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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.