11010070CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 N DE ANZA BLVD FLR 1
NER'S NAME: APPLE INC
,✓NER'S PHONE: 4089744876
Er LICENSED CONTRACTOR'S DECLARATION �}
License Class 8 Lic.4 V J I 1 �3
Contractor L?i,�✓6aV (�PN6J_ Date 2 %
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 t is
permit is issued. 31
APPLICANT CERTIFICATION
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,
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 a Cupertino Municipal Code, Section
9.18.
nature /V v Date t
C
I hereby affirm that I am exempt from_1Ser-ontractor'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
constructthe 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 sous 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 I have read this application and state that the above information is
rnrrect. I agree to comply with all city and county ordinances and state laws relating
,iilding construction, and hereby authorize representatives of this city to enter
.,n the above mentioned property for inspection purposes. (We) agree to save
,demnify 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 ppr the Cupertino Municipal Code, Section
9.18.
Signature
Date
CONTRACTOR: DEVCON PERMIT NO: 11010070
CONSTRUCTION INC
690 GIBRALTAR DR DATE ISSUED: 02/01/2011
MILPITAS, CA 95035 PHONE NO: (408)942-8200
JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL 11
FLOOR 1 - COMM'L TENANT IMPROVEMENT(82SQFT)-
REMOVE
EXISTING CLOSET & PROVIDE NEW ELECTRICAL
CLOSET.
AREA OF WORK IS 82SQFT;NO RE -ROOF & NO
STRUCTURAL
Sq. Ft Floor Area:
Valuation: $7500
APN Number: 31622017.FLR1 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM 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(x) 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 Muni ipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505 2553 nd 25534.
Owner or authorized agent. Date: 2-
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
October 27, 2015
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Attention: :Pat G.
Reference: Permit ##: 11010070
10500 N. De Anza Blvd
Cupertino, CA 95014
BY
Dear Pat,
DEVCON CONSTRUCTION Devcon Construction, Inc. would like to cancel permit #11010070
INCORPORATED as no work was performed. Project was cancelled by the client.
General Building Contractors
690 Gibraltar Drive
Milpitas, California 95035
Phone (408) 942-8200
FAX (408) 262-2342
www.devcon-const.com
Very truly yours,
DE CONSTRUCTION, INC.
Paulette Roseberry
Project Executive
CITY OF CUPERTINO
. FEE ESTIMATOR — BUILDING DIVISION
imlADDRESS:
10500 n. de anza blvd. 1st floor
DATE: 01/11/2011
REVIEWED BY: bobs.
PC FEE ID
APN:
BP#:
*VALUATION: 1$7,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
Commercial Building
IBTIPLNCK
PENTAMATION 1 B TI
USE:
Clec. lay. Fee:
PERMIT TYPE:
WORK
construct new electrical closet at ex.commercial bldg.
hrs
$0.00
SCOPE
PME Unit Fee:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,111-B,IV,V-B
85
$1,856.00
IBTIPLNCK
$520.00
IBTIINSP
Clec. lay. Fee:
$520.00
Suppl. Insp. Fee -,G Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Corislrruclion Tax
Acoustical Fee: 0 Yes E) No
$0.00
0
E)
Work Without Permit? ® Yes E) No
$0.00
TOTALS:
85
$1,856.00
Trywel Docwnenlolion Fees:
$520.00
Strong Motion Fee: IBSEISMICO
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY Q Yes 'Q No
ELEC, HOURLY Q Yes (D No
A -tech, Plan Chcelr
Phrn1h. Plan Checl,
Elec. Plan Check
1i'lech. Perwit Fee;
Phollh. Pelwnit l'e'e:
Glec. Permit Fec:
Outer Alec•h. h7.cp.
Other Phimb Tnsp.
Other Dec lnvs ,
110ck hasp. Fee:
Phnnb. Insp. Fee:
Clec. lay. Fee:
N07F- Tbeca Fee.c am hosed nn the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS ("Fee Resolution 09-051 E . 7/1/10,
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,856.00
Select a Misc Bldg/Structure
or Element of a Building ,
Suppl. PC Fee: 0 Reg. 0 OT
rb.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$520.00
Suppl. Insp. Fee -,G Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Corislrruclion Tax
Acoustical Fee: 0 Yes E) No
$0.00
0
E)
Work Without Permit? ® Yes E) No
$0.00
Planning Fee: PLLONGRNGC
$0.00
G
Trywel Docwnenlolion Fees:
Strong Motion Fee: IBSEISMICO
$1.58
Select an Administrative Item
Bldjz Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:;
$2,378.58
$0.00 TOTALFEE:
$2,378.58
Revised: 12/07/2010
CITY OF
CITY OF CUPERTINO l 6 Off`
TENANT IMPROVEMENT
CUPERTINO PERMIT APPLICATION FORM
APN # ' `P t /
Date:
Building Address.
119-5-0
Mailing Address (if different from building address):
Tenant N (If tenant please provide a letter from the building owner approving the tenant improvement.)
B lding Owner ❑
Are Hazardous Materials being used as part of this project? Yes ❑ No t
Tenant/Building Owner's Name:
Phone #:
Contractor: _
Phone `°2-0
Fax #:
Cupertino Business License: State Contractor License #:
ContactPhone #:
Cot -5;0 (\J / 13 1 Fax /e-mail:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
If 2,500 sq. ft. or less, compliance with the Landscape Water -Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Job Description (be specific):-
Tenant Improvement Includes Re -Roof. Yes ❑ No�S. If yes, number of squares
Tenant Improvement Includes Structural Yes ❑ No
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B IMII/V-A ❑ II/III P ` TIT, V -B ❑ Valuation:.
Project ize: Counter ❑ Express Standard Large ❑Major ❑
Green Building: Please complete Leed for commercial interiors checklist & attach it to the application
or if applicable, include in plans & sheet index
LEED Points Achieved
*** For Office Use Only*** Revised 12-06-10