12110072MY OF cCUP ElfB' RN(G BUM DRNG P EIEBNUT
BUILDING ADDRESS: 10500 N DE ANZA BLVD
CONTRACTOR: DEVCON
PERMIT NO: 12110072
CONSTRUCTION INC
OWNER'S NAME: MISSION WEST PROPERTIES LP IV
690 GIBRALTAR DR
DA'L'E ISSUED: 12/13/2012
OWNER'S PHONE: 4089961010
MILPITAS, CA 95035
PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL U COMMIERCIALL]
License Class Lic. # 3
APPLE - COMMERCIAL TENANT bMQPl[ OV EM ENT(5,702
/3 ��
SQFT)
Contractor Date
��
OFFICES1PAO]E/LAB,NON-STRUCTURAL INCLUDEI
hereby affirm that I am licensed under the provisions f Ch ter 9
IYi[IECHANICAIL,IEILIECTRICAIL & NO PLUMBING(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: $675000
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
1 certify that I have read this application and state that the above information is
jPjE](gM17 EXPIRES IF WORK dS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
to building hereby this to
���ff�� Il ®���� ®� ����,� ISSUANCE ®�
construction, and authorize representatives of city enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY ®M ]LASS' CALLED INS PIECU j .
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
Issued by: Date:
with all non-point source, regulations per the Cupertino Municipal Code, Sec 'on
9.18.
RE-ROOFS:
Signatu Datef
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.
❑ ER- ECLARATION
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MA'T'ERIALS 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 T 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
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25 d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent. Date
Z�)S' /W/,'?
permit is issued.
1 certify that in the performance of the work for which this permit is issued, I shall
�TRU?CTIONLENDING
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
C 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
COO STR CTO PER T APP_ CA ON
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 ^ buildingCcDcupertino.org
121 ( 0(-J-1 2-
[—]NEW CONSTRUCTIOW ❑ ADDITION [3 ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECTADDRESS 10500 DE ANZA BLVD
APN a
OWNERNAME APPLE INC.
PHONE C(� I o I
E-MAIL
STREET ADDRESS ONE INFINITE LOOP
CITY, STATE,ZIP CUPERTINO, CA 95014
FAX
CONTACT NAME LANCE KIM
PHONE 408.862.9799
E-MAIL lance.kim@apple.com
STREET ADDRESS 1 infinite loop, ms:47-2-ddc
CITY, STATE, ZIP CUPERTINO, CA 95014
FAX408.974.8870
IM OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME RYAN LESS I NG
LICENSE NUMBER
LICENSE TYPE
BUS, LIC H
COMPANY NAME DEVCON
E-MAIL rlessing@devcon-const.com
FAX 408-262-2342
STREETADDRESS 690 GIBRALTAR DRIVE
CITY, STATE, ZIP MILPITAS, CA 95035
PHONE 408-393-3929
ARCHITECT/ENGINEERNAME SCOTT COLSON
LICENSE NUMBER
BUS. LIC#
COMPANY NAME REEL GROBMAN
E-MAILScolson@reelgrobman.com
FAX 408-286-0851
STREET ADDRESS 96 N. SECOND STREET
CITY,STATE,ZIP SAN JOSE, CA 95113
PHONE 408-213-8232
DESCRIPTION OF WORK
TENANT IMPROVEMENT INCLUDING CONSTRUCTION OF NON -LOAD BEARING PARTITIONS., CEILING AND
ASSOCIATED FINISHES, ON PORTION OF THE SECOND FLOOR OF THIS EXISTING 4 -STORY BUILDING.
EXISTING USE
OFFICE/ LAB
PROPOSED USE CONSTR
OFFICE/ LAB
TYPE
I -A
H STORIES
4
USE
TYPE
OCC.
SQ.FT.
VALUATION($)
AREA 5,702 S
AREA
NEW FLOOR -
AREA
DEMO
AREA -
TOTAL
NET AREA
r.
/
BATHROOM
REMODEL AREA N.A.
KITCHEN
REMODEL AREA N.A.
OTHER
REMODEL AREA
PORCH AREA
N.A.
DECK AREA
N.A.
TOTAL DECK/PORCH AREA
N.A.
I GARAGE AREA: DETACH
N.A. ❑ATTACH
#DWELLING UNITS:
N.A.
IS ASECOND UNIT OYES
BEING ADDED? ❑NO
SECONDSTORY []YES
ADDITION? ❑NO
PRE -APPLICATION DYES LF YES, PROVIDE COPY OF
PLANNING APPL It NO PLANNING APPROVAL LETTER
IS THE BLDG AN YES
EICHLERHOME± NO{y
RECEIVED BY: ///JJJ `"'
!
TOTAL VALUATION:
®®
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the propertyowner's beha f 1 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 b ' ding construction. I oriize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicandAgent: / % —� Date: �� 4
SUPPLEMENTAL INFORMATION REQUIRED
_ 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.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form 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.
PLAN CHECK TYPE ROUTING SLIP
❑ OVER-THE-COUNTER UILDING PLAN REVIEW
❑ EXPRESS ANNING PLAN REVIEW
TANDARD ❑� PUBLICWORKS
❑ LARGE L�FIRE DEPT
❑ MAJOR ❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_1011.doc revised 06/11/11
,r'ITrrIPVT rh", r-ITr TTrnTf,'4T)rmTrT\T?T
OCCUPANCY 'TYPE:
' - \L.11 R R "LUll \1.. UR IL` IMI R R11qALU
FEE ESTIMATOR - BUILDING (DIVISION
FLR AREA
s.S.
PC FEES
ADDRESS: 10500 n de anza blvd. and floor DATE:
REVIEWED BY: bobs.
IBI? IFEEE IID
APN:
EBP#: d' /
5,702
`VALUATION: 1$675,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Tenant Improvement
PRIMARY Commercial Building
$6,846.80
Suppl. Insp. Fee:Q Reg. 0 OT
PENTAMATIION 113 TI
USE:PE[�MI
$0.00
PME Unit Fee:
T TYPE:
WORK
t.i. comm offices ace/lab non structural include M E no Ps
SCOPE
OCCUPANCY 'TYPE:
TYPE OF
CONSTR.
FLR AREA
s.S.
PC FEES
PC (FEE IID
IBP FEES
IBI? IFEEE IID
B (Tenant Improvements)
I -AJ -e
5,702
$3,457.12
1BTIPLNCK
$6,846.80
1BTIINSP
F,lcc. Insp. Fee.-
ere:
$6,846.80
Suppl. Insp. Fee:Q Reg. 0 OT
Q,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction lax.
Administrative Fee:
01
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
5,702
$3,457.12
Trpvel Documentation Fees:
$6,846.80
Strong Motion Fee: IBSEISMICO
MECH, HOURLY 0 Yes 0 No
NOTE.
PLUMB, HOURLY 0 Yes (E) No
ELEC, HOURLY 0 Yes (D No
ifech. Plan Check
.Plumb. Plum Checb
Dec- Plan Check FIL
Mec•h, Permit Fee:
P Limb. Permit Fee:
Flee. Permit Fee:
Other :Uech. Insp•
011ier Plumb Ins��.
Other Elec•. Insp.E�l
llech. Imp. Fee:
Phmmb. htsp. Fee:
F,lcc. Insp. Fee.-
ere:
NOTE. This estimate does not include fees due to other (Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer (District, School
District. eta). These fees are based on the nreliminary information available and are onlv an estimate Contact the Deot for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112)
(FEE
QTY/FEE
MESC ITEMS
Plan Check Fee:
$3,457.12
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$6,846.80
Suppl. Insp. Fee:Q Reg. 0 OT
Q,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction lax.
Administrative Fee:
01
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Plannin& Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
Trpvel Documentation Fees:
Strong Motion Fee: IBSEISMICO
$141.75
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$27.00
SUBTOTALS:
$10,472.67
$0.00
TOTAL FEE:
$10,472.67
Revised: 10101/2012
CONTRACTOR / SUBCONTRACTOR LMT
Buunldlnng Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 405-777-3225
Fax: 405-777-3333
JOB ADDRESS: {, �l10 f a
PERMIT # /,71/
OWNER'S NAME:
PHONE # 3��• '
GENERAL CONTRAC R:
BUSINESS LICENSE #
ADDRESS: -
G� ?' CITY/ZIPCODE:
*Our municipal code requires all businesses/workipfg in the city to have a City of Caupneufli o lbminess license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPIECTlON(S) WILL BE SCHEDULED UNTIL '11'H E
GENERAL CO]`1'1<'llBACTOR AND ALL SUBCONTRACTORS ]FLAME OBTAINED A CITY OF CUP EIEBTIINO
BUSINESS LICENSE.
L am not using any subcontractors:
Signature
please check applicable subcontractors and complete the ffoflo wndng i nfformatn®n:
Date
�✓
SUBCONTIlBACTOR
BUSffN]ESS NAME
IWKN]ESS LffC]ENSIE
Cabinets & Millwork
P 0 0
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
�'ga 02
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
e /�
��
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Q1�� y, �� �, .� l
��j / r�
Tile
15ei / Contractor Signature
CUPERTINO
PURPOSE
HaLa�DOOIJS (�A EF ,4 5 CHECK IS
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 • buildinQ(a cupertino.orp
C
To minimize possible delays that would result for the Fire Department plan review, plea -Lcpq lmplete the
following checklist to determine if an additional level of Hazardous Materials plan revieCw e
required. Q
MARK'YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE f`®L_LC G?
PLEASE MARK YOUR ANSWER WITH ARI 'X' IRI THE VES OR NO BOX ON THE SIDE
BELOW.
VES
NO
1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases,
hazardous materials, etc.
2. Battery back-up rooms or racks.
3. Propane tanks.
4. Gasoline stations with underground tanks.
5. Installation or replacement above ground or underground storage of liquid petroleum
products, liquefied petroleum gases, compressed natural gas, explosives or other
regulated hazardous materials.
6. Gas rooms for dentist, doctors or veterinarians.
7. Generators with back-up diesel or other fuels.
8. Large refrigeration systems.
9. Fuel cell systems.
10. Commercial pool systems.
11. Chemical Storage areas.
12. Flammable liquid storage.
13. Compressed Gases.
14. Dry cleaners.
15. Print Shops.
16. Auto Repair and Auto Body Shops.
17. Research and Development.
For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa
Clara County Fire Department, at (408) 378-4010.
HasMat 2011.doc revised 03/07111