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15080047CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR: DEVCON PERMIT NO: 15080047 CONSTRUCTION INC OWNER'S NAME: SI 50 LLC 690 GIBRALTAR DR DATE ISSUED: 08/06/2015 OWNER'S PHONE: 4087384444 MILPITAS, CA 95035 PHONE NO: (408)942 -8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ APPLE TENANT IMPROVEMENT (FIRST FLOOR) (3828 SQ c� / 2 License Class Lic. # 3 / f1K FT). Contractor aCNG� A �z71 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: 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: $191400 performance of the work for which this permit is issued. ave 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: 32610053.00 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 DAYS FROM LAST CALLED 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 /1 /- Issued by: R1Gt 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 /f/j^�� / 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, Section 505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized S Date: �/ permit is issued. agent: 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, l 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 �� (408) 777 -3228 • FAX (408) 777 -3333 • buildinciecupertino.orct ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION/Ti ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 20650 Valley Green Drive APN# 326 -10 -047 OWNER NAME Apple In %/ /5U / f _� PHONE 408 - 738 -4444 E -MAIL STREET ADDRESS /Pb_ 64© 1"FrIZ4 CITY, STATE, ZIP Cupertino CA 9501x'+_ CITY, STATE, ZIP Cupertino CA 9501 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 IPM CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCmTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME DEVCON Construction LICENSE NUMBE R399163 LICENSE TYPE B BUS. LIC # COMPANY NAME DEVCON Construction E -MAIL tfullerton @devcon- const.com FAX408- 946 -7713 STREET ADDRESS 690 Gibraltar Drive CITY, STATE, ZIP Milpitas, CA 95035 PHONE 408-519-8372 ARCHITECT/ENGINEER NAME Brent Downing LICENSE NUMBER C-32444 BUS. LIC# COMPANY NAME DEVCON Construction E-MAIL bdownin devcon- const.Corn 408 - 942 -7713 STREET ADDRESS 690 Gibraltar Drive CITY, STATE, ZIP Milpitas, CA, 95035 PHONE 408-942-8200 DESCRIPTION OF WORK Modification to an existing space, Selective demo added walls, door & ceilings with associated Electrical and Mechanical. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES B B 1IA 1 4 USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA Lab B 3828 191,400.00 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UMTS: 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 RECEIVED B TOTAL VALUATION: PLANMNG APPI. # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO �- ®�� (AOv o 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 build onstruction. uthorize representatives of Cupertino to enter the above - identified property for inspection purposes. 8/6/15 Signature of Appl icant/Agent: Date: SUPPLEMENTAL INF ATIONREQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building OVER- THE-COUNTER BUILDING PLAN REVIEW permit for new building. . ❑ EXPRESS ❑ 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. ❑ 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_201 l.doc revised 06121111 FM--7 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ialADDRESS: 20650 Valley Green Dr DATE: 08/06/2015 REVIEWED BY: Sean PC FEE ID APN: BP #: , 0 *VALUATION: 1$191,400 `:PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: $4,188.23 PENTAMATION 1 B TI PERMIT TYPE: WORK le Tenant Improvement First Floor 3828 sq ft). [,A SCOPE 0.0 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 3,828 $3,012.68 IBTIPLNCK $4,188.23 IBTIINSP Permit Fee: $4,188.23 Suppl. Insp. Feel@ Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consil- le-lion T('w: F ,'(,hnh,,i troi;vt: P'ee'- O G Work Without Permit? Yes (j) No $0.00 TOTALS: 3,828 $3,012.68 r - �� "i $4,188.23 �a �s,.. 1VIECH H0[1RLY `® Yes No ter. PLUMB, HOURLY Q Yes Q No V E'L1C+ C,' HOURLY' ®Yes Q No , <' �i ic'Ci7. T�i.:;l't ('fa:.�,,. 1',•" d.'f ? /). !:,'L li? (, �JieCK LT `.f2f ;. .1 �7 %�! ?'; (. �i�JL'(;'i Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. 0 OT 0.0 I {�sY•8T :S'r'i`! ?. li ?: 3. X ( h;.i. ^7;. .1t... r uus:a .J, E3 $0.00 Permit Fee: 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 nreliminarv, information available and are only an estimate. Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 11 -053 F %f. T "111 ) FEE QTY /FEE MISC ITEMS Plan Check Fee: $3,012.68 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. 0 OT 0.0 I hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,188.23 Suppl. Insp. Feel@ Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consil- le-lion T('w: F ,'(,hnh,,i troi;vt: P'ee'- O G Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Q Building or Structure o , ) Strong Motion Fee: IBSBISMICO $53.59 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $8.00 SUBTOTALS 3 $7,262.501 $0.00: TOTAL FEE: - $7,262.501 Revised: 07/02/2015 From: 08/12/2015 09:03 #125 P.001/001 JOB ADDRESS: () to So 0 j C) PERMIT # t5 O$ O O L{ ^r OWNER'S NAME: S PHONE # LA p —0j L- a —'g 2��0 GENERAL CONTRACTOR: p BUSINESS LICENSE # O to ADDRESS: CITY /ZIPCODE: s *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 subcontractorl and complete the following information: Date Owner / Contractor Signature �C,ui Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical oczo- c,1 tr (e,�T VC a © v Excavation Fencing Flooring / Carpeting Linoleum/ Wood Glass / Glazing Heating $ a a Insulation Landscaping Lathing Masonry Painting / Wallpaper (/L Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock D, Tile Owner / Contractor Signature �C,ui Date