13120116CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 N DE ANZA BLVD
CONTRACTOR: DEVCON
PERMIT NO: 13120116
CONSTRUCTION INC
OWNER'S NAME: MISSION WEST PROPERTIES LP IV
690 GIBRALTAR DR
DATE ISSUED: 01/08/2014
OWNER'S PHONE: 4083933929
MILPITAS, CA 95035
PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
APPLE T.I. TO EXPAND (E) CHAMBER PIT IN LAB AREA &
License Class Lic. # 3 y g `3
INSTALL 3 (N) CHAMBERS
Contractor be YPOI- Date %h
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
Sq. Ft Floor Area:
Valuation: $750000
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
APN Number: 31622017.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY A CALLEDINSPECT .
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Date:
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.
/
& ��/
RE -ROOFS:
Signature Date
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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25 255 d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: � a xlll;�
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 N DE ANZA BLVD I CON TRUCT ON INC DEVCON I PERMIT NO: 13120116
OWNER'S NAME: MISSION WEST PROPERTIES LP IV 1 690 GIBRALTAR DR I DATE ISSUED: 01/08/2014 1
OWNER'S PHONE: 4083933929 MILPITAS, CA 95035 1PHONE NO: (408)942-8200
19/ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
APPLE T.I. TO EXPAND (E) CHAMBER PIT IN LAB AREA &
License ClassLic. # 3 M(el 3 INSTALL 3 (N) CHAMBERS
Contractor 1)2V,-0,,1 VCOt,I rrlr54 Date
I hereby affirm that I am licensed under the provisions of Chapter 9 DEFERRED #2 REVISE RESTROOMS CORE PLANS AND SITE
(commencing with Section 7000) of Division 3 of the Business & Professions ACCESSIBILITY- ISSD 5/7/2014
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 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 the Cupertino Municipal Code, Section
9.18.
Signature Date <—/7
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 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.
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, 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
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
Sq. Ft Floor Area: I Valuation: $750000
APN Number: 31622017.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D7o7i
OM LAST CALLED INSPECTION.
Issued by: Date:,5 % /`
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 S , an 534. –7
Owner or authorized agent: Date: T �S
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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13120116
10500 N DE ANZA BLVD CUPERTINO CA 95014 (316 22 017) Devcon Construction
690 Gibraltar Dr. Milpitas,
CA 95035
OWNER'S NAME: MISSION WEST PROPERTIES IV I I DATE ISSUED: 01/08/2014
OWNER'S PHONE: 408-393-3929 PHONE NO: 408-393-3929
LICENSED CONTRACTOR'S DECLARATION I BUILDING PERMIT INFO:
License Class Lic. # It 16 J
Contractor Devcon Cons ruction Date 2/+ 1 ! ` JD
I hereby affirm that 1 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:
t. 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.
__.11Ihave 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 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 the Cupertino Municipal
Code, Section 9.18.
Signature Date 2/ 111 4
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. 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)
2. 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:
t. 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.
2. 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.
3. 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 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 the
Cupertino Municipal Code, Section 9.18.
Signature Date
—BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
APPLE T.I. TO EXPAND (E) CHAMBER PIT IN LAB AREA &
INSTALL 3 (N) CHAMBERS
DEFERRED #2 REVISE RESTROOMS CORE PLANS AND SITE
ACCESSIBILITY- ISSD 5/7/2014 /
DEFERRED #I -STRUCTURAL CALC FOR CHAMBERS ' 15_sue
- �I�+1f6
Sq. Ft Floor Area: I Valuation: $750000.00
APN Number: Occupancy Type:
316 22 017
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Phuong Devries
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
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, Section 5, 25533, and 25534.
Owner or authorized agent:
Date:?ijI(A b
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
Professic
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10500 N DE ANZA BLVD CUPERTINO CA 95014 (316 22 017)
CONTRACTOR: PERMIT NO: 13120116
OWNER'S NAME: MISSION WEST PROPERTIES IV DATE ISSUED: 01/08/2014
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor Date
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:
1.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.
2.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 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 the Cupertino Municipal
Code, Section 9.18.
Signature___________________________________ Date
OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor’s License Law for one of the
following two reasons:
1.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)
2.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:
1.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.
2.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.
3.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 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 the
Cupertino Municipal Code, Section 9.18.
Signature___________________________________ Date
BUILDING PERMIT INFO:
BLDG ELECT PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
APPLE T.I. TO EXPAND (E) CHAMBER PIT IN LAB AREA &
INSTALL 3 (N) CHAMBERS
DEFERRED #2 REVISE RESTROOMS CORE PLANS AND SITE
ACCESSIBILITY- ISSD 5/7/2014
DEFERRED #1-STRUCTURAL CALC FOR CHAMBERS
**BIN B-3**
Sq. Ft Floor Area: Valuation: $750000.00
APN Number:
316 22 017
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: -1
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:
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________________________________________________
it
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 31622017.00
DATE ISSUED.......: 11/02/2015
RECEIPT #.........: BS000028598
REFERENCE ID # ...: 13120116
SITE ADDRESS .....: 10500 N DE ANZA BLVD
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OPERATOR: suew
COPY # : 1
OWNER ............: MISSION WEST PROPERTIES LP IV
ADDRESS ..........: 10050 BANDLEY DR
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: ABRAHAM THOMPSON
CONTRACTOR .......: FILIZETTI, GARY LIC # 11068
COMPANY ..........: DEVCON CONSTRUCTION INC
ADDRESS ..........: 690 GIBRALTAR DR
CITY/STATE/ZIP ...: MILPITAS, CA 95035
TELEPHONE ........: (408)942-8200
FEE ID
UNIT
QUANTITY
AMOUNT PD
-TO -DT
THIS REC NEW BAL
1BCBSC
VALUATION
750,000.00
30.00
30.00
0.00 0.00
1BSEISMICO
VALUATION
750,000.00
157.50
157.50
0.00 0.00
1BTIINSP
VALUATION
1,000.00
1553.85
1553.85
0.00 0.00
1BTIPLNCK
VALUATION
1,000.00
3107.76
3107.76
0.00 0.00
1DEFSUBM
HOUR
6.00
834.00
834.00
0.00 0.00
1EXTPER
FLAT RATE
1.00
231.00
0.00
231.00 0.00
1STINSP
UNITS
2.00
286.00
0.00
286.00 0.00
----------
-----
------------
TOTAL PERMIT
6200.11
5683.11
517.00 0.00
METHOD OF
PAYMENT
AMOUNT
REFERENCE
NUMBER
-----------------
CREDIT CARD
---------------
517.00
--------------------
AMER EXP
TOTAL RECEIPT
517.00
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CITY OF CUPERTINO
Fm --7, FEE ESTIMATOR — BVfLDING DIVISION
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 prelimina information available and are onl , an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft' 7,1 J 3)
ADDRESS: 10500 n de anza blvd
DATE:
REVIEWED BY: Mendez
NMI
APN:
BP#:
"VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
Suppl. PC Fee: Q Reg. Q OT
PENTAMATION
PERMIT TYPE: 1 GENCO
WORK
deferred #
SCOPE
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 prelimina information available and are onl , an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft' 7,1 J 3)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
3 #
$834.00
Deferred Submittal
IDEFSUBM
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C:onstrwcfion K7.v:
, r -"c
O
0
Work Without Permit? O Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
�
°°"r-r�rf 1>cr't+trr��alrafir>rr t�'c�s:
Stronm Motion Fee:
$0.00
Select an Administrative Item
Bld,.i Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$834.00
TOTAL FEE:
$834.00
Revised: 01/15/2014
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
10500 N DE ANZA BLVD
DATE: 12/16/2013
REVIEWED BY: MELISSA
JimADDRESS:
APN: 316 22 017
BP#: I3/d, /
`VALUATION: 1$750,000
xPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
__TPERMIT
PENTAMATION
TYPE: 1 B TI
WORK
APPLE T.I. TO EXPAND E CHAMBER PIT IN LAB AREA & INSTALL 3 N CHAMBERS
SCOPE
Suppl. Insp. Fee -.0 Reg. 0 OT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
I -A,1 -B
1,000
$3,107.76
1BTIPLNCK
$1,553.85
IBTIINSP
Permit Fee:
$1,553.85
Suppl. Insp. Fee -.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction TtLv:
Administrative .Feer:
0
0
Work Without Permit? 0 Yes No
$0.00
TOTALS:
1,000
$3,107.76
I1-civel Documentation I`ccF s
$1,553.85
Strong Motion Fee: 1BSEISMICo
MECH, HOURLY 0 Yes 0 No
PLUMB, HOURLY 0 Yes 0 No
ELEC, HOURLY 0 Yes 0 No
Piech. Plan C,'heckPlumb.
Plan Check
Elec..Plan (..heck
6lech. Permit Fee.
Plumb. Pc 'c:
flee. P, � 1,C,
Other Alech. Insp.
Other Plumb Inst. Li
Other Elec, Insp.
$0.00
Permit Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are hased on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,107.76
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,553.85
Suppl. Insp. Fee -.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction TtLv:
Administrative .Feer:
0
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
i
I1-civel Documentation I`ccF s
Strong Motion Fee: 1BSEISMICo
$157.50
Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC
$30.00
SUBTOTALS:
$4,849.11
$0.00 TOTAL FEE:
$4,849.11
Revised: 10/01/2013
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
MtADDRESS: 10500 N DE ANZA BLVD DATE: 04/03/2014 REVIEWED BY: MENDEZ
N: BP#: 13120116 VALUATION: $0
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION 1 GENCOM
USE: Commercial Building PERMIT TYPE:
WORK 4/3/2014- DEFERRED #2- DEMOLISH OF 2 EXISTING CHAMBERS& CONSTRUCT 2 NEW PITS
SCOPE I AND INSTALL 3 NEW CHAMBERS
v ;i r, Cnwor t)ictript School
NOTE: This estimate does not tnctuae fees aue ro omer uepart meme3 (t.r...u111.••. , • „ .-� - -� - -
__._. _ i'numnf a., r]ont far addn'l info.
District, etc.. These fees are based on tnepreammary
FEE ITEMS (Fee Resolution 11-053 E1_71,132
im urimmmure u—.uu..
FEE
u.... �•
QTY/FEE
�••• �•- - -- -
MISC ITEMS
Plan Check Fee:
$0.00
#
$556.00
Deferred Submittal
1DEFSUBM
Suppl. PC Fee: Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:) Reg. ) OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_T_=
Work Without Permit? ) Yes ) No
$0.00
Advanced Planning F'ee:
$0.00
Select a Non -Residential
T= Building or Structure
)
)
i
Strony, Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$556.001TOTAL FEE:
$556.00
nUV 0 1. v�iv uw
CUPERTINO
se'^CL -No ma .1 L2 -=h •�
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION V\
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building(-cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI D REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS (DS OD M. r>*_Am,._ blvd•
APN #
OWNER NAME �l{
PHONE�CO'
E-MAIL
M
STREET ADDRESS
1 svfini�i•C Loop
CITY, STATE, ZIP
CV tt�i ro � �5035-
FAX
CONTACT NAMEI. O� vu_ e- v ;
PHONE
0% 3Q3' 34 Z4
E-MAIL
•ti Ic. car—
STREET ADDRESS
1 ,•4c L
CITY, STATE, ZIP
e� � C�1 5�3�
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME a.,` L c ss� �
LICENSE NUMB R
LICENSE TYPE BUS. LIC #
f3
COMPANY NAME
E-MAIL FAX
STREET ADDRESS
CITY, STATE, ZIP i C Q' 4 402S.PHONE 3 q1•s9 a9
CHITECTIENGrNEER NAME LICENSE NUMBER BUS. LIC #
-- a L -
COMPANY NAME E-MAIL.'►?n V La ^ � C • 'FMAX
• e. 0\'N'S' a _ CA . C a,,% -
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK �MC � � � o ` —
d7
�Cjo
ll �
C w.c� r.s\}•. �l 3 -Q.Z� %e
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
USE TYPE OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: EIDETACH
❑ ATTACH
# DWELLING UN'rrS:
IS A SECOND UNIT ❑ YES
SECOND STORY []YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
- RECEIVE
TOTA ATIO
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following: I am the property owner or authorized age -5 to act on the property owner's behalf. I have read this
application and the information I have provided is correct. have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin rize re esentatives of Cupertino to enter the above-identifie7prperty for inspection purposes.
Signature of Applicant/Agent: r -o- Date: .3
SUPPLEMENTAL ATII
PLAN CHECKTXTE 7LT
ROUTING SLIP
❑ OVER-THE-COUNTER
❑- BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demo 1 to pe it for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
EXP",
PLANNINGPL.ANREVIEWCommercial
Bldgs: Provide a completed Hazardous Materials Disclosure
;ITANIISID .
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY sEwER DISTRICT
submittal of Building Permit application,
❑ " ENVIRONDIENTAL HEALTH,
BldgApp_2011.doc revised 06/21/11
toNl i
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - buildingacupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION
❑ ALTERATION / TI 9 REVISION / DEFERRED
ORIGINAL PERMIT # (e2-,1-2(�)t t 0
PROJECT ADDRESS
APN#
OWNER NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
�
PHONE Q E-
IreZ
STREET ADDRESSC
�T TECES
-7
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTYMAWE 4
,
LICE E
LICENSEgE
BUS. LIC #
CO E
J�F-MAILC.F
/3
7f
STREE D ZIP
WNE
ffSTA,15 QA
l
AR T/ENGIR NA E
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
!M
STRE DDRESS
CI , STAT P
PHO E
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONS
IR.YYPE
#STORIES
1
USE
TYPE
OCC
SQ I-1-
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
I
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN C] YES
RECEIVED BY:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
..," "- -"
�•�
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on a property owner's behalf. I have read this
application and the information ave pro ded is rrect. I have read the Description of Work and verify it is accurate. I a ee to comply with all applicable local
ordinances and state laws relating uild g c on. I authorize re es efCupertino to enter the abov, Iden ified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL FO A ION REQVD
PLAN CHECK TYPE
ROUSING 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.
❑ E.XPRE§s
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
El PUBLICWORKS
_
Form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.oro
C O P E RT I N O I
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS /A �U� N An r-,, I::� .
(V
APN # -5 16 — Z Z — O , _L—
OWNER NAME 'G M.LS•5���
PHONE
yvif•343 -3yd�l
E-MAIL
% Ssl►� eve - �
STREET ADDRESS
CITY, STATE, ZIP
d!
FAX
cr a
CONTACT NAME
PHONE E-MAIL
STREET ADDRESS
CITY, STATE, ZIP „^` FAX
L,
M%LN❑
/AGENT
,.,,/
OWNER 11 OWNER -BUILDER 11 OWNER AGENT LS CONTRACTOR 11 CONTRACTOR ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 55
LICENSE NUMBER 3 3
J
LICENSE TYPE
BUS. LIC #
COMPANY NAME
�..`
E-MAIL *
es s�
FAX
o•k er JA r
c>(evc�_Corlsf.
STREET ADDRESS � �, // �
CITY, STAT 23P Q�
PHONE • � � . ? ��
�I
J
ARCHITECTiWGrNEER NAMED�b
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
2 VC
E-MAIL
FAX
STREET ADDRESS w'
CITY, STATE, ZIP ^ , <
PHONE
V /
!�
DESCRIPTION OF WORK
�i
n oma, o 3 n d& KA
EXISTING IPE
i / O �/� C e_
PROPOSEP USE CONSTR.
/ e)r -,
TYPE
1A
# ST4ES
USE TYPE OCC.
SQ.FT.
VALUATION ($)
AREA Cot
AREA NARF FLLOO/''7
�� I �QO
TOTAL
NET AREA a%O
`(3
woo
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREATOTAL
DECKTORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑YES
SECOND STORY OYES
BEI, GADDED? ONO
ADDITION? ONO
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES -RECEIVED
TOTAL VALUATION:
PLANNING APPL # ONO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
SO Go
By my signature below, I certify to each of the following: I am the property or aut ori ent to act o e pro owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Wor and verify it " accurat agree to comply with all applicable local
ordinances and state laws relating to buildin to onz representatives of Cupertino to ent the a -i nti/fled ro erty for inspection purposes.
v
Signature of Applicant/Agent: Date:
SUPPLEMENTAL IN�.pp
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwelldemolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
1-1STANDARD
El PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
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
COM
CONSTRUCTION
MAU TESTING SERVICES
Summary Report #3
March 31, 2014
Apple, Inc.
Attn: Lance Kim (email)
Job No: J9535
Job Name: DA03 New Chambers 1 & 2
10500 N. De Anza Blvd
Cupertino, CA
Permit #:evading
March 22, 2014
Lisa Marie Vossen reported to the jobsite. Observed
anchors from chamber A, OTA lab.
TESTING
INSPECTION
ENGINEERING
&X_V_d EIr! °
'APR 16 2014
'iY
Performed torque test to 100% to 60ft.-lbs. with zero failures.
KBTZ wedge anchors and seismic
Work observed was, to the best of Lisa's knowledge, in conformance with approved plans, specifications and
applicable standards of workmanship.
Laboratory test results are enclosed if testing was done during the period covered by this report.
Limitations. These inspections were performed in accordance with requirements, but please note this report shall
not be relied upon by others, as acceptance or guarantee of the work. Even with diligent inspection techniques, the
contract is so 1 liable for defects or failures to adhere to the code.
4/10/2014
Reviewed Jona Felts Date
Staff Engpleer
Technical Contact: Timothy Casey, Senior Engineer (tcasey@cts-1.com)
Administrative Contact: Yolanda Deras (yderas@cts-I.com)
cc: Building Department — City of Cupertino
Contractor — Devcon (email)
CTS PM — Aaren McBride -Solis (email)
CTS Staff Engineer — Jonathan Felts (email)
LH
2118 Rheem Drive, Pleasanton, CA 94588 0 Phone (925) 462-5151 Fax (925) 462-5183
4770 Duckhorn Drive, Sacramento, CA 95834 & Phone (916) 419-4747 Fax (916) 419-4774
One Embarcadero Center, Suite 535, San Francisco, CA 94111 • Phone (415) 334-4747 • Fax (4 15) 438-2357
246 30`1' St., Suite 101, Oakland, CA 94601 Phone (510) 444-4747 • Fax (510) 835-1825
�~ CONSTRUCTION
TESTING SERVICES
Summary Report #2
March 24, 2014
Apple, Inc.
Attn: Lance Kim (email)
Job No: J9535 ��
Job Name: DA03 New Chambers 1 & 2
10500 N. De Anza Blvd
Cupertino, CA
Permit #: Pending
March 17, 2014
TESTING
INSPECTION
ENGINEERING
R.ECEI`iED
APR 01 2014
BY
Mauricio Septimo reported to Abner with Devcon at the jobsite. Performed torque test on the 5/8" Hilti KBTZ
expansion anchors for the new chamber angle iron plates. Tested 100% of the 5/8" anchors at 60 ft. -lbs. per Hilti
manufacturers specifications. Overall locations B -C/12.8-13.7 at level 1. No failures.
Work observed was, to the best of Mauricio's knowledge, in conformance with approved plans, specifications and
applicable standards of workmanship.
Laboratory test results are enclosed if testing was done during the period covered by this report.
Limitations: These inspections were performed in accordance with requirements, but please note this report shall
not be relied upon by others, as acceptance or guarantee of the work. Even with diligent inspection techniques, the
contractor is solely liable for defects or failures to adhere to the code.
Reviewed by Jonathan Felts
Staff Engineer
3/25/2014
Date
Technical Contact: Timothy Casey, Senior Engineer (tcasey@cts-Isom)
Administrative Contact: Yolanda Deras (yderas@cts-I.com)
cc: Building Department — City of Cupertino
Contractor — Devcon (email)
CTS PM — Aaren McBride -Solis (email)
CTS Staff Engineer — Jonathan Felts (email)
ARS
2118 Rheem Drive, Pleasanton, CA 94588 Ahone (925) 462-5151 • Fax (925) 462-5183
4770 Duckhorn Drive, Sacramento, CA 95834 • h Phone (916) 419-4747 • Fax (916) 419-4774
One Embarcadero Center, Suite 535, San Francisco, CA 94111 Phone (415) 438-2357 • Fax (415) 334-4747
246 30"' St., Suite 101, Oakland, CA 94601 • Phone (510) 444-4747 0 Fax (510) 835-1825
CONSTRUCTION
TESTING SERVICES
March 24, 2014
*Revised April 10, 2014
Apple, Inc.
Attn: Lance Kim (email)
Job No: J9535
Summary Report #2
Job Name: DA03 New Chambers 1 & 2
10500 N. De Anza Blvd
Cupertino, CA / -
Permit #: Ps,�
March 17, 2014
TESTING
INSPECTION
ENGINEERING
RECEIVE
'APR .16 2014
BY
Mauricio Septimo reported to Abner with Devcon at the jobsite. Performed torque test on the 5/8" Hilti KBTZ
expansion anchors for the new chamber angle iron plates. Tested 100% of the 5/8" anchors at 60 ft. -lbs. per Hild
manufacturers specifications. Overall locations B -C/12.8-13.7 at level 1. No failures.
Work observed was, to the best of Mauricio's knowledge, in conformance with approved plans, specifications and
applicable standards of workmanship.
*March 21, 2014
Rich Dalton reported to Scott with SEMC at the jobsite. Observed anchor installation. After talking with Scott, the
required inspection was for torque testing. No torque wrench was available. No workperformed. Show up time.
Laboratory test results are enclosed if testing was done during the period covered by this report.
Limitations: These inspections were performed in accordance with requirements, but please note this report shall
not be relied upon by others, as acceptance or guarantee of the work. Even with diligent inspection techniques, the
contractor is solely liabk for defects or failures to adhere to the code.
A �
4/10/2014
Reviewed Jona an Felts Date
Staff Eng
Technical Contact: Timothy Casey, Senior Engineer (tcasey@cts-l.com)
Administrative Contact: Yolanda Deras (yderas@cts-I. com)
cc: Building Department — City of Cupertino
Contractor — Devcon (email)
CTS PM — Aaren McBride -Solis (email)
CTS Staff Engineer — Jonathan Felts (email)
ARS/LH
2118 Rheem Drive, Pleasanton, CA 94588• Phone (925) 462-5151 Fax (925) 462-5183
4770 Duckhorn Drive, Sacramento, CA 95834 0 Phone (916) 419-4747 Fax (916) 419-4774
One Embarcadero Center, Suite 535, San Francisco, CA 94111 • Phone (415) 438-2357 • Fax (415) 334-4747
246 30"' St., Suite 101, Oakland, CA 94601 0 Phone (510) 444-4747 Fax (510) 835-1825