10100160112
CITY OF CUPERTINO BUILDING PERMI
BUILDING ADDRESS: 20650 VALLEY GREEN DR
CONTRACTOR: DEVCON CONST -PERMIT—NO: 10100160
INC
OWNER'S NAME: APPLE INC
690 GIBRALTAR DR DATE ISSUED: 12/08/2010
OWNER'S PHONE: 4089744876
MILPITAS, CA 95035 PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
r r
PERMIT INFO: BLDG r
BUILDING ELECT PLUMB
License Class ) Lic. #
MECH r RESIDENTIAL r COMMERCIAL r
Contractor � �Date
a )6
I hereby affirm that I am licensed under the provisions of Chap er 9
JOB DESCRIPTION: COMM'L TI INTERIOR MODIFICATION TO EXISTING
(commencing with Section 7000) of Division 3 of the Business & Professions
TENANT
INCLUDING
Code and that my license is in full force and effect.
ELECTRICAL,MECHANICAL,PLUMBiNG,WALLS,DOOR &pp
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
–r+ f� rn n j; nr, ,, 3� b �(�-4j I`�•
Compensation, as provided for by Section 3700 of the Labor Code, for the
for
1'`T �1' (�� –A ✓ �� ` TA rt
cx�
performance of the work which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as for by
n
provided
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $300000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 32610053.00
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 EXP RES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. diti y, the applicant understands and will comply
WITHIN 1 AYS OF PERMIT ISSUANCE OR
with all n oint Du, gul o s per the Cupertino Municipal Code, Section
180 DA M LAST CALLED INSPECTION.
9.18.
14—
- f ^
Signature Date
L4
Issued by: v� Date:
F=
❑ WNER-BUILDER DECL\IATION
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
1, as owner of the property, 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)
I, 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(x) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as deft ed 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
maintain complianc with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Hea t & Sa etyo e, Sections 25505, 25533, and 25534.
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.
wrier an r g t:
Date•
APPLICANT CERTIFICATION
ONS ION LENDING AGENCY
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 cons ction lending agency for the performance of work'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
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 10100160
INC
OWNER'S NAME: APPLE INC 16" GIBRALTAR DR I DATE ISSUED: 12/08/2010 1
OWNER'S PHONE: 4089744876 1 MILPITAS, CA 95035 1 PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DECLARATION
License Class Lie. # _I9 (, (a_S
Contractor' 1,JZT Date kzldto
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 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 no int so a ions per the Cupertino Municipal Code, Section
9.18.
Signa tui� Date �2
❑ . OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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, 1
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
1 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
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: COMM'L TI INTERIOR MODIFICATION TO EXISTING
TENANT
INCLUDING
ELECTRICAL,MECHANICAL,PLUMBING,WALLS,DOOR &
Sq. Ft Floor Area: I Valuation: $300000
APN Number: 32610053.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA OM LAST CALLED INSPEC%TION.
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 1 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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health& Safity Bode, jSgctions 25505, 25533, and 25534.
all
1 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
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
Fm -N
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
LfecFt. ('Ian C'Dieck
ADDRESS: 20650 valley green dr. 1st floor
DATE: 02/16/2011
REVIEWED BY: bobs.
Other A/Etch. Insp.
APN:
BP##:
'VALUATION:
1$5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
hrs
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
revise t.i. comm. space drawings to separate phase 3 into 3a and 3b 3b identified only.
SCOPE
LfecFt. ('Ian C'Dieck
Plumb. Plan Check t.lec. i'ian Check
,Lfecll. Perwit Fee:
wnh. Pei sril Fee: 1 Permit F e:
Other A/Etch. Insp.
Other Plumb Li
Other Ftec. lnsp. Li
llech. Insp. Fee:
Plumb. hisp. Fce.: Elec. Imp. /,L,(,
NOTE: These lees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resohition 09-051 E& 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes (E) No
$0.00
hours Plan Check, Hourly
$252.00 ISTPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee10 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
ConsIniction Tax
Acoustical Fee: 0 Yes 0 No
$0.00
Q
E)
Work Without Permit? 0 Yes G No
$0.00
Planninp- Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICO
$? 05
Select an Administrative Item
Bldg; Stds Commission Fee: IBCBSC
SUBTOTALS:
$2.05
$252.00
TOTAL FEE:
.05
Revised: 01/15/2011