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14020088 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR:DEVCON PERMIT NO: 14020088 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED:03/05/2014 OWNER'S PHONE: 4088624397 MILPITAS,CA 95035 PHONE NO:(408)942-8200 it LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL APPLE T.I. TO RECONFIGURE (E)OFFICE SPACE License Class CA O,, Lie.# �Q�7 (2000S.F.) Contractor t(„y« (�N,�, 1/1 Co Date I IF 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: 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$150000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31622017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to tr comply with all city and county ordinances and state laws relating WITHIN 18�$AYS O ERMIT 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 LAS CALLED INSPE/ETON. 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'�'i/ granting of this permit. Additionally,the applicant understands and will comply Issued by: �. Date: 77 with all non-point urc gulations per e Cupertino Municipal Code,Section 9.18. 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) 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. 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 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Munici 1 Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 255 2 a 5534. Section 3700 of the Labor Code,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,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,1 must 1 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 l have read this application and state that the above information is correct. 1 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 1 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 CONSTRUCTION PERMIT APPLICATION o v COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION /O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 V (408) 777-3228• FAX(408)777-3333•buildingacu ertino.orq �� CUPERTINO ❑NEW CONSTRUCTION ❑ (ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS Igloo J. 4,,-1.6% rIv AP NN# ( / ZZ I O 1 OWNERNAMEP�f 'M f t�S S 1 O S PHO 6 f (y E-MAIL STREET ADDRESS f Ih '„; L0 CITY, S ATE,ZIP � +,Al G A FAX CONTACT NAME Ate `r1 j PHONE E-MAIL� v u LO.... STREETADDRESS J„�N: 1 • CITY,STATE,ZIP �V C /L FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENr ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT E3 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME V _ ^ r it LICENSE NUMBER f LICENSE TYPE C,` BUS.LIC# COMPANY NAME f E-MAIL , FAX pG�u••, Co -f- n` :r%4, A G•vN. STREET ADDRESS 1���' ✓ ��• CITY,STATE,ZIP M. ` PHONE �-�`I ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# 7 COMPANY NAME }�- r E-MAIL FAX YLVG�V1 c.iH�i� C . STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 14 ww 4A'UL f,PaL tit �� cl i V”" --v KLw v✓- -e" , t,w Vit VV% ;41/0_4_ k rt • i'► I�VA'c. EXISTING USE PROPOSED USE CONSTR TYPE 1 #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH f❑ [:]#DWELLING UNITS: IS A SECOND UNrYES SECOND STORY YES BEING ADDED? []NO ADDITION? ONO PRE-APPLICATION OYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES $[ ,. ': TOTAL VALUATION: PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? [3 NO By my signature below,I certify to each of the following: I am the property owner orized agent to act on the ope er's behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify it is a I agree to comply with all applicable local ordinances and state laws relating to buildin ccwAruction. I authgri�epresentatives of Cupertino to enter the above-identified pro erty for inspection purposes. � . ._ 2 C3 Signature of Applicant/Agent: ( ` Date: SUPPLEMENTAL INFORMATION REQUIRED Q rr ArrcxYrE� �� xoaJzvvcsi� . ,,�a _New SFD or Multifamilydwellings: or emotion ifor or dlliApply pp1y fdemolition p ❑' OVER TII2rCOtII�TERt� ❑ BIIILDINGPhAlYREYIE�� ; existing building(s). Demolition permit is required prior to issuance of building k permit for new building. L� EXPRESSc r �'� lI� r 4xnvcPt xiEw , Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ."i] STANDA7tD s ❑ r,.usT Towo �.. �. 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. SO i " Q ARS nTs2itlL-t .�- i as ,-;., .1hA�,. .. ,� uu��.4r��NYIIiOrIIVII+'+\•A�IIFiA.CTR%'�a.§ Bldg4pp_201].doe revised 06/21/11 CITY OF CUPERTINO ILIFEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10500 N DE ANZA BLVD DATE: 02/13/2014 REVIEWED BY: MELISSA APN: 316 22 017 BP#: J 'VALUATION: 1$150,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK APPLE T.I. TO RECONFIGURE E OFFICE SPACE 6000S.F. SCOPE 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 2,000 $3,251.30 1BTIPLNCK $2,635.75 1BTIINSP TOTALS: 2,000 $3,251.30 $2,635.75 MECH,HOURLY © Yes (D No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No Lj NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn't info. FEE ITEMS (Fee Resolution FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,251.30 Select a Misc Bldg/Structure Suppl. PC Fee: (F) Reg. 0 OTf 0.0 1 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $2,635.75 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential G Building or Structure 0 Strong?Motion Fee: IBSEISMICO $31.50 Select an Administrative Item Bld&Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $5,924.55 $0.00 TOTAL FEE: F$5,924.55 Revised: 01/15/2014