15040117CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: DEVCON PERMIT NO: 15040117
CONSTRUCTION INC
OWNER'S NAME: MISSION WEST PROPERTIES LP IV 1 690 GIBRALTAR DR I DATE ISSUED: 04/16/2015 1
OWNER'S PHONE: 4087384444 MILPITAS, CA 95035 PHONE NO: (408)942 -8200
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
_ APPLE TENANT IMPROVEMENT IN LAB 1403 (348 SQ FT). ���
Contractor
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
of the work for which this permit is issued.
,fhave 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
Nc rtify 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 " ms's,;; v;a'=Dafe `¢� / NO
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor'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
construct the 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, l 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
Sq. Ft Floor Area: 1 Valuation: $17500
APN Number: 31622017.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: 4z�� Date: ia "
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 505, 25533, and 25534
Owner or authorized agen�'
z — l
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must I 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
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
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
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPER -FIND
1�o�a�17
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 ^ FAX (408) 777 -3333 • building(a1cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10500 DeAnza Blvd
APNN 316 -22 -017
1:"J/GwV
OWNER NAME Apple Inc
PHONE 408 - 738 -4444
E -MAIL
�—
STREET ADDRESS 1 Infinite Loop
CITY, STATE, ZIP Cupertino CA 95032
FAX
CONTACT NAME Terry Fullerton
PHONE 408 - 519 -8383
E-MAIL tfullerton @devcon - const.com
STREET ADDRESS 690 Gibraltar Drive
CITY, STATE, ZIP Milpitas, CA, 95035
FAX 408-946-5513
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME DEVCON Construction
LICENSE NUMBE 8399163
B LICENSE TYPE
BUS. LTC #
COMPANY NAME DEVCON Construction
E-MAIL tfl.Illerton @devcon- const.com
FAX408- 946 -7713
STREET ADDRESS 690 Gibraltar Drive
CITY, STATE, ZIPN /lil itas, CA, 95035
PHONE 408-519-8372
ARCI-IITECT/ENGINEER NAME Brent Downing
LICENSENUMBERC -32444
l' J
BUS. LTC#
COMPANY NAME
DEVCON Construction
E -MAIL
bd own ing devcon- const.Corn
FAX
408 - 942 -7713
STREET ADDRESS 690 Gibraltar Drive
CITY, STATE, ""Milpitas, CA, 95035
PHONE 408-942-8200
DESCRIPTION OF WORK Modification to an existing space, remove chamber addition of raised floor and
associated Electrical, Structural.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
B
B
1-b
4
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA348 of work
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
Office
B
348
17,500,00
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
[] 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 ❑ YES
RECEI BY:
TOTAL VALUA ION:
PLANNING APPL # [J NO PLANNING APPROVAL LETTER
EICHLER HOME? 11 NO
/ O T
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I 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 Ing constru . II authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
4/16/15
Signature of Applicant/Agent: ✓�� Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
tPRESS ER- 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.
PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
p
LARGE
FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
INADDRESS:
10600 DeAnza Blvd
DATE: 04/16/2016
REVIEWED BY: Sean
Plan Check Fee:
APN:
BP #:
*VALUATION:
1$17,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
$0.00
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
A Improvement 348 s ft .
SCOPE
0 0
OCCUPANCY TYPE: TYPE OF FLR AREA FP C FEES PC FEE ID BP FEES [BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II- B,111- B,IV,V -B 1 348 1 $2,102.26 IBTIPLNCK 1 $656.36 IBTIINSP
I TOTALS: I 348 I $2,102.26 $656.36
;i tech. IT'ldn Check
-,, h. Perrai4 Fee:
Other ,A,Ieeh. hw , •
Xlec;'z. insp. FtA- :
Plumb. Pict: Ctieck
Pi twb. P. rtrdf I ee:
Other Plrturb
Pluotb. Imp, Fee:
I7r:c..Nan Check
lslec..1'ernait I'
Other Elec. Insl;.
Is:ec..brs��. I =ec:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). 1hese.Jees are based on the preliminary in_/ormation available and are only an estimate contact the Deptjor aadn'l Info.
FEE ITEMS (Fee Resolution 1.1- 053Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,102.26
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (E) Reg. 0 OT
0.0
hr's
$0.00
PME Plan Check:
$0.00
Permit Fee:
$656.36
Suppl. Insp. Feel@ Reg. Q OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
%'ons1ructintt T xv:
AdminiVralive Fee:
0
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non- Residential Q
Building or Structure 0
I
/ ,avel DocuinC station .Pees:
Strong Motion Fee: IBSEISMICO
$4.90
Select an Administrative Item
Blda Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS.
.,..... ,a ..... . _ . .:
$2,764.52
$0.00 TONAL FEE `
$2,764.52
Revised: 04/01/2015
0510112015 10:21 fAX)
CUPERTINO
CONTRACTOR/ SUBCONTRACTOR LIST
P.001/001
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 -777 -3228
Fax: 408 - 777 -3333
JOB ADDRESS:
PERMIT # �s
OWNER'S NAME:
PHONE # R
GENERAL CONTRAC OR:
BUSINESS LICENSE #
ADDRESS:
CITY /ZIPCODE: Al
*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
V
Electrical
c
Excavation
Fencing
Flooring / Carpeting
a2
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Tlu(g �
Date
STATEMENT OF SPECIAL INSPECTIONS, 2013 CBC
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
C U P E RTi M t7 10300 TORRE AVENUE " CUPERTINO, CA 95014 -3255
(408) 777 -3228 " FAX (408) 777 -3333 • buildinoQcuoertino,orm
SITE ADDRESS 10500 N. DeAnza Blvd
APN 316-22.017
BP# / D 0
f
Owner..... Mission Was t ».
Contragor , D,9.Y1~RO. CQO& tOlCtl40 ................................
Address...10050 Bandley Dr. ........................... ................................. ........
Address.,620 Gibraltar Dr.....•......,..,........,..,........... ...............................
CilylSt_2Tertino CA .................... ZIP., 95014 ........ Phone4,08,725.0700
City /S!. Milpitas CA _ ....... _. ... Zip 95035.,...,, Phone 4QB:942& P
Devcon
Applicant ........................•.....»...........,...... Construction ...,.,................ ...•.............,....,........
Devcon
Engineer/Architect .... ...................,..... Conswction ...... - .. .Br
... ent ..... Downing . ...,.......,.......•.,.,...,...
Address......_ 690 Gibraltar Drive
..
690 Gibra ltar Dr{ve
Address. ................-......... ................................
............. . . .
Mil itas CA 95035 408- 942 -8200
City/3t...... P 21p..., Phone ...................•.
City /St.Mlipitas CA ....................... Zip 50 : ..... Phone 40&9A2 -8200
PROJECT DESCRIPTION: Addition of raised floor and guard rail, Anchor bolt connection to concrete floor.
This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment or the requirements of CDC Sections 1704 and 1705. This
form is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONC) mode
statement of Special Inspections. Also, included with this form is the following:
Q • "LIST OF SPECIAL INSPECTION AGENCIES (page 2). A fist, of tasting agencies and other special inspectors that will be
retained to conduct the tests and inspections for this project
Q "SCHEDULE OF SPECIAL INSPECTION" (page 3 — 6). The Schedule of Special Inspections summarizes the Special
Inspections and tests required. Special Inspectors vAll refer to the approved plans and specifications for detailed special
inspection requirements. Any additional tests and inspections required by the approved plans and specifications shall also
be performed.
Special Inspections and Testing will be performed in accordance with the approved plans and specifications, this statement and CBC
Sections 1704, 1705, 1706, 1707, and 1708. Interim reports will be submitted to the Building Official and the Registered Design
Professional in Responsible Charge in accordance with CBC Section 1704.1.2,
A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in
the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704.1.2). The Final Report will
document:.
c Required special inspections.
4 Correction of discrepancies noted in inspections.
The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to
implement this program of special inspections. In partial fulfillment of these obligations, the Owner will retain and directly pay for the
Special Inspections as required in CBC Section 1704,1,
This plan has been developed with the understanding that the Building Official will:
Review and approve the qualifications of the Special Inspectors who will perform the inspections.
Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their
duties as called for in this Statement of Special Inspection.
o Review submitted inspection reports.
o Perform inspections as required by the local building code.
I have read and agree to comoty I'm the terms and conditions of this statement
Prepared By:
Project ❑ Engineer ;f Architect
Registered Design Professional in Charge
Si nature........ .......
.......Lic.# .. 7'7 ...............
Owner Name: A f GC /k'&
/ {� ('
(t�l �'
�^' h-n "iflJ�
_
j••
Owner'sAulhorization
Si nature ..�.
t= .Dale:
y.
Inspection Agency i Inspector Name:
J , .3
/
--C t Q
SI nature ..... .................
.... ...............................
Date:. ...................
uil mg Officials des(gne .
Signature ....... ,.
......
Date:
5pecialnvpeciionl -o)7n 2012.doc revised 09106112