13120134CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20401 STEVENS CREEK BLVD
CONTRACTOR: NOVO CONSTRUCTION
PERMIT NO: 13120134
OWNER'S NAME: WDV PROPERTIES
1460 O'BRIEN DR
DATE ISSUED: 12/1812013
OWNER'S PHONE: 6506901660
MENLO PARK, CA 94025
PHONE NO: (650)701-1500
Is LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
p
APPLE T.I. - REPLACE (E) 20 TON ROOFTOP AIR
License Class Lic.# 71
HANDLER
ContractorM06- 06- Cdk ti .P' Dater '�° ' 17
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Codc and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 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: $35000
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insuranec, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
APN Numbcr: 31626090.20401
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 DAY ST LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses whieh may accrue against said City in consequence of the
2 I $ r
granting of this permit. Additionally, the applicant understands and will compI
with all -non -point source regulations per the Cupertino Municipal Code, Section
9.18.
/
7�� JlJ
RE -ROOFS:
Signatur 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.
❑ O%VNER-BUILDER DECLARATION
Signature of Applicant: Date:
I 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 followiug three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should 1 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 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2,V895, 25513, and 25534.
Section 3700 of the Labor Cade, for the performance of the work for which this
Owner or authorized agent: Date: '
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 of exemption, I
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. I agree to comply with all city and county ordinances and stale laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (Wc) 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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
90300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building .cu ertino.org
❑ NEW CONSTRUCTION ❑ ADDITION
ALTERATION 1 TI ❑ REVISION 1 DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
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OWNER NAME
PHONE
E-MAIL
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STREET ADDRESS
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CITY, STATE,ZIP
SO -J a 9yo497
PAX
CONTACT NAME /
PHONE
E-MAIL
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STREET ADDRESS
C1TY.STATB, ZIP
FAX
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSETYPE
BUS. LIC N
COMPANY NAME ('
E-MAIL
FAX
,110 CQA;'5rZQ(-001J
STREET ADDRESS
CITY, STATE, ZIP
PHONE
S Am s Su �
ARCHI TECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
V 4ti
COMPANY NAME
E-MAIL
FAX
I
'1 co
STREET ADDRESS
Reale,
CITY, STATE ZIP
9
PHONE
- COO SO
�I 5 p
5ft 1 w- 69 513
09 7- 7%
DESCRI ]O F�K
r 6 r 20 7a 7cft5 FrP ,12 A9N%LZe,
EXISTING USE
PROPOSED USE CONSTR
TYPE
I STORIES
C)ffe/cx
Qrf7
2
USE
TYPE OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA JI
AREA
AREA
NET AREA
r
cr!—
V (�
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODELAREA
REMODELAREA
PORCH AREA
DECK AREA±AND
TAL DECKlPORCH AREA
GARAGE AREA: DETACH
[:]ATTACH
N DWELLING UNITS:
TWIT ❑YES
SECONDSTORY ❑ YES
DED? ❑NO
ADDITION? []NO
PR&APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
R D
TOTAL VALUATION:
PLANNING APPL Al ❑ NO PLANNING APPROVAL LETTER
EICHLER HORSE? F]NO
�$ +1
By my signature below, l certify to each of the following: I am the property owne or authorized ent tont r erty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description or' ork and verify it is a C. I agree to comply with all applicable local
ordinances and state laws relating to b ' 'n constru I authorize representatives of Cupertino to enter the ab�o7ve-'denti red property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
R
❑ BUILDING PLAN REVIEW
_ New SFD Or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
-THE -COUNTER
CC
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bidgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUDLIC WORKS
form if any Hazardous Materials are being used as part ofthis project.
❑ LARGE
❑ FIRE DEPT
—Copy of Planning Approval Letter or Meeting with Planning prior to
ElMAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
w -ft FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
20401 STEVENS CREEK BLVD
DATE: 12/1812013
REVIEWED BY: MELISSA
PC FEE 1D
APN: 31626090.20401
BP#: �d 3
"VALUATION: 1$35,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
IBTIPLNCK
PENTAMATION 1 B TI
PERMIT TYPE: A
WORK
APPLE T.I. - REPLACE E 20 TONE ROOFTOP AIR HANDLER
SCOPE
Suppl. Insp. FeeQ Reg. Q OT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE 1D
BP FEES
BP FEE ID
B (Tenant Improvements)
If-$,III-B,IV,V-B
100
$2,036.00
IBTIPLNCK
$571.00
IBTIINSP
Elm Insp. pore;
$571.00
Suppl. Insp. FeeQ Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
LJ
Ad►ninistrative Fee:
Q
Work Without Permit? Q Yes Q No
$0,00
TOTALS:
100
$2,036.00
Travel Documentation Fees:
$571.00
Strom Motion Fee: 1BSEISMICO
MECH, HOURLY Q Yes G No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
Much. Plan Check
Phmrb. Plan Check
Elec.. Plan Check
ifctclr. Permil Fee:
Plumb. Pennit Fee:
Elec. Permit Fre:
Other hlewh. Insp.
Other Plumb Insp,
Other Elm Insp. ET
llech. Insp. Fec.
Plumb. hup, ree:
Elm Insp. pore;
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School
District. etc). These fees are based on the arelinunary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Efir 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,036.00
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT
0,0hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$571.00
Suppl. Insp. FeeQ Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
LJ
Ad►ninistrative Fee:
Q
Work Without Permit? Q Yes Q No
$0,00
Advanced Planning Fee:
$0,00
Select a Non -Residential Q
Building or Structure Q
Travel Documentation Fees:
Strom Motion Fee: 1BSEISMICO
$7.35
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$2,616.35
$0.00 TOTAL FEE:
$2,616.35
Revised: 1010112013
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:Z6 Ljo I Sr,6k6rL,1S C44gg,,'
PERMIT # r 3l Zd r
OWNER'S NAME: WPP
PHONE # 6J_6
GENERAL CONTRACTOR: "pV Car.�l bu
BUSINESS LICENSE #
ADDRESS: gl I,J R.rtivGf
CITYIZIPCODE: Gsii?A4K e614
*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
✓
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
/ Confr.Wtof Signature
Ze&l Z37
Date