15100082CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 N DE ANZA BLVD
CONTRACTOR: DEVCON
PERMIT NO: 15100082
CONSTRUCTION INC
OWNER'S NAME: MISSION WEST PROPERTIES LP 1V
690 GIBRALTAR DR
DATE ISSUED: 10/12/2015
OWNER'S PHONE: 41087384444
MILPITAS, CA 95035
PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
�jAPPLE
- T.1. PREP FOR 4TH FLR (BP # 15100080)
3 y9�6 3
License Class Lic. #
�./v
�r
Contractor Ywrn ti- ^ 3 / 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.
Sq. Ft Floor Area:
Valuation: $4000
I hereby affirm under penalty of perjury one of the following two declarations:
APN Number: 31622017.00
Occupancy Type:
t. I have and will maintai: 0 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.
1 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 EXPIRES IF WORK IS NOT STARTED
permit is issued.
WITHIN 180 DAYS OF P SUANCE OR
APPLICANT CERTIFICATION
180 DAYS F LED INSPECTION.
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
e /0 ZIS
upon the above mentioned property for inspection purposes. (We) agree to sa
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
RE -ROOFS:
all non -point so gulations per the Cupertino Municipal Code, Section 9.18.
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 Date jb�iL
Signature of Applicant: Date:
❑ OWNER -BUILDER DECLARATION
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
HAZARDOUS MATERIALS DISCLOSURE
compensation, will do the work, and the structure is not intended or offered for
I have read the hazardous materials requirements under Chapter 6.95 of the
sale (Sec.7044, Business & Professions Code)
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
2. 1, as owner of the property, am exclusively contracting with licensed contractors to
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
construct the project (Sec.7044, Business & Professions Code).
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
1 hereby affirm under penalty of perjury one of the following three declarations:
contaminants as defined by the Bay Area Air Quality Management District I will
t. 1 have and will maintaio a Certificate of Consent to self -insure for Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation, as provided for by Section 3700 of the Labor Code, for the
Health & Safety Code, Sections 25505, 25533, and 255%34.
performance of the work for which this permit is issued.
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
O or authorized agent:
Date:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
CONSTRUCTION LENDING AGENCY
3. 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any personi, in any manner so as to become subject to the Worker's
1 hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of'California. If, after making this certificate of exemption, I
for which this permit is issued (Sec. 3097, Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code, I
Lender's Name
must forthwith comply, with such provisions or this permit shall be deemed
Lender's Address
revoked.
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I understand my plans shall be used as public records.
correct. I agree to comply with all city and county ordinances and state laws relating
Licensed Professional
] 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
i
7
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �/
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org G
❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / Tl ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10500 DeAnza Blvd
APN# 316-22-017
OWNIFRNAME Apple Inc Nt.�sS�°^� I�Jv3
'I'-1�S
PHONE 408-738-4444
E-MAIL
L Ip
�nrc�-
STREET ADDRESS 1 Infinite Loop l�� 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
FAX408-946-5513
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME DEVCON Construction
LICENSE NIUMIE1399163
LICENSE TYPE B
BUS. LIC#
COMPANY NAMEDEVCONConstruction
E-MAIL tfullerton@devcon-const.com
FAX408-946-7713
STREET ADDRESS690 Gibraltar Drive
CITY, STATE, Z1PMiI itas, CA, 95035
PHONE408-519-8372
ARCH] TECT/ENGINEERNAME Brent Downing
LICENSE NUMBER
C-32444
BUS. LIC#
COMPANY NAME
Construction
E-MAIL
bdownin devcon-const.com
FAX
408-942-7713
408-942-7713
STREET ADDRESS690 Gibraltar Drive
CTTY,STATE,Z1PMilpitas, CA, 95035
PHONE 408-942-8200
DESCRIPTION OFWIORK11L� 6F ,s-c�c�7- w.9-�-LJ� pdurs,
%��/ e" -O" t-" Loi F� ✓ v Tom,
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
B
B
1-15
USE TYPE OCC.
4
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA Office B
11,052
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREAS DETACH
❑ ATTACH
N DWELLING UNITS:
ISA SECOND UNIT []YES
SECOND STORY []YES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION YES IF YES, PROVIDE COPY OF
PLANNING APPL # NO PLANNING APPROVAL LETTER
IS THE BLDG AN CEIVETOTAL�VALUATION-
EICHLER HOME?
By my signature below, I certify to each of the following: I am the property owner ora orized agent to ac e rty owner's behalf. I have re is
application and the information 1 have provided is correct. I have read the Description of Work and ver' ccurate. 1 agree to comply with all applicable local
ordinances and state laws relating to buil onstruction. 1 authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
10/12/15
Signature of Applicant/Agent: T Date:
SUPPLEMENTAL INFO AT10N REQUIRED
PLANCHEcxTYPE
ROUT INGSLIP
p ovER-TaE coDNTm'
❑ 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
❑ PUBL7c 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 SEWIERDISTRICF
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH'
B1dgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
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 hated an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13
ADDRESS: 10500 DE ANZA BLVD
DATE: 10/12/2015
REVIEWED BY: MELISSA
APN: 316 22 017
BP#:
*VALUATION: 1$4,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE: 7
0.0
PENTAMATION 1TIPREP
PERMIT TYPE:
WORK
APPLE - T.I. PREP FOR 4TH FLR BP # 15100080
SCOPE
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 hated an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$417.00
Tenant Improvement Prep
ITIPPEP
Suppl. PC Feer, 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
�
Strong Motion Fee: IBSEISMICO
$1.12
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.12
$417.00
` TOTAL FEE: `
$419.12
Revised: 10/01/2015