inu 10300 Torre AvcnuC Cvpcniuo.[iV-50N'3255 To|up6unc:408'777']228 Fux:4U8'777'3333 1013ADDK6,�S 10100 m Tanta 0 %V N E WS N A jM L: Cupertino Gateway Partners LLC PHONE, �q408-974-8821 �0xrm till icipui Code rcqoirmuUbuxillcssu wwrkixg,ill |bc City |o have nCihu{Cuyuinohusiuoa|ccu»e. NO KU|iQ/M; HNAiUR FYNAL0CC'BPAWY | 8P[(O-lwN(S) \VUl BE SCH[DOLF) UNTIL THE (,E,NV.R\|. 00Y3R\(T0R AND ALL SND(l)NTKA(..[0R0 114VK 011<.\INED A <�|Tf OF (IT Y[Ql N0 8U8{WESSLi[ENSE. 1um not uxiogooysubcooirucNm, --------------------______- 9ig/atoo Bute Please check applicable stibconti-actoi-S and complete tile following i lift) I-111ation: Ccnient Finishing Electrical Sprig Electric Fxcmiatioll Crown Sanitation, 11c Heatilia ACCO Engineered Systems Painting / wallpaper Pyramid Painting 1"llumblI10 ACCO Engineered Systems State Wide Septic Tank Sheet Rock F1 le