11100053CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20525 MARIANI AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 11100053
OWNER'S NAME: 20525 MARIANI DRIVE LP
851 BUCKEYE CT
DATE ISSUED: 10/27/2011
OWNER'S PHONE: 4088629799
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
❑ LICENSED CONTRACTOR'S DECLARATION
Ir (— f
(i 4� ��
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
r, r—
� 'Z� �1
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: APPLE- COMMERCIAL TENANT
(commencing with Section 7000) of Division 3 of the Business & Professions
IMPROVEMENT(2117SQFT)
CONVERT OFFICE SPACE TO LAB SPACE, INCLUDES
Code and that my license is in full force and effect.
MECHANICAL, ELECTRIC & NO PLUMBING
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
Sq. Ft Floor Area:
Valuation: $500000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 32656001.20525
Occupancy Type:
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,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and a enses which accrue against said City in consequence of the
granting of ' permit. Aqditipnally, a applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-po t source r ul tuns er the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date
Issued by: Date:
❑ ER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of theproperty, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
[ certify that in the performance of the work for which this permit is issued, I shall
contHants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintai coin , ce with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption; I
Health & afe C e, Se Coos 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
Owner or th d age t:
forthwith comply with such provisions or this permit shall be deemed revoked.
Date: II I
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
\J
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
I hereby affirm that there is a construction lending agency for the performance of mrk's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.1&
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FRM7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20525 mariani ave
DATE: 10/07/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$500,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1BTI
PERMIT TYPE:
WORK
U. commercial convert offices ace to labs ace includes M Es no plumbing.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-A,III-A,V-A
2,117
$2,577.36
IBTIPLNCK
$2,245.64
IBTIINSP
TOTALS:
2,117
$2,577.36
$2,245.64
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District; School
Divtrirl. etc 1_ The_ce fees are hated an the nrelininary information available and are only an estimate Contact the Dent for addn'1 info
FEE ITEMS (Fee Resolution 11-053 L' . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,577.36
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,245.64
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
)
0
0
Work Without Permit? 0 Yes O No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
T; , ....' n > c_ ,.. -r; rt) "..,, ,.
Strong Motion Fee: IBSEISMICO
$105.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
1 $20.00
SUBTOTALS:
1 $4,948.00
$0.001
TOTAL FEE:
$4,948.00
Revised: 10/01 /2011
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(&cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION x❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS ^ qA4\M � '-�( /
f ` ItPHH'O'(NEE
APN k � 1` O()
OWNERNAME Apple Inc
408 . 996 LOJ0
-T
STREET ADDRESS 1 Infinite Loop
CITY, STATE, ZIP Cupertino, CA 95014
FAX
CONTACT NAME Marco Innocenti
PHONE 408.240.6000
E-MAIL,
minnocenti@xlconst.com
STREETADDRESs 851 Buckeye Court
CITY,STATE, ZIP Milpitas, CA 95035F408.240.6001
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Marco Innocenti
LICENSE NUMBER 6 4 7 4 8 0
LICENSE TYPE B
BUS. LIC # 21836
COMPANYNAME XL Construction
E-MAIL minnocenti@xlconst.com
FAX 408.240.6001
S-FREETADDRESS 851 Buckeye Court
CITY, STATE, ZIP Milpitas, CA 95035
PHONE408.240.6000
ARCHITECTIENGINEER NAME " j [1-,A {, I
LICENSE NUMBER
BUS. LIC N
COMPANY NAME psy'!I (_I �ijl�/t
Fes+--civ lTr" v..^
E-MAIL
FAX 415 . 398 . 3829
STREETADDREss405 Howard St Suite 588
c'TY,sT' a ZIP
CA 941051PHONE
PHONE 415. 398 . 7575
DESCRIPTION OF WORK
EXISTING ;S
PROPOSED USE CO\
T ^I"YPE
q STORIES
J
USE
TYPE
OCC.
SQ.FT.
VALUATION($)
EXISTG
AREA 2 l ice-
NEW FLOOR
AREA 2 /�
DEMO
AREA
TOTAL
NET AREA
10C
/
1
BATHROOM N/A
REMODEL
KITCHEN
REMODEL
OTHER N/A
AREA
AREAN/A
REMODEL AREA
PORCH AREA
N/A
DECK AREA
N/A
TOTAL DECK/PORCH AREA
N/A
GARAG AREA: DETACH
N%A []ATTACH
# DWELLING UNTIS
N/A
IS A SECOND UNIT ❑ YES
BEING ADDED? NO
SECOND STORY YES
ADDITION' HNO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # UNO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑�OI YES
EICHLER HOME' N NO
RECEIVED BY:
J
TOTAL -" - - I'ATION:
• 500,000
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 this
application and the information I have ovided i rrect. I e read the Description of Work and verify it is accurate. I agree to comply with all applicable local
Ordinances and state laws relating to bui ing w ction. I uthorize representatives of Cupertino to enter the above -id tifie property for inspection purposes.
Signature of Applicant/Agent: Date:Lo ILI
SUPPLEMENTAL RMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
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
permit for new building.
EX
PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
XT STANDARD
El P KS PUBLIC WORM
form if any Hazardous Materials are being used as part of this project.
❑LARGE
-FIRE
DEPf
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11