15110025CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 16500 N DE ANZA BLVD
CONTRACTOR; DEVCON PERMIT NO: 15110025
CONSTRUCTION INC
OWNER'S NAME;,;. MISSION, WEST PROPERTIES LP IV
690 GIBRALTAR DR DATE ISSUED: 11(0412015
OWNEWS PHONE: 4087384444
MILPITAS, CA 95035 PHONE. NO: (408)942-8200
t LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTI'ION: RESIDENTIAL Q COMMERCIAL ❑
.
APPLE - T.I., 2ND FLR TO RECONFIGURE (E) AREA (1,578 S.F.)
License Class. Lic. #>j Ax q
Contra,A4 /I S % Date
I hereby afrm thatI am licensed under the provisions of Chapter 9
(commene.ing 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 maimain a certificate of consent to self -insure for Worker's
Compensationas:,prvided for by Section 3700 of the Labor Cade, for the
Sq. Ft Floor Area:
Valuation: $22500
performance of the work'for.1which this permit is issued.
I have and wtil maintain Worker`s Compensation Insurance, as provided for by
motion 3700 of the Labor Code, for the performance of the work for which this
permit is issued I
i
APN Number: 31622017.00
Occupancy Type:
AI'PL_ ICANT CERTIFICATION
I citify 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 130 ERMI ' SUANCE OR
to building construction, and hereby authorize representatives of this city to enter
_
upon the above tgentioned property for inspection purposes. (We) agree to save
1 �ROIVT LAS QED INSPECTION.
indemnify and keepharmles's the City of Cupertino against liabilities, judgments,
costs, and expenses -which may accrue against said City in consequence of the�t—
grantmg of this permit Additionally, the applicant understands and will
with all non -point source regulations per the Cupertino Municipal C e, Section
9.18.
RE -ROOFS:
Signature t' 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.
C 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
I, as owner. ofthe property "' t' employees with wages as their sole compensation,
ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER
will do the work, and— the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as ownera€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 bfConsent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit bazardous
Ccmpensation, 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
perforniance of the work forwhich 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, Sec�05,25531,aqSection
3700 ofthe Labor Code, for the performance ofthe work for which this
Owner or authorized agent:Date /%
permit is sued r
I ocrtiify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensaiion laws cfCalifomia. If, after making this certificate of exemption, I
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 provision's or this permit shall be deemed revoked.
work's for which this permit is issued (See. 3097, Civ C.)
Lender's Name
Lender's Address
APPLICANTMT CERTIFICATION
I cdrtify that Ihave read thia,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
mdemnifyjand 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.r8..
y
Si ;nature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 - building(a)cupertino.org
0 (9
NFW CONSTRUCTION D ADDITION r9 ALTERATION/Tl [71 RFVfSION/DFFERRFD ORIGINALPERNI1T#
PROJECT ADDRESS
I.
10500 DeAnza Blvd
TYPE
APNii 316-22-017
NAME
Apple Inc
"'408-946-7713
PHONE 408-738-�4747E-MAIL
CITY, STATE, z""Milpitas, CA, 95035
SOWNER
STREETADDRESS
1 Infinite Loop
CITY, STATE, ZIP Cupertino CA 95032 FAX
I
. ........ . .
CONTACT NAME
Terry Fullerton
F—MAIL bdowning@devcon-const.com
PHONE 408-519-8383
E-MAIL tfullerton@devcon--const.com
STREET ADDRESS
690 Gibraltar Drive
STATE,z'p
' Milpitas, CA, 95035
FAX
408-946-5513
Ir1 owNrR 11 OWNER-DLqLDrR El OWNER AGENT X CONTRACTOR 11 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 11 DEVELOPER 11 TENANT I
CONTRACTORNAME
DEVCON Construction
LICENSE NUMBER
399163
TYPE
BUS. LIC
COMPANYNAME DEVCON Construction
E-MAIL tfullerton@devcon-const.com
"'408-946-7713
STREET
"""690 Gibraltar Drive
CITY, STATE, z""Milpitas, CA, 95035
PHONE 408-519-8372
A RCHITECT/ENGINEER NAME
Brent Down
CENSE NUMBERC
-32444
BUS. LIC I'
COMPANY NAME DEVCON Construction
F—MAIL bdowning@devcon-const.com
FA'408-942-7713
STREET ADDRESS 690 Gibraltar Drive
CITY, STATE, ZIP Milpitas, CA, 95035
PHONE 408-942-8200
DESCRIPTION OF IA70RK Modification to an Existing space on 2nd floor. Removing a wall, cutting opening for a new door.
Misc Electrical & Lighting work, and removing existing CDA lines.
EVSTINGUSE
PROPOSED USE CONSTR,
TYPE
4 STORIES
Date:
SUPPLEMENTAL INFORMATION REQUIREDROUTING
B
B
1-b
4
USE TYPE OCC. SQFT.
VALUATION (S)
FXISTG
AREA
NEW FLOOR
AREA
DEMO TOTAL
AREA NFI'AREA
Office B 1,578
22,500.00
BATHROOM
KITCHEN
OTHER
Copy of Planning Approval Letter or Meeting with Planning prior to
n MAJOR
RI NIODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREATOTAL
DECK/PORCH AREA
GARAGFTFTT
ODETACH
ATTACH
I
#DWELLINGUNITS:
ISA SECOND UNIT OYES
SECONDSTORY OYES
BEING ADDED? []NO
ADDITION? []NO
PRE'APPLICATION [3YES IF YES, PROVIDE COPY OF
IS THE BLDG AN 13 YL&—_-
TOTAL VALUATION:
PI.YINNINGAPPL9 E)NO PLANNING APPROVAL LETTER
EICHLER HOME? [3 NO
1 By my signature below, I certify to each of the following: I am the property owner O�thorized agerif�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 veri;4i�10.1:riite. I agree to comply with all applicable local
ordinances and state laws relating to �straction. I authorize representatives of Cupertino to enter the above -identified P operty for inspection purposes.
S ignature of Applicant/Agent: �huildin
I
Date:
SUPPLEMENTAL INFORMATION REQUIREDROUTING
:PLAN CHECKTYPF
SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance Of building
El OVER.TH&COUN'TER
❑ BUILDING PLAN REVIEW
permit for new building.
n EXPRESS
0 PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure,
El STANDARD
❑ PUBLIC WORKS ,
T
(;i7m if any Hazardous Materials are being used as part of this project.
0 LARGE
FIRE DFVF
Copy of Planning Approval Letter or Meeting with Planning prior to
n MAJOR
0 SANITARY SEWER DISTRICT
Submittal of Building Permit application.
0 .ENVIRONMENTAL ]HEALTH
BIdgApp_201 Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10500 DE ANZA B VD
DATE: 11/0412015
REVIEWED BY: MELISSA
All, APN: 316 22 017
BP#:
$3,262.69
Select a Mise Bldg/Structure
or Element of a Building A
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
Commercial Building
USE:
PME Plan Check:
��NTAT ATIO
L
P 7
J�nT�
APPLE-T.I. .2NP-FLR TO RECON FIGURE (E) AREA
$2,233.46
Suppl, Insp. Fee -,(F) Reg. 0 OTFo —,o I
hrs
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (S.f.)
B (Tenant Improvements) I -A,1-13 1,578 $3,262.69 IBTIPINCK $2,233.46 1BTITNTSP
TOTALS: 1,578$3,262.69 $2,233.46
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District etrA These tees are haled on the nreliminary information available and are only an estimate. Contact the Dent for addu 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY(FEE
MISC ITEMS
Plan Check Fee:
$3,262.69
Select a Mise Bldg/Structure
or Element of a Building A
S-uppl. PC Fee: (j) Reg. 0 OT=brs
1 $0.00
PME Plan Check:
$0.00
Permit Fee:
$2,233.46
Suppl, Insp. Fee -,(F) Reg. 0 OTFo —,o I
hrs
$0.00
PIVE Unit Fee:
$0.00
PME Permit Fee:
$0.00
Fee.
0
G
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning -Fee:
$0.00
Select a Non -Residential
Building or Structure 0
I 'A
,,-za
I., -one,,a-,n Fees:
Stront! Motion Fee: IBSEISMICO
$6.30
Select an Administrative Item
B10, Stds Commission Fee: IBCBSC
1 $1.001
Stjtf TALS
$5,503.45
$0.001 TOTAL FEE:
$5,5)3.45
Revised: 10/01/2015
Building Department
City Of Cupertino
10300 ToiTe Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS:10500 N De Anza Blvd, Cupertino, CA PERMIT # 1510025-5 OCA6
SUBCONTRACTOR
OWNER'S NAME:Apple, Inc. PHONE #
BUSINESS LICENSE #
GENERAL CONTRACTOR:Devoon Construction BUSINESS LICENSE #399163
Cabinets & Millwork
_ _
ADDRESS:690 Gibraltar Drive ClTY/Gl PCOI)E: Milpitas, CA 95035
*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.
1 am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Digitally sigrad by Stephen Archer
Stephen Archer—t—, DN: —Stephan -USA ctrer, o, ou, emeil•sam rer®devco r 12/11/15
Date: 2015.12.1109:57:58 -08'00'
Owner / Contractor Signature
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
x
Electrical
Redwood Electric
Excavation
Fencing
x
Flooring / Carpeting
RE Cuddle
Linoleum / Wood
Glass / Glazing
x
Heating
ACCO
Insulation
Landscaping
Lathing
Masonry
X
Painting / Wallpaper
Magnum Drywall
Paving
Plastering
Plumbing -'---__- --
- —
Roofing
Septic Tank
Sheet Metal
T Magnum Drywall
x
Sheet Rock
Tile
Digitally sigrad by Stephen Archer
Stephen Archer—t—, DN: —Stephan -USA ctrer, o, ou, emeil•sam rer®devco r 12/11/15
Date: 2015.12.1109:57:58 -08'00'
Owner / Contractor Signature