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14080072 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: t0500 N DE ANZA BLVD CONTRACTOR: DEVCON PERMIT NO: 14080072 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED:08/11/2014 OWNER'S PHONE: 4088624397 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONT'RACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL APPLE T.I. -2ND FLR RECONFIGURATION TO LABS& License Class «C-C' Lic.9 9`t I U-Z� OFFICE SPACE. ADD(N)MECH UNIT ON ROOF TOP Contractor �'Z s/ ✓t �'+^��� � � Date e, rl �� 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: I have and wilt 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. Sq.Ft Floor Area: Valuation:$800000 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:31622017.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DA MIT 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 D SIFROM L ALLED 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 granting of this permit. Additionally,the applicant understands and will co Date: with all non-point source r ations ertino Municipal Code,Section 9.18. t� RE-ROOFS: Signature Date ✓ ff All roofs shall be inspected prior to any rooting material being installed. If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code), 1 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 1 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 CupertMunicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 5533,a 534. Section 3700 of the Labor Code,for the performance of the work for which this 11� Owner or authorized agent: ate: f 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 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, 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. Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR:DEVCON PERMIT NO: 14080072 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED:08/11/2014 OWNER'S PHONE: 4088624397 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL 0 COMMERCIAL E] APPLE T.I. -2ND FLR RECONFIGURATION TO LABS& License Class A— Lic.# �' b OFFICE SPACE. ADD (N)MECH UNIT ON ROOF TOP Contractor Date 1./,4 /q 1 hereby affir that I am lice's under the provisions of Chapter 9 DEFERRED#1-ACCESSIBLE PATH OF TRAVEL,RESTROOM ADA,MECH (commencing with Section 7000)of Division 3 of the Business&Professions DUCT HANGER-ISSD OTC 9/4/24 Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: elo 1 have and will maintain a certificate of consent to self-insure for Worker's Q rr Compensation,as provided for by Section 3700 of the Labor Code,for the i� performance of the work for which this permit is issued. q.Ft Floor Area: Valuation:$800000 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:31622017.00 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 DAYS OM I. T CALLED INSPECT N. 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 Issued by: Date: with all non-point source regul tions per the Cupertino Municipal Code,Section 9.18. ��� ,y 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 S ign ature of App I icant 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 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) 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(x)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 Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 5,2553 d 25534. Section 3700 of the Labor Code,for the performance of the work for which this Y Owner or authorized agent: Date: 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,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.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, 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR:DEVCON PERMIT NO: 14080072 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED:08/11/2014 OWNER'S PHONE: 4088624397 MILPITAS,CA 95035 PHONE NO:(408)942-8200 10 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL Ej COMMERCIAL E] APPLE T.I.-2ND FLR RECONFIGURATION TO LABS& License Class= C��— Lic.# (P 2j OFFICE SPACE. ADD(N) MECH UNIT ON ROOF TOP DCV<<ti &1s7 q�z� Contractor � ryJ Date �REV# 1 -REMOVE TRANSFORMER FROM(E)SCOPE OF I hereby affirm that I am licensed under the provisions of Chapter 9 WORK-ISSUED 9/29/14 (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. Sq.Ft Floor Area: Valuation:$800000 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 APN Number:31622017.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN Igo DAYS IT 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 D M 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 th 2 S granting of this permit. Additionally,the applicant understands and will comply sue Date: / G with all non-point source r gulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to an roofing material being installed.if a roof is installed without first obtai spection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature ofApplica Date: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 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. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.I2 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous 1 have and will maintain aCertificate 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 Munici a Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 55 5533, 5534. Section 3700 of the Labor Code,for the performance of the work for which this 2Ci (e� Owner or authorized agent: Date:�l permit is issued. I certify that in the performance of the work for which this permit is issued,1 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. 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, 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 CONSTRUCTION PERMIT APPLICATION ` COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 \Q (408) 777-3228 • FAX (408)777-3333• buildinoCa),cuoertino.org \ CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINTAL PERMIT PROJECTADDRESS p, 1 �E d' \ ^ APN2-- r 0 OWNER NAME IIJJ IV �`7'>S-PONA'WaPHONE X7 E-MAIL _� 1 �L� urJG �►o�7-�ivZ- �l 3q7 ot'91��,� ��. L C, STREET ADDRESS CITY, STATE,ZIP l )�V0 G FAX ITE LOGS 7 I CONTACT NAME Fv)� I Wl o PHONE 4o�_71z-W E-MAJL k'�Yw 4f-VCGn-C.A5-k ,yl STRHETADDRESS N CITY,STATE, IZIP -1 FAX( 016 C-►;�,�p �I�, Dt pp�� M; �,fi�is C A- ❑ OWNER ❑ OUTiER-BUILDER ❑ DVARIER AGENT &CONTRACTOR ❑CONTRACTOR AGENT ❑ ARC'=--CT ❑ENGLKEER ❑ DEVELOPER ❑ TENA?Sr CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE I BUS.LIC R kEVI �J I yvt 3 G-7G U73 COMPANYN.aME E-MAIL ,/ ,JW C. d�VC0 CGV1�T•j,'�F.aX STREET ADDRESSr!-- CITY,STATE,ZIP �" PHOTt UIQ ,b r� D�. 1v�;j ,;mitis C 408 - 7 12-9,@5a ARCHIIECTIFENGTNEER NAME LICENSE NUMBER BUS.LIC 1; COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIPPHONE. DESCRIPTION OF WORK f ted EXISTING USE PROPOSED USE CONSTR TYPE :STORIES IDFku. 1. f r�" 046 1 _ p USE TYPE OCC. SQ.FT. VALUATION(S) EX1SSTG NEW FLOOR DEMO TOTAL AREA H, AREA f/, AREA �p Iko. NErAREA 44,,'k'o BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECK AREA TOTAL DECK/PORCH.AREA GARAGEAREA: DETACH ❑ATTACH R DP.ELLING UNITS: IS A SECOND UNIT )]YES SECOND STORY ❑YES BEING ADDED? [:J NO ADDITION'. [3 NO -PRE-A-PPLICAT10N--❑-1'ES--IFITS,3_RONME-COP]'_OF IS THE BLDG AN n 1 t5 1 ED -14 - TpT.Al.VALUATION: PLA3.'NINGAPFL: ❑NO FL4T�T`L'�TGAPPROVALLETTER EICHLERHOME". ❑N - - �' x _ By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on e property owner's behalf. I have read this application and the information I have provided is correct. I ad the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bytt ' constructi authorize representatives of Cupertino to enter the above-identified property for inspection purposes. l S i mature of Applicant/Agent: Date: SUPPLE1,fENT,,kII�tFOR-N,IAT \T REQUIRED Pi a cHEcxTrPE�' �_ NewSFD or Multifamily d\x e)]ings: Apply for demolition permit for mE00 ' fl OVERTIURBUIII7II�GPLA'\RELY existing buildinggCOTER(s). Demolition permit is required prior to issuance of building $ ; e 1r permit for ne\vbuilding. ❑ ELPRESSv PLANI�I\GPLANREiLEYi' x . _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sT I,pWPD. IcwoRas z. form if any Hazardous Materials are being used as part of this project. '� � _Copy of Planning Approval Letter or Meeting with Planning prior tox �° rWOR 4 i1IA7GR s s� syr _ €sRYTARI SER�ET2DISTRICT* , submittal of Building Permit application. NO��. � �D�E1Q\'IROA'I�IENTS39HE.:I,TIi; CONSTRUCTION PERMIT APPLICATION! COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ^vn - 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 �/ �^ . (408) 777-3228 • FAX(408)777-3333 • 5uiidino(a cuoertino.oro ILI CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTEPU-MON/iI REVISION/DEFERRED ORIGINAL PERMIT 4 PROrEL7 ADDRESS APN R O*AR:ERNP.ME \sPHONE I I -1 E-MAIL �PP�-C � �r�c _ � MS�o / (vll. ogl 9(dLk;o 1 An1,.rVu� p1 12•c'Lwl STREET ADDRESS I CITY, STATE,ZTP FAX rN F+N rr F t��1� CONTACT NP1JL PHONL E-A4AIL CVioJ �>Zw )04ed2Vu:A—cc..sf. C.c.w� STREET ADDRESS &�O `I.6"11, ['✓ CITY,STATE, ZIP M, , I C FAX ❑ ORAER ❑ OWNER-BUILDER ❑ ORR,tRAGE'N-r tCONIRACTOR ❑CON7R4CTOAAGEN'1 ❑ ARCIIZIECT ❑n.'G-2"E ❑ DF�tLOPER ❑ TEN!?\TT CONTAACTORN.4A,EK VIN [awi 1 LICtSSEN[Th^EA ���t 2 LICENSPTYPE C-1 C.- I BLS.LIC COMPANY NAME / -I^� E•MAIL CAJJ_FLAX ��r'w•'� � ,.�✓tc In -Con S�-_tc�+'1 ST REET ADDRESS /'-�© (tea CITY,STATE,ZIP 1 S C� FHONE ARCHITECT/ENGR.TEER NAME v (( LICENSE NUMBER BUS.LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,S7A7E,ZIP I PHONE DESCRIPTION OF WORT{ T-t5 co w1 Ac � II cj O^J-0 d J e-� �vAc y C r/v4 EXISTING USE PROPOSED USE CON5TRTYPE mSTOP.IES USE TYPE I OCC. SQ.FT. VA-LUATION(S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA REMODELAMAREA REOD'EL AREA I REMODEL AREA PORCH AREA DECK AREA�TOTALDECK/PORCHARFA GARAGE AREA: DETACH ❑.ATTACH R DRILLING UNITS: IS A SECOND UNIT [3—S SECOND STORY [3 YES BEING ADDED? ❑NO ADDITION? ANO -PP -A7PPLIC-An0N--0-YES rr-S S.-MOYYMECOM01 _IAH )Es ARBY �� TOTAL VALUATION: PLA.T2NGkPPLk ❑NO ?LANTLGAPPROVEA E 10 m A — By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's b-ehalf. I have read this application and the information I have provided is or,ect. I have TP e Description of Work and verify it is accurate. I aRree to comply with all applicable local ordinances and state laws relating to bug istruction. rize representatives of Cupertino to enter the above-identifi d property for inspection purposes. Signature of Appl icant/Agent: Date; 4 SUPPLEMENTAL .TFORMATION_ UIRED r Q X New SFD or Multifamily d-vvellings: Apply for demolition permit for TE[E-COUNTER c� `� BUII.DII�GPZS''�REi�A' ` existing building(s). Demolition permit is required prior to issuance of building � � permit for ne-w building. � am WIN� 3Y ,54�i,,C its-.^em,yiF$ a`- �•-4aw �..'��S' �'S.3 '9s . _Commercial Bldgs: Provide a completed Hazardous MaM Materials Disclosure AMIIZD ss��;ORRS "b form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to � Uzi �` •.isnRmisTRr�T�� submittal of Building Permit application. :a_ ry ham.. ER�SIZOATiENTAT HE�3: A_ BldgApp_2011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ;q A9 (408) 777-3228• FAX(408)777-3333• building(a)cupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ! U 5&e /� /�14 / APN# // OWNER NAME /�s/ �d PHON✓E E-MAIL STREET ADDRESS CITY, STATE,ZIP /) FAX CONTACT NAME I "'V��i w y�/1 PHONE {,.J Q^� _(g6(, E-MAIL - ( / O 12— r rwr.n l�tvcG✓t—tCv15T COW? STREET ADDRESS q CITY,STATE, ZIP A II I '.� / FAX "I�OU �7.1�ra ,, DV, ❑ 7 OWNER ❑ OWNER-BUILDER OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEI r�w 1 COMPANY NAME LICENSE NUMBER LICENSE TYPE BUS LIC# 1 wv1 I/ 11\J 1`D �CGly CCAJ5� (�CE-MAIL• AY wa Y1 4vc_cv%-CCNS�-LCw FAX STREET ADDRESS 06 UI'l I�Ya', �� CITY,STATE,ZIP ", i'' PHONE q0`11 Z_q fJ5 l ^ ARCHITECT/ENGINEER NAME LICENSE NUMBER 'V` BUS.LIC# (I T Y COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK r EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES Q ' USE TYPE OCC. SQ.FT VALUATION($) EXISTGV NEW FLOOR DEMO TOTAL /� i((,^,W AREA AREA AREA NET AREA J-1 Elbv /i `�` { Ar 6/A-3 J4,i g BATHROOM KITCHEN OTHER VV Vv {{{{ �T REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE.AREA: DETACH []ATTACH #DWELLING UNITS IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION YES ff YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: _ TOTAL VALUATI PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO - 4 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read t is application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' 1,911luction. I auth ' representatives of Cupertino to enter the aboovve entifi dp operty for inspection purposes. Signature of Applicant/AgenL Date: f n SUPPLEMENTAL MORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. Q"EXPRESS - ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any 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 sEwERnISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH - BldgApp 2011.doc revised 06,121/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10500 N DE ANZA BLVD DATE: 08/11/2014 REVIEWED BY: MELISSA APN: 316 22 017 BP#: g�Q 7 "VALUATION: $800,000 'PERMIT TYPE: Building PermitPLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK APPLE T.I. - 2ND FLR RECONFIGURATION TO LABS & OFFICE SPACE. ADD N MECH UNIT ON SCOPE ROOF TOP OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) I-A,I-B 4,168 $3,631.04 IBTIPLNCK $5,395.64 IBTIINSP TOTALS: 4,168 $3,631.04 $5,395.64 MECH,HOURLY 0 Yes Q No PLUMB,HOURLY 0 Yes Q 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. . Theseees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (/,-cc Resolution 11-053 Ef' '.7 13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,631.04 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $5,395.64 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes ) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Q Building or Structure 0 i Strom Motion Fee: 1BSE1SM1CO $224.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $32.00 SUBTOTALS: $9,282.68 $0.00 TOTAL FEE: 1 $9,282.68 Revised: 0711012014 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION tADDRESS: 10500 N DE ANZA BLVD DATE: 09/29/2014 REVIEWED BY: MELISSA 16 22 017 BP#: 14080072 `VALUATION: $0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1GENC0 i WORK REV# 1 - REMOVE TRANSFORMER FROM E SCOPE OF WORK- ISSUED 9/29/14 SCOPE NOTE:This estimate does not include fees due to other Departments(i.e.Planning, Public Works, Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the prelimina information available and are on an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 11-053 Lf* 7,11113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ®Yes Q No $0.00 L 1 1 hours Plan Check, Hourly Suppl. PC Fee: Q Reg. 0 OT0,0 hrs $0.00 $143.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Supp/. Insp. Fee:Q Reg. 0 OTQ.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 i Strom Motion_Fee: $0.00 Select an Administrative Item Bldg* Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $143.00 TOTAL FEE: $143.00 Revised: 08/20/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P ERTI NO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: l e5oo N , DF p*j zA j3�_V PERMIT# 1`10 sb, 0r--1 -2- OWNER'S NAME: = PHONE# ytCP GENERAL CONTRACTOR: wc Cc, y f- � �_. BUSINESS LICENSE# ADDRESS: Com,b.:, jr CITY/ZIPCODE: i aoS C *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 Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting 9-jF6d e,&4-E wE'y- � 6 V-C:5 a(e Linoleum/Wood ss /Glazing Heating kuc' a- Insulation Landscaping Lathing asonry YZ Painting/Wallpaper ,o PA-1„r rl,J Paving IA- Plumbing Roofing ptic Tank IfflSheet Metal ;�tSheet Rock t� 0P--'wf� Tile Owner/Contractor Signature Date