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14060195I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10600 N TANTAU AVE I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 14060195 1 OWNER'S NAME: CAMPUS HOLDINGS INC OWNER'S PHONE: 4153854474 ❑ LICENSED CONTRACTOR'S DECLARATION AV License Class Lic. # � q )OC)'a Contractor�Cvd 045l4raL s1 Date 6 �U � 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 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. /% Signature ' ;.� Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 ofCupertino 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 1460 O'BRIEN DR I DATE ISSUED: 06/30/2014 MENLO PARK, CA 94025 1 PHONE NO: (650)701-1500 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] APPLE- ADDITION OF NEW POWER AND DATA RECEP.. Sq. Ft Floor Area: I Valuation: $5000 APN Number: 31618035.10600 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1�0 DAYS OFTERMIT ISSUANCE OR 180 DAYS ROM LAST CALLED INSPECTION. Issued by: �� Date:�� RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CO /;D �( CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO 01h CONSTRUCTION PERMIT APPLICATION v� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �' n 10300 TORRE AVENUE' CUPERTINO, CA 95014-3255 vl (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org \ ❑ NEW CONSTRUCTION ❑ ADDITION � ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT R PROJECT .ADDRESS,y / D I APN a� OWNER NAME PHONEMIC - 3Q5- '1-f ` E-MAIL alle�n� A 1p D Qrn STREETADDRESS CITY, STAT ZIP) FAX Ol I V1`in I` wo CONTACT NAME � ' PHONE S / _ E-MAIL/VCW I k!OFVOA CoilS�1�U��` f V STREETADDRESS 6oO I Bc QAw ID� C 5 A IP Rl FAX ❑ oRT-R ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME , 1 w� LICENSE NUMBER 721 Oa a LICENSE TYPE 16 N BUS. LIC R COMPANY NAME E-M?.IL � J.1. FAX Novo �o� u�. �.� oet coxn� STREET .ADDRESS O O' CITY ST ZIPI� PFic O - (S �J f 1 w O'Z< ARC T ENGINES N A4E LICENSE NUMBER BU& LIC k' i 1 COMPANY NAME, .v E -f 4AIL � /. / 1 �C FAX vx�1/dI/J � ' e O v t, STREET AD KESSit A t OO 1 CITY, ST TE, ZIP C� PHON'$ 0 7 DESCRIPTION OF WORKS a LQ P P O EXISTIN USE PROPOED L` CONSTR. TYPE MSTORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA C> U d BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH 9 DV,'ELLING UNITS: ISA SECOND UNIT []YES SECOND STORY ❑ YES BEING ADDED? r7 NO ADDITION? NO -PRE-APPLICATION --[}YES----IF-S'ES, PROVIDE_COP� OF_.__ - ___ :JS THE BLr)G.A.N ___ []YES REGEIVEDBY - `_ _ TO AL VALUATION: PLANN'INGAPPL9 F7 NO PLA.NA�GAPPROVAL LETTER EICHLERHOME. []NO•" °' -: • -� t f '. yam,, --- - ' Ov __-- -- - -- By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property bmmer's behalf. I have read this application and the information I have provided is correct. I haver the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I a ize representatives of Cupertino to enter the above-i1entified roperty for inspection purposes. Signature of ApplicanUAgent: Date: - SUPPLEMENT.AL IINTFORMATION REQUIRED PL, � ca�Cd r�PE- " Y xovTLicsilP - _ o New SFD or Multifamily dvv'ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildin, �R Talrcoul<TERBUILDIl\GPLA� " REVIEW tats x, permit for new building. EaPRESS � .k � 'PLANriII�GPLA1sREVI1fVi'.3 Commercial Bldas: Provide a completed Hazardous Materials Disclosure sTannitD x L7 PUBLzexvoRxs _ form if any Hazardous Materials are being used as part of this project. �? _ Copy of Planning Approval Letter or Meeting with Planning prior to 014?T032L�€ �' } 0 submittal of Building Permit application. .SAITARI SL�iRDISTRICT' ��� ENVIROnfi1ENTAI IIEAL'I'A�'� - n' (!t% CITY OF CUPERTINO F -M -ft FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10600 n tantau ave FEE DATE: 06/30/2014 REVIEWED BY: Mendez APN: BP#: y S VALUATION: 1$5,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building 0.0 hrs PENTAMATION PERMIT TYPE: 1 GENCO WORK a le- addition of new power and data rece .. SCOPE Permit Fee: Hourly Only? 0 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 )_ These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS Fee Resolution 11-053 1,-f 11-053 ?%1:'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes Q No $0.00 2 hours $278.00 Plan Check, Hourly ISTPGNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.Q 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 T7_ 0 G Work Without Permit? © Yes) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 Strom Motion Fee: IBSEISMICO $1.05 3.0 hrs $417.00 Inspections ISTINSP Inspection, Hourly Bldg, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.05 $695.00 TOTAL FEE: $697.05 Revised: 04/01/2014 CUPERTINO PURPOSE HAZARDOUS MATERIALS CHECKLIST COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingRcupertino.orq To minimize possible delays that would result for the Fire Department plan review, please complete the following checklist to determine if an additional level of Hazardous Materials plan review will be required. MARK'YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING? PLEASE MARK YOUR ANSWER WITH AN 'X' IN THE YES OR NO BOX ON THE SIDE BELOW. YES NO 1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases, hazardous materials, etc. X 2. Battery back-up rooms or racks. X 3. Propane tanks. X 4. Gasoline stations with underground tanks. X 5. Installation or replacement above ground or underground storage of liquid petroleum products, liquefied petroleum gases, compressed natural gas, explosives or other regulated hazardous materials. X 6. Gas rooms for dentist, doctors or veterinarians. X 7. Generators with back-up diesel or other fuels. X 8. Large refrigeration systems. X 9. Fuel cell systems. X 10. Commercial pool systems. X 11. Chemical Storage areas. 12. Flammable liquid storage. X 13. Compressed Gases. X 14. Dry cleaners. X 15. Print Shops. X 16. Auto Repair and Auto Body Shops. X 17. Research and Development. X For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa Clara County Fire Department, at (408) 378-4010. HasMat 2011.doc revised 03/07/11