15110070CITY OF CUPERTINO BUILDING PERMIT
BUILDIN�0ADDRE$$; t465, 00 N DE ANZA BLVD
CONTRACTOR: DEVCON
PERMIT NO: 15110070
CONSTRUCTION INC
OWNER'S NA14E ;MISSION WEST PROPERTIES LP N
690 GIBRALTAR DR
DATE ISSUED: 11/12/2015
OWNER'S ''HONE: 4089961010 ''
MILPITAS, CA 95035
PHONE NO: (408)942-8200
N.
❑ °' i LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
y,�•:'• p
APPLE TI 3RD FLOOR ROOM SUPERNOVA (800 SQ FT).
License Class '''f' CJ' .:' • r "Lic #
Contractor. Q(wo .j r ' '� J % Date 1Z4 L
I hereby -affirm that I am licensed under the provisions of Chapter 9
(commencing;with,$ect'ion 7000) of Division 3 of the Business & Professions
Code'and'that. my license is'iu.full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and�•will'mairitain a.'certificate of consent to self -insure for Worker's
1,�
:... :: .. ........ ..
Compensatton; as pioytded, for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $60000
erfortnance of the work'for`which this permit is issued.
I have and will maintain Wo{kens Compensation Insurance, as provided for by
Section 3700 6 .theLabor Code, for the performance of the work for which this
-„
permit is issued:' i+ • ' -'
APN Number: 31622017.00
Occupancy Type:
APPLICANT CERTIFICATION
1 certify that I have read- this'application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agreeito'comply with all city and county ordinances and state laws relating
to building construction; and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon, the above xrtentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnifyand keep;hannless the City of Cupertino against liabilities, judgments,
costs, and expenses whichmay accrue against said City in consequence of the
j
Issued by: CA/fY 4i/ Z-1 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.
Signature'i' ,1 '. "'. :, Date
RE -ROOFS:
Al All roofs shall be inspected prior to any roofing material being installed. if a roof is
4
installed without first obtaining an inspection, I agree.to remove all new materials for
inspection.
❑ ''OWNER -BUILDER DECLARATION
I her affirm, that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons: ;!' '•
I, as owner of the property;�ormy employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i
will do the work;'and,'the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code) '
'r
I, as owner of e,pr6perly,;aiii•exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the projeoi (Sec.7044; Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
',,
I hereby affirm pnder'penalty of one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
perjury
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations: kill'i •'. `;' :
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
Compensaiion,tas 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 Worke'r's Compensation Insurance, as provided for by
the Health &Safety Code, Section 505, 25533, and 25534.
Section 3700 of e th&bonCode, for the, performance of the work for which this
ermit is issue
Owner or authorized agent: Date: L
1 certify, that imthe perfotmance of the work for which this permit is issued, I shall
not employ!any,p erson many, manner so as to become subject to the Worker's
Compensation;laVs'of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subjecttq 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,witli' such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
i� I," '
Lender's Name
Lender's Address
APPLICANT CERTIFICATION
I certify that I haveead this -application and state that the above information is
correct. I agree to'c{mply 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; inentioned property for inspection purposes. (We) agree to save
"
ARCHITECT'S DECLARATION
inderpnifyiano keep hamiless the City of Cupertino against liabilities, judgments,
costs, and expenses,which�may accrue against said City in consequence of the
be
I understand my plans shall 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. ' I I :;,' '',, , i
Signaturerf., 'it')' ;i ' Date
,
CUPERTINO
CONSTRUCTION PERMIT APPLICATION 151100 0
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
APN # 316-22-017
OWNER NAMEPHONE - E-MAIL
-�'R� �i �'� .
STREETADDRESS IC)0:50 GZlatl�1,N Le�-�/ {��% CITY, STATE, ZIP (:Upr fO ^�/ s/�� FAX
�Jf \ (EE-M/`AILLt,�ullerton
CONTACT NAME Terry Fullerton
PHONE 408-519-18`3.`8t3�
Q@deVCon-const.com
STREET ADDRESS 690 Gibraltar Drive
CITY, STATE, ZIP Milpitas, CA, 95035
FAX408-946-5513
❑ OwNER ❑ OwNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME DEVCON Construction
LICENSE NIE
99163
LICENSE TYPE
B
BUS. LIC #
COMPANY NAMEDEVCONConstruction
E-MAM tfullerton@devcon-const.com
FA"408-946-7713
STREETADDRESS690 Gibraltar Drive
CITY, STATE, ZIP Milpitas, CA, 95035
PHONE408-519-8372
ARCHITECT/ENGINEER NAME Brent Downing
LICENSENUMBERC-32444
BUS. LIC#
COMPANY NAMEDEVCONConstruction
E-MAIL bdownin devcon-const.COM
FA"408-942-7713
STREET ADDRESS 690 Gibraltar Drive
CITY, STATE, ZIP Milpitas, CA, 95035
PHONE 408-942-8200
DESCRIPTION OF WORK 3RD FLOOR - DEMO (E) wall, and install new glass door with glazing system.
Misc electrical and piping.
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
B
B
1-b
4
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
Office
B
800
60,000,00
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: EIDETACH
❑ 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
RECEIVED BY:
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LEITER
EICHLER HOME? ❑ NO
CJ 70
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 Iocal
ordinances and state laws relating to b . mg construction. I au representatives of Cupertino to enter the above -id nrified rope2M for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
Or 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.
❑ .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
❑ NIAaoR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
EF�Wlzlll
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
10
ADDRESS: 10500 N De Anza Blvd
DATE: 11/12/2015
REVIEWED BY: Sean
Plan Check Fee:
APN:
BP#:
*VALUATION: 1$60,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial BuildingPENTAMATION
USE:PERMIT
PME. Plan Check:
113TI
TYPE:
woRK
Apple Tenant Improvement on third floor in Supernova room (800 sq ft).
SCOPE
Suppl. Insp. Fee -(F) Reg. 0 OT
OCCUPANCY TYPE: TYPE OF FLR AREA � PC FEES PC FEE ID BP FEES BP FEE
E ID
CONSTR. (S-0 I I I
B (Tenant Improvements) 11-13,111-13,IV,V-13 800 1 $2,123.301 IBTIPLNCK 1 $929.80 � IBTIEVSP I
TOTALS: I 800 I $2,123.30 I $929.80
Nfech. I'lan g ck
bvmb. 1"m Check f
1� U .Jec. Plan Clteck
111w!1b, Permit F*e"...
I ec. Pera."i" Fee:
Li klec' Insp. Li I
Odler 1)1.,tr,,b Insp. Utlucr
NOTE., This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District oh- )_ Thovo foov aro hawd an tho nrPliminary inforinafinn availahlo and aro only an ovdinato- Contact tho Dent for addnl info-,
FEE ITEMS (Fee Resolution 11-053 Eff. ZgLIJ3
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,123.30
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PQT . ee % : O' Reg. 0 OT
0.0
hrs
$0.00
PME. Plan Check:
Permit Fee:,
_$0.00
$929.80
Suppl. Insp. Fee -(F) Reg. 0 OT
0.0
hrs
$0.00
PME Unit'Fee:,
$0.00
PMEPermit Fee:
$0.00
c6hsfia cfioji 7-
0
G
Work. Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
Cupientq I tion . F'e . es.,
Strong Motion Fee:-' IBSEISMICO
$16.80
Select an Administrative Item
h1dg,'Stds.6'J"mmi9s'io'n Fee: IBCBSC
$3.00
01 VM111" N,
SUBTOTALS °
$3,072.90
$0.00
$3,072.90
Revised: 10/01/2015