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15120151CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15120151 19339 STEVENS CREEK BLVD (316 20 114) DEVCON 690 GIBRALTAR DR MILPITAS, CA 95030 OWNER'S NAME: APPLE DATE ISSUED: 12/16/2015 OWNER'S PHONE: 408-974-3516 PHONE NO: 408-393-3929 LICENSED ED ONT A TOR' DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #399163 Contractor DEVCON Date 02/28/2016 _ BLDG _ELECT _PLUMB MECH RESIDENTIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing — _ _COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: APPLE - T.I. (OFFICE 1, MAIN STREET) - DETAILS FOR I hereby affirm under penalty of perjury one of the following two declarations: EQUIPMENT ANCHORAGE ON ALL 4 FLOORS (PHASED 1. I have and will maintain a certificate of consent to self -insure for Worker's. INSPECTIONS) Compensation, as provided for by Section 3700 of the Labor Code, for the 2/9/16 - REV # 1 - ADD TOOL FIT, 2 SMALL CLOSETS & FANS performance of the work for which this permit is issued. REV #2 (11/21/16) - NEW LOCATION FOR TOOL FIT -UP ISSUE ^ 2. I have and will maintain Worker's Compensation Insurance, as provided for by 12/16/2016 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $30000.00 I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 316 20114 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. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations Whg-Ru u icipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur Date 12/16/2016 Issued by: Leeacv OWNER- AM,DER D . L RATION Date: 12/16/2015 - I hereby affirm that I am exempt from the Contractor's License Law for one of the &ROOFS, following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sce.7044, Business & Professions Code). Date: 12/16/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code., for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 5. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 2 31 and 25534. be deemed revoked. /' . - Owner or authorized agent: APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is Date: 12/16/2016 CONSTRUE correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 12/16/2016 Licensed Professional CONSTRUCTION PERMIT APPLICATION 21 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(aD-cupertino.org CUPERTINO tt 0 NEW CONSTRUCTION ❑ ADDITION 0 ALTERATION / TI YIIREVISION / DEFERRED ORIGINAL PERMIT # l Z04 G PROTECT ADDRESS 33 APN # J / _ &0 OR'NER NAMJ' �' � /+'l �/ V S /�'J✓�� � �� ���i� ` J � EMAIL STREET ADDREtg e Z (� / e.CITY, STATE ` CONTACT NAME . PunKm E-MAIL , �.v.. Le55� o� 3�3. �.� r/CSs eweVC0,7-<an STREET ADDRESS CITY, STATE, ZIP tG ` a ,� FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME /s � LICENSE NUMBER LICENSE TYPE BUS. LIC#r COMPANY NAME' Deveen d rvea�i`�'�.- -MAIL rle SS de veon - tc"s�- eem FAX STREET ADDRESS 6 �o / p� CITY, STATE, ZIP if 76-2)36 ( P ® -3�jS -.3 7 3 9A 9 ARCHITECTIENGINHER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME <P L EMAILr�� m SIA �IC9 j , t FAX STREET ADDRESSe)4�-B q0 S� CITY, STATE, ZIP -`or PHO/'73 NE 2 �^q ±� .0^rA _ ~%t ASCO r p • .: - 13 17. DESCRIPTION OF WORK t 4 Z4. &F +&D1 -A' J ern (Q-6 ;�►1.'S �t3 � S EMSTING USE - PROPOSED USE CONSTR TYPE # STORIES Zr -a USE TYPE OCC. SQ.FT. VALUATION (i) EXISTGNEW FLOORI� DEMO TOTAL AREA ld 4 5F l AREA �/. AREA NET AREA BATHROOM KITCHEN - OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK.AREA _ TOTAL DECKIPORCH AREA GARAGE AREA:. EIDFTACH I E] ATTACH I #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY E] ES ^ BEING ADDED? []NO ADDITION? ❑NO - PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN:RFFGfiI ,,; . ` :;' s-a•t' TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? r By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on roperty owner's behalf. I hav is application and the information I have provided is correct. i have read the Description of Work and veris accurate. I agree to comply with all applicable o ordinances and state laws relating to building co action. authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: C SUPPLEMENTAL EJATIONOIRED"x x5 L 4�,CHECITYPEr,'�� �:. ..., _ROUi'I11G':SLIP„...- ...��`.` New SFD or Multifamily dwellings: Apply for demolition permit for i o� ER rxE eoiI�TER k Y S i sulLniG PLS IiEt IE\3 _ existing building(s). Demolition permit is required prior to issuance of building fi permit for new building.ExPRI pPRO, ssm ❑ PLA V �L\G PLJ1v RE�ZEiV $ z , ©PUBLIci Comnlereial Bldas: Provide a completed Hazardous Materials Disclosure STinARD oRl�s _ form if ally Hazardous Materials are being used as part of this project. LARGE Y ❑ FIRE DEPT Copy of Plarming Approval Letter or Meeting with Planning prior to tl� hI.4JflR �% � S�'�ITARiSE\'1ERDISTRICT _ submittal of Building Permit application. E?Vi'IROiMENTALHEALTH Bldg-App_2 011. doc revised 0 612 1/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19339 STEVENS CREEK BLVD CONTRACTOR: DEVCON PERMIT NO: 15120151 CONSTRUCTION INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 690 GIBRALTAR DR DATE ISSUED: 12/16/2015 OWNER'S PHONE: 4089743516 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL APPLE - T.I.- (OFFICE 1, MAIN STREET) - DETAILS FOR License Class Lie. # 13 917 1 EQUIPMENT ANCHORAGE ON ALL 4 FLOORS (PHASED INSPECTIONS) Contractor e—Date I hereby affirm that I am licensed under the provisions or 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: $30000 performance of the work for which this permit is issued. F 4xve and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31620109.19339 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED 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 WITHIN 1 DAYS E P IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 1 'CALLED' INSPECTION. 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 th sued b Date: �f granting of this permit. Additionally, the applicant understands and will c with all non -point source regulation"er the Cupertino Municipal Co ion RE S: being installed. If a roof is 9.18. Signature — Date All roofs shall be inspected prior to any roofing material - y installed without first obtaining an inspection, I agree to remove all new materials for inspection. DECLARATION ❑- - NER-BUILDER 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) HAZARDOUS MATERIALS DISCLOSURE I, as owner of the property,. am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. will maintain compliance with the Health &Safety Code, Sections 25 5,255335 25534. I have and will maintain Worker's Compensation Insurance, as provided for by work for which this Date: Section 3700 of the Labor Code, for the performance of the Owner or authorized agent: . - permit is issued.., is issued, I shall / I certify that in the performance of the work for which this permit not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY 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 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. 1 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, which may accrue against said City in consequence of the I understand my plans shall be used as public records. costs, and expenses 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 Is, COMMUNITY DEVELOPMENT DEPARTMENT ® BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO; CA 95014-3255 CUPIrRiI © (408) 777-3228 • FAX (408) 777-3333 • buildingaa.cupertino.org �'/ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECTADDRESS !61'!'�C( �t�VW $ GGV w } O APN # t�c �� OWNER NAME r PHOO ® y J `MAIL STREET ADDRESS 'r C F . STAT � ® FAX CONTACT NAME PHONE E STREET ADDRESS I t 1 C� ,STA , ZIPA t q r •� ry FAX ❑ OWNER ❑ OWNER -BUILDER' ❑ OWNERAGENT 13 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECTI ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ��/,A V t SE NUMBER 1 LICENSE TYPE jZ,, BUS. LIC # COMPANY NAME / ,�y� � e# ► ,(� _T" � �/ � E AIL FAX (/V]v�jr 1Yz#!'r,�/�� N e�� G6M STREET ADDRESS rA� V ! E }1r�A j (! � ' CIA? • iTf �T ri � I�'A i oil- 4109 ij PHONE 4* - f4 ARCHITECT/ENGINEERNAME ��" {ri`_ t" 1' ��,�r� LI SE r'` 1 BUS. LIC# ig COMPANY NAME e10 TV n Jt _ Ap, I Rt }ed E-MAI�G,�„y i`= _ N ill W( f e, Con, FAX STREET ADDRESS j!I CITY STATE, ZIP , PHONE �"'Y f v d Jt- DESCR 4- ORK ''NC$tAW)kqY"ivv "• v . n EXISTING USE PROPOSED USECO STR TYPE L rs # ST Rlhs USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO ' TOTAL AREA AREA NETAREA AREA BATHROOM KITCHEN - OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING. ADDED? ❑NO .ADDITION? ❑NO � � TOTA PRE -APPLICATION [J YES IF YES, PROVIDE COPY OF IS THE BLDG AN [3 YES RECEIVED $Y L VALUATION:0 OQ NO PLANNING APPL # ONO PLANNING APPROVAL LETTER EICHLER HOME? ❑ o wner's behalf. I have read this By my signature below, I certify to each of the following: I am the property owner or author prope a ree to comply with all applicable local application and the information I have provided is correct. I have read th z erty for inspection purposes. ordinances and state laws relating to building cons ction._I,authorize representatives of Cupertino toe e above -i en' Date: Signature of Applicant/Agent: .:. _ New SFD or Multifamily dwe rags: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building pen -nit for new building. . Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ?o—nn if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FFF F CTTM A Tn P — RITTT DINE nivisioN ADDRESS: 19339 STEVENS CREEK BLVD DATE: 12/16/2015 REVIEWED BY: MELISSA APN: 316 20 114 BP#: *VALUATION: 1$30,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION 1GENCOM PERMIT TYPE: WORK APPLE - T.I. OFFICE 1 MAIN STREET -DETAILS FOR EQUIPMENT ANCHORAGE ON ALL 4 SCOPE FLOORS (PHASED INSPECTIONS) JVnTF• This vctim,7tn dnec not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. Theseees are based on the preliminar FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/131 Plan Check Fee: Hourly Only?0 Yes !; No Suppl. PC Fee: Reg. 0 OT 0.0 hrs PME Plan Check: Permit Fee: Hourly Only? 0 Yes No Supp/. Insp. Fee:Q Reg. Q OT 0,0 hrs PME Unit Fee: PME Permit Fee: Aldlrdnisirafive Fee; Work Without Permit? O Yes (E) No Advanced Planning Fee: Strong Motion Fee: IBSEISMICO Bldg Stds Commission Fee: IBCBSC SUST(TALS, mation available and are only an estimate. c.ontacr me uepr.Lur uuurt FEE QTY/FEE I MISC ITEMS $0.00 2 hours Plan Check, Hourly $0.00 $286.00 ISTPLNCK- $0.00 $0.00 $0.00 — $0.00 $0.00 $0.00 $0.00 Select a Non -Residential T---71 Building or Structure $8.40 15.0 hrs Inspections $2.00 $2,145.00 ISTINSP . Inspection, Hourly $10.40 $2,431.00 TOTAL FEE:~. $2,441.40 Revised: 10/01/2015