14050134CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100 N TANTAU AVE
CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 14050134
OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC
1460 O'BRIEN DR DATE ISSUED: 05/29/2014
OWNER'S PHONE: 4153854474
MENLO PARK, CA 94025 PHONE NO: (650)701-1500
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
APPLE — INSTALL DEHUMIDIFIER IN PARKING LOT
-f ( 0o1a
License Class 3 Lia # 79
AREA
Contractor /J6116 C0454rA e. Date 0 g �S
ON GROUND
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
Sq. Ft Floor Area:
Valuation: $50000
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
APN Number: 31619061.10100
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 18 AYS 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 OM LAST CALLED 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
tIla
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations er the Cupertino Municipal Code, Section
9.18.
a 9 ��5(
RE -ROOFS:
Signature Date -
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
Signature of Applicant: Date:
1 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
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)
I, 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 Cupertino Muni 'pal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533 ud 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Z-211/1� of
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued, l 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, 1
CONSTRUCTION LENDING AGENCY
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. l 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.
Signature Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION O
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - buildinq(akupertino.org
LI NEW CONSTRUCTION J ADDITION U ALTERATION / TI L REVISION/DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
(38AP5N D/Owv Trtau
OWNERNAME Uele ?WhPHONE E-MAIL
Oh
STREET.ADDRESS
CITY, STATE,ZIP FAX
'55c> )May)�- Nwlw F «.o C A 0 y l l
CONTACT NAME PHONE E-MAIL
o8 yS 7 8 3g 3�,c�- las e k e �o� c-.4 N. Com
STREET A�DrDRESS t S k.��AY, STATE,eZIP r� n I �G FAX
El OWNER 1:3 OWNER -BUILDER 7 El Y -
AGENT 1:1 CONTRACTOR 1:1 CONTRACTOR AGENT I ❑ ARCHITECT ❑ ENGINEER ❑ DEI -'ELOPER ❑ TENANT
CONTRACTOR NAME r"N� BUS. LIfM VN13
7COMPANY NAME ` E-M.AILFAX
'vUJ6 O»S�✓v.t,�,nv� D �'OVOCo»S}fug.
STREET ADDRESS /h r t N CI Y, 5 AT1 i�'1 CA Q y oa s PHONE
s0- Loo _/ s Q t
�AICITECT/ENGTNEERNAME LS I N� LICENSE NUMBER a�5 8g BUS. LIC 9
W.
COMPANY NAME E-MAIL FAX
\J 1:ane POlc m /a&r "�ckK r� a Okc D 14A
STREET ADDRESS CT -YY, STATE, ZIP PHONE
8S lu Alb-wAedw S4 54e. WJona CA Q5 )X v8 - `157- 083 e a I
DESCRIPTION OF WORK ffj� l I t
Ofi 'pPV000v0'CAAA DQU %k M.44; 2 i 1iYi I�• i r� ii0�[" �l rl C af'�d
11
USE I TYPE I OCC. I SQ.FT. I VALUATION ($)
I
AREA NEW FLOOR AREA TOTAL
TAREA I ��jU OOo I
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA I DECK AREA I TOTAL DECK/PORCH AREA I GARAGE AR
ATTACH
k DWELLING UNITS: I
ISA SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEINGADDED? ❑NO
ADDITION? No
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL k ❑ NO PLANTING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
BY
TOTAL VALUATIO :
S� 06
By my signature below, I certify to each of the following: I am the property owner or authori nt
the property is behalf. I have read this
application and the information I have provided is correct. I e read the Description of Work and verify I
. agree to comply with all applicable local
ordinances and state laws relating to building cduthorize representatives of Cupertino to enter the
arbov-id fed property for inspection purposes.
Signature of Applicant/Agent: VP
Date:
SUPPLEMENTAL INFORMATION REQUIREDPian
CHECK TYPE
ROUTING S' P
❑ OVER THE COUNTER
❑ EXPRESS
❑ BUILDING PLAN RENTER
❑ PLANNING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Q STANDARn
❑ �ruBLlCwoxxs
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
i� LARGE,
DIAJOR_:
❑ FIRE DEPT
❑ SANITARY, SEWERDISTRICT
BldgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10100 N TANTAU AVE
DATE: 05/22/2014
REVIEWED BY: MELISSA
APN: 31619 061
BP#:
Plan Check Fee:
`VALUATION: 1$50,000
°-PERMIT TYPE: Building Permit
FT #
$70.00
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
Suppl. PC Fee: 0 Reg. 0 OT
PENTAMATION
PERMIT TYPE: 1 CMAP
WORK
APPLE - INSTALL DEHUMIDIFIER IN PARKING LOT AREA ON GROUND
SCOPE
$0.00
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 onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fire Resolution 11-053 Eff T 1%13)
Mech. Plan Check O.p hrs $0.00
Mech. Permit Fee: 1MPERMIT
Other Mech. Insp. Ej
Ll
L_j
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 onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fire Resolution 11-053 Eff T 1%13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
FT #
$70.00
Mechanical
IBAPPLOT Other Appliance/Equip
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
T
T_F
Administrative Fee: 1ADMIN
$44.00
E)
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
Travel Documentation Fee: ITRA VDOC
$47.00
Strong, Motion Fee: IBSEISMICO
$10.50
Select an Administrative Item
BldLl Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$150.50
$70.00
TOTAL FEE:
$220.50
Revised: 04/0112014
Building Department
City Of Cupertino
1030.0 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR SUBCONTRACTOR Elsa"
JOB ADDRESS: G G' i '�-I 14 - sif'
PERMIT S e ( `
OWNER'S NAME: � � �� �f` u c� G�� � � �.LL
PHONE #
(3:E:NERAL CONTRA TOR.: i/u tri b bio 1
BUS.I..NESS LI:C:ENSE I#
ADDRESS: { . r t,,--� ,-
CITY/ZIPCODE: A( -\,�,.'
*Our municipal code requires all bmiraesses workiang in the city to have :a City of Cupertino 1)usinness license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHRDUTAI D UNTIL TBE
GENERAL CONTRACTOR ANIS ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CU.PrRTIN0
BUSINESS LICENSE.
am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Dante
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement F'inisbing
Electrical
Excavation
Fencing
Flooring I Carpeting
Linoleuan / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
T�- C_ 0
Roofing
Septic Tank
S.lieet Metal
� � r
Sheet Rock
Ti le
✓ f l`
r
°6 ontx Gtor Signature
bate
Testing Engineers, Inc.
Quality Assurance Services
Materials Consulting
Since 1954
Regular Concrete Compression Test Report
Project No.: 58135 Client: NOV010 Sample No.: 240278
Project Name: Report Date : 06/27/14
Tantau 7 - Mechanical Room #1161 RECEIVED Sample Date: 05/31/14
Air Handler Pad t O I o .
Cupertino, CA UUL 2 4 2014 Date Received : 06/02/14
Permit #s 1208-0013; 1405-0134 Inspector: M. Tellesen, TEI
Supplier: Dryco
Mix: KT4000
Ticket No.: 173269
Location:
Footings between lines D and E from
3 to 4 and machanical duct pad
outside of the building.
BYSpecimens Cast (ASTM C-31) : 5
Air Temperature (ASTM C-1064) :
Mixture Temperature (ASTM C-1064) :
Slump (ASTM C-143) : 3 inches
� etv
Date Tested
06/06/14
06/27/14
06/27/14
06/27/14
HOLD
ID Number
2A
213
2C
2D
2E
Mark Sample
Dimension, Inches
Diameter
4.01
4.01
4.01
4.01
Length
8
8
8
8
Area, sq. inches
12.63
12.63
12.63
12.63
Ultimate Load, Ibs
60000
81000
75000
84000
Ultimate Str., psi
4750
6410
5940
6650
Average, Str., psi
Age Tested, Days
6
27
27
27
HOLD
Fracture Type
1
1
1
1
Dry Unit Weight, pcf
Specified Strength, psi
3000
3000
3000
SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD
The Material <— WAS WAS NOT The Material Tested MET DID NOT MEET THE
SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS.
REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS.
Remarks: Samples Tested in General Conformance with ASTM C-39
1 cc. City of Cupertino
1 cc. Novo Construction
Reviewed By:
Robert reen
Concrete Lab Supervisor
Corporate Office - 2811 Teagarden Street, San Leandro, California 94577 - (510) 835-3142 - Fax (510) 834-3777
TESTING ENGINEERS, INC.
2811 Teagarden St. 510-835-3142 510-834-3777 fax
San Leandro, CA 94577 800-660-3142
San Leandro • San Jose • Martinez
INSPECTION REPORT Week Ending: 6/6/14
PROJECT # 58135
PROJECT:
Tantau 7 - Mechanical Room # 1161
Air Handler Pad
Cupertino, CA
Permit # 1405-0134; 1208-0013
DATE 5/31/14 (Saturday)
HOURS 4 of
INSPECTOR M. Tellesen
TYPE OF INSPECTION:
Concrete Placement/ Epoxied Dowels
PLACE OF INSPECTION:
Jobsite
Reported to Allen of Novo Construction at the jobsite as requested.
Monitored loads arriving at the jobsite for correct mix and proper slump. Inspected placement operations and vibrating
procedures. Performed 1 slump test (3") and cast 1 set of compression test specimens (5 each) Sample # 240278, for Concrete
Mix # KT4000 from Dryco (specified strength 3000 psi, slump 3") for concrete placed at column footings between lines D and
E from 3 to 4 and mechanical air duct pad outside of building. Total cubic yards placed: 2.
Inspected the placement of reinforcing steel for the above.
Inspected predrilled holes for proper diameter and depth. Observed the cleaning of holes and the injection of Hilti Hit Hy
200 R epoxy (exp. 12/14). Witnessed the proper insertion of nine (9) #4 reinforcing steel bars, 20" in length, embedded 4" for
two (2) column footings on line 3 between lines D and E.
The preceding work was, to the best of my knowledge, in compliance with approved plans and specifications, including
revisions by engineer, dated 5/15/14.
Reviewed by:—'�
David Chippero
Special Inspection Division Manager
Icc: Novo Construction/N. Dudley
City of Cupertino/Bldg. Inspection Dept.
This report can be reproduced only in its entirety unless written permission from TEI is obtained.