14060172 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100 N TANTAU AVE CONTRACTOR:NOVO CONSTRUCTION PERMIT NO: 14060172
OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC 1460 O'BRIEN DR DATE ISSUED:08/18/2014
OWNER'S PHONE: 6504701501 MENLO PARK,CA 94025 PHONE NO:(650)701-1500
V`b LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
APPLE- ADD NEW ROOF TOP EXHAUST FAN FOR ADDED
LicenseClasssLic. 1N 71 SNORKEL*HAZMAT*
Contractor NOVO DateI
I hereby affirm that I am licensed under the provyi-.L- 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. Sq.Ft Floor Area: Valuation:$7500
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31619061.10100 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. 1 agree to comply with all city and county ordinances and state laws relating WITHI�1 1$O D�1 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 YS FROM ST 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: Y
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature /� Date—9/ v All roofs shall be inspected prior to any roofing 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
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)
1,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. 1 will
1 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 1 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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued. e 01
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 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 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, 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
12 COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228• FAX (408) 777-3333• buildingna,cupertino.orq ;
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 10100 N Tantau, Cupertino, CA 95014 APN# -, V U(pl. b0
OWNER NAI EApple Inc. PHOT- , ES �$4,�-y�l%�f E-MAIL H.gallen@apple.com
STREET ADDRESS 1 Infinent Loop CITY, STATE,ZIP Cupertino(,, CA, 95014 FAX
J
CONTACT NAME Nathan Dudley PHONE ( U..� 0,11UU 15 E-MAILndudley@novoconstruction.com
STREET ADDRESS 1460 O'Brien Drive CITY,STATE, 71PMenlo Park, CA, 94025 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT IN ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Nathan Dudley LICENSE NUMBER 791022 LICENSE TYPE B BUS.LIC 823891
COMPANY NAME Novo Construction E-MAIL ndLid ley@novoconstruction.COM FAX
STREET ADDRESS 1460 O'Brien Drive CITY,STATE,ZIP Menlo Park, CA, 94025 PHONE � � c;0_ 1440
ARCHITECT/ENGINEER NAME Sherry C ha u m pl uke LICENSE NUMBER BUS LIC#
COMPANY NAME ACCO Engineered Systems E-MAIL schaumpluke@accoes.Corn FAX
STREET,ADDRESS 1 133 Aladdin Avenue CITY,STATE,ZIP San Leandro, California, 94577 PHONE 510-346-4328
DESCRIPTION OF WORK
New roof top exhaust fan for added snorkel.
EXISTING USE LAB PROPOSED USE LAB CONSTR.TYPE #STORIES 1 USE TYPE OCC. SQ.FT, VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
ASA 100 AREA AREA NET AREA O Lab V 13 $7,500
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTALDECKIPORCH AREA GARAGE AREA: DETACH
[]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 'CEIVED BY: TOTAL`ALUATION-
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO Q v
By my signature below,1 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 this
application and the information I have provided i 7correct. �1�have the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bwld' 0 6truction. ze representatives of Cupertino to enter the ab/owe�dfen ified oopeerty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION 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. ❑ EXPRESS LANNING 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 y-O�f"AIA e--
Z
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21%11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10100 N tantau DATE: 06/26/2014 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$7,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK ��-_aadd new roof top exhaust fan for added snorkel
SCOPE
I'?' dt Ph.w
Alecdt, Per)nit Fee: I'lwnb. Perfna[Cc: Elec.Pcm,z FCc,
fn: p. fart c>r l iw,ih hi n, 001-r FF
M-(h' Msp. £- P` hlq,, t'ee;
NOTE:This estimate does not include fees due to other Departments(Le.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 De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Efl: 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ()Yes Q No $0.00 hours Plan Check, Hourly
Suppl. PC Fee: (Z) Reg. 0 OT0.0 hrs $0.00 $278.00 1 STPLNCK
PME Plan Check: $0.00
Pen-nit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp. Fee:Q Reg. () OT O.O hrs $0.00
PME Unit Fee: $0.00
PME Pen-nit Fee: $0.00
€ons•rruction Tux:
rlt/ntitusrrcaiit,e f ee:
Work Without Permit? 0 Yes (j) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
Irt?1'PI ��r)E'fb7?1E:72itfPftslt fees:
Strong Motion Fee. 1BSEISMICO $1.58 4.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $556.00 ISTINSP Inspection,Hourly
SUBTOTALS: $2.58 $834.00 TOTAL FEE: $836.58
Revised: 04/01/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: le,/,0 /L// PERMIT#
OWNER'S NAME:� /-& C•,�, .��, /��_�� _--f LSC- PHONE # 4
GENERAL CONTRACTOR: v✓� -�s f� <<T BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE: 4;
*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.
am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/WaIlpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal ' s
Sheet Rock
Tile
Own /Contractor Signature Date