09060083 CITY OF CUPERTIPIO BUILDING PERMIT
BUILDING ADDRESS: 10495 N DE ANZA BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO:09060083
INC
O` R'S NAME: APPLE,INC. 1690 GIBRALTAR DR DATE ISSUED:08/26/2009
OWNER'S PHONE: 4089741373 MILPITAS,CA 95035 PHONE NO:(408)942-8200
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT F_ PLUMB tf-
License Class_._ Lic.# e39� �3 r— r�ja//�(,1�/ MECH RESIDENTIAL COMMERCIAL �
Contractor
f /!gWy Date O
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COWL TI SITE IMPRVMENTS FOR EXTERIOR
(commencing with Section 7000)of Division 3 of the Business&Professions PATIO&
Code and that my license is in full force and effect. RELOCTN OF PARKING SPACES(695SQ)
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:$54228
permit is issued.
APPLICANT CERTIFICATION APN Number:32633110.00 Occupancy Type:
I certify that I have read this application and state that the above information is
corroct. 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations pe the Cupertino Municipal Code,Section
9.18.
Si )late Pa�� Issued by: Date:
❑ OWNER-BUILD ION
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
[,as owner of the roe nstalled without first obtaining an inspection,I agree to remove all new materials for
property,rty,or my employees with wages as their sole compensation, nspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) signature of Applicant: Date:
1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by i ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3100 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit i,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,l shall ontaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's health&Safety Code,S ' ns 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
h become subject to the Worker's Compensation provisions of the Labor Code,I must t r auth i� t:
forthwith comply with such provisions or this permit shall be deemed revoked. _ Date: i:(d'9
APPLICANT CERTIFICATION ONSTRUCTI ENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply .vith all city and county ordinances and state laws relating f rr which this permit is issued(Sec.3097,Civ C.)
to r- 'i;ng construction,and hereby authorize representatives of this city to enter bender's Name
U. :above mentioned property for inspection purposes.(We)agree to save
ina:::uilfy and keep harmless the City of Cupertino against liabilities,judgments, bender's Address
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 ARCHITECT'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTIPIO BUILDING PERMIT
BUILDING ADDRESS: 10495 N DE ANZA BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO:09060083
INC
O` R'S NAME: APPLE,INC. 1690 GIBRALTAR DR DATE ISSUED:08/26/2009
OWNER'S PHONE: 4089741373 MILPITAS,CA 95035 PHONE NO:(408)942-8200
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT F_ PLUMB tf-
License Class_._ Lic.# e39� �3 r— r�ja//�(,1�/ MECH RESIDENTIAL COMMERCIAL �
Contractor
f /!gWy Date O
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COWL TI SITE IMPRVMENTS FOR EXTERIOR
(commencing with Section 7000)of Division 3 of the Business&Professions PATIO&
Code and that my license is in full force and effect. RELOCTN OF PARKING SPACES(695SQ)
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:$54228
permit is issued.
APPLICANT CERTIFICATION APN Number:32633110.00 Occupancy Type:
I certify that I have read this application and state that the above information is
corroct. 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations pe the Cupertino Municipal Code,Section
9.18.
Si )late Pa�� Issued by: Date:
❑ OWNER-BUILD ION
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
[,as owner of the roe nstalled without first obtaining an inspection,I agree to remove all new materials for
property,rty,or my employees with wages as their sole compensation, nspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) signature of Applicant: Date:
1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by i ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3100 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit i,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,l shall ontaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's health&Safety Code,S ' ns 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
h become subject to the Worker's Compensation provisions of the Labor Code,I must t r auth i� t:
forthwith comply with such provisions or this permit shall be deemed revoked. _ Date: i:(d'9
APPLICANT CERTIFICATION ONSTRUCTI ENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply .vith all city and county ordinances and state laws relating f rr which this permit is issued(Sec.3097,Civ C.)
to r- 'i;ng construction,and hereby authorize representatives of this city to enter bender's Name
U. :above mentioned property for inspection purposes.(We)agree to save
ina:::uilfy and keep harmless the City of Cupertino against liabilities,judgments, bender's Address
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 ARCHITECT'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: !0495 N DE ANZA BLVD CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO:09060083
INC
OWNER'S NAME: APPLE,INC. 690 GIBRALTAR DR DATE ISSUED:08/26/2009
OWNER'S PHONE: 4089741373 MILPITAS,CA 95035 PHONE NO:(408)942-8200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT T_ PLUMB�
License Class Lic.tl t��T�G -3 T" f" �"`
MECH RESH)ENTIAL COMMERCIAL
Contractor Re/L(y(/ j/,S (/ iIOYV DateSOZZ4/4
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COWL TI SITE IMPRVMENTS FOR EXTERIOR
(commencing with Section 7000)of Division 3 of the Business&Professions PATIO&
Code and that my license is in full force and effect. RELOCTN OF PARKING SPACES(695SQ)
1 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.
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 Sq.Ft Floor Area: Valuation:$54228
permit is issued.
APPLICANT CERTIFICATION APN Number:32633110.00 Occupancy Type:
I certify that I have read this application and state that the above information is
corn:ct.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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations pe the Cupertino Municipal Code,Section
9.18.
Signatu; Date � q Issued by: Date:
❑ OWNER-BUILD ION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation,
inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the i have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3 700 of the Labor Code,for the performance of the work for which this 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
I certify that in the performance of the work for which this permit is issued,I shall 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
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,S ns 25505,25533,and 25534.
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 r anth ize
forthwith comply with such provisions or this permit shall be deemed revoked. Date:�t
APPLICANT CERTIFICATION QQNSTRUCTIM�XNDINC AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
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 ARCHITECT'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
C)� �og �
CITY OF CUPERTINO
TENANT IMPROVEMENT
CUPERTINO PERMIT APPLICATION FORM
APN# 33 " Date: 6 , 1.S• O
Building Address: /O�F f5-
Mailing
SMailing Address (if different from building address):
Owner's Name: p,4r , /Nc . Phone#: ,ef6e. 97-,�' X373
Contractor: PxvcpN Colyglzw c7io/y &C . Phone#: #Off. 57 f , 03'3,
Fax 26 2 . Z 3�2
Contractor License#: 3
Cupertino Business License#:
Contact: 1 �IWIA Phone#: GSp. 3.Gs, d600
Fax#: ��• S• od 70
Alternate Contact:� i� Wov��yy/�y Phone#: 408 .
/ Fax#: 46t. ZG Z. z3 Z
Valuation(cost of project):
Job Description(be specific): 7-
416-1-0 64
Tenant Improvement Includes Re-Roof: Yes ❑ No If yes, number of squares
Tenant Improvement Includes Structural Yes❑ No_RJ,
Type of Construction(Usage Class): Occupancy Type:
I .- 1-B ❑
Project Size: Standard Large❑ Major E]
Green Building: Attach LEED Checklist to plans and identify in sheet index.
LEED Points Achieved:
*** For Office Use Only*** Over The Counter❑
j
1
4
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITYOF Fax(408)777-3333
CU PEkTINO
Building Department
JOB ADDRESS: PERMIT #
t --,y 9 75- /,-1 5 ✓ 1
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR t:i�VC,6-/1 FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contr ctor Signa e Date