15070061CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20525 MARIANI AVE
CONTRACTOR: DEVCON
PERMIT NO: 15070061
CONSTRUCTION INC
OWNER'S NAME: 20525 MARIANI DRIVE LP
690 GIBRALTAR DR
DATE ISSUED: 07/09/2015
OWNER'S PHONE: 4087833025
MILPITAS, CA 95035
PHONE NO: (408)942 -8200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
C G I `1
APPLE - T.I. 2ND FLR, EAST WING - RECONFIGURE &
License Class Lic. # l
REMODEL (E) LAB (852 S.F.)
�
Contractor ((; /1 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 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: $150000
performance of the work for which this permit is issued.
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: 32656001.20525
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 PERM M 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 DAYS F ST D INSPECTION.
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
Date-
Date:
with all non -point source regulations per the Cupertino Municipal Code, Sect
9.18.
7l�lls—
RE- ROOFS:
re
Signat - 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
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
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
1 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(x) 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, 5505, 25533, +td 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized age � Date:
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
•
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 - building(aDcugetno.org !-,f L
❑ NEW CONSTRUCTION ❑ ADDITION & ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT n
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❑ O%;NER ❑. OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINIEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR LAME
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LICENSE TYPE
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COMPANY NAME
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CITY STATE, ZIP
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EXISTING USE
PROPOSED USE CONSTR
TYPE
4 STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
AREA
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
LJ_ IT
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCHAREA
DECK AREA
TOTAL DECK/PORCHAAEA
GARAGE AREA: DETACH
E] ATTACH
DWELLINGUNITS:
ISASECONDUNrr El YES
SECONDSTORY ❑YES
_
BEING ADDED? ❑ NO
ADDITION? ❑NO
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PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL m ❑ NO PLANN'IN'G APPROVAL LETTER
IS THE BLDG AN
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TOT-Ai-V) UATION:
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By my signature below, I certify to each of the following I am the property o wner or 11 rized- aseixttr} art ti e prop e ner's behalf. I have read this
application and the information I have provided is correct. I have read the Descripti _ o €h §JOrk and verify it ' accura aeree to comply with all applicable local
ordinances and state laws relating ilding const c uthorize representatives of Cupertino to r th ve- identified property for inspection purposes.
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Signature of Applicant/Agent� ate:
SUTPLEMENTAL INTFORMIATION REQUIRED
PraN cHECzT PE 3
T _ iovrLnc -sL>P3
OVER THECOTJvTER
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BUIIDL�GPLANREVIEFi
New SFD or Multifamily dv>,ellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building,
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PLaI.NL:GPLAn zEizEw = �'-
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure�srANnaRD
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form if any Hazardous Materials are being used as part of this project.
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_ Copy of Planning Approval Letter or Meeting with Planning prior to
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submittal of Building Permit application.
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BldgApp_2011.doc revised 06121111
FM_7 CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 20525 MARIAM AVE
DATE: 07/09/2015
REVIEWED BY: MELISSA
PC FEE ID
APN: 326 56 001
BP #:
"VALUATION: 1$150,000
*PERMIT TYPE: Building Permit
PLA Y4 CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1BTIPLNCK
PENTAMATION 1B TI
PERMIT TYPE:
WORK
APPLE - T.I. 2ND FLR EAST WING - RECONFIGURE & REMODEL E LAB 852 S.F.
SCOPE
PME Plan Check:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II- A,111-A,V -A
852
$2,660.54
1BTIPLNCK
$1,247.70
1BTIINSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,247.70
Suppl. Insp. Fee :Q Reg.
Q OT
ro.oThrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
852
$2,660.54
$0.00
$1,247.70
NOTE: This estimate does not include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt otr. 1. Thoco fooc tyro hacod an tho nroliminaru infarmatian availahlo and tyro nnhy an actimnto_ Cnntart tho Dont Far addn'1 info_
FEE ITEMS (Fee Resolution I1 -053 Eff 7,'1113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$2,660.54
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (F) Reg. Q OT
FO.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,247.70
Suppl. Insp. Fee :Q Reg.
Q OT
ro.oThrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
G
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
G
/ .
Strong Motion Fee:
IBSEISMICO
$42.00
Select an Administrative Item
1
Bldg, Stds Commission Fee: IBCBSC
$6.001
SUBTOTALS:
$3,956.241
$0.00
TOTAL FEE:
$3,956.24
Revised: 07/02/2015
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 -777 -3333
JOB ADDRESS: Q1015 35; CL - ,es- -(m ctGoN
PERMIT #
BUSINESS NAME
OWNER'S NAME: ,pk \c
PHONE #
GENERAL CONTRACTOR: D 1e-V
BUSINESS LICENSE # 8
ADDRESS: ai 6v( A*ar— o give ��� � s q�c�3S
CITY /ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
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Insulation
Landscaping
Lathing
Masonry
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Painting /Wallpaper
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Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
ve'
Sheet Rock
Tile
Owner / Contractor Signature
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