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15120116MA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: DEVCON PERMIT NO: 15120116 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED: 12/14/2015 OWNER'S PHONE: 4087384444 MILPITAS, CA 95035 PHONE NO: (408)942-8200 rg LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ APPLE - (1ST FLR) T.I. TO RECONFIGURE (E) OFFICES License Class Lic. # � 9/6 3 (1,030 S.F.) Contractor,//pe✓GO h GOns T 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: $125000 _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 APN Number: 31622017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES + OT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18 F PER SSUANCE OR to building construction, and hereby authorize representatives of this city to enter _ R INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save 180D indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the y granting of this permit. Additionally, the applicant understands and will comply with all non -point sou a regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature 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) I, 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 1 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 1 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, Sectio 05, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: Z /J permit is issued. I certify 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 Compensation laws of California. 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 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10500 DeAnza Blvd APN # 316-22-017 OWNER NAME Apple Inc PHONE 408-738-4444 E-MAIL STREET ADDRESS 1 Infinite Loop ld� 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 Milpitas, CITY, STATE, ZIP itas, CA, 95035 FAX408-946-5513❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT % CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER399163 LICENSE TYPE BUS. LIC # DEVCON Construction COMPANYNAMEDEVCON Construction E-MAIL tfullerton@devcon-const.com FA -X408-946-7713 STREET ADDRESS 690 Gibraltar Drive CITY, STATE, ZIP Milpitas, CA, 95035 PHONE408-519-8372 ARCHITECT/ENGINEER NAME Brent Downing LICENSENUMBERC-32444 L BUS. LIC# COMPANY NAME DEVCON Construction E-MAIL bdowning@devcon-const.com FAX 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. (1 ST FLOOR) Removing select walls, door. Constructing new walls, doors, glazing. New ceiling and lights. Associated Mechanical and Electrical. 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 1,030 125,000.00 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY E] YES BEING ADDED? NO ADDITION? NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ED BY: TOTAL VALU PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 125,000.0 By my signature below, 1 certify to each of the following: I am the property owner or autho ' e t 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 ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui construction. I auba ' resentatives of Cupertino to enter the above -identified property for inspection purposes. 12/1415 Signature of Applicant/Agent:Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10500 N DE ANZA BLVD DATE: 12/14/2015 REVIEWED BY: MELISSA APN: 316 22 017 BP#: `VALUATION: 1$125,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building $3,209.28 PENTAMATION 1 B TI PERMIT TYPE: WORK APPLE- 1ST FLR T.I. TO RECONFIGURE E OFFICES (1,030 S.F. SCOPE $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) I -A,1 -B 1,030 $3,209.28 IBTIPLNCK $1,702.24 1BTIINSP hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,702.24 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 TOTALS: 1,030 $3,209.28 $0.00 $1,702.24 MECH, HOURLY O Yes G No PLUMB, HOURLY Q Yes (j) No ELEC, HOURLY Q Yes (2)No ltech. Man Ch k art:!,. 111taai Chi c;' Plan Check Fee: $3,209.28 L...................... Select a Mise Bldg/Structure or Element of a Building .............. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Fire, Sanitary Sewer vesirtci, acnuut n.* .4.; 0 IF/. "ro 1, th ad on e nreliminary informatinn availahle and are only an estimate. Contact the Dept for addn'l info. ..��,�," �'.Z. .,.� w, w ..... ------------ FEE ITEMS (Fee Resolution 11-053 Elf.' 7111131 - -- FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,209.28 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: Reg, 0 OT p.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,702.24 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 T7_ :hninhi Irafive Fee G Work Without Permit? Yes ) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure A Strong Motion Fee: IBSEISMICO $35.00 Select an Administrative Item Bldg Stds Commission Fee. IBCBSC $5.00 SUBTOTALS: $4,951.52 $0.00 TOTAL FEE: $4,951.52 Revised: 10/01/2015 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: M5Y0 N. Dc q..z1 G3wa PERMIT # OWNER'S NAME: / PHONE # GENERAL CONTRACTOR: t>",ovl Cav sN a-u.cctoa BUSINESS LICENSE # ADDRESS: 60tD pV6.% CITY/ZIPCODE: h1t�pCCkS,C�'c c15 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 subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing �o►c �F�� be caa�.K (�,�a�-re Electrical 12�v0-0CFD Excavation 7 o seP A b Qa ts�- S Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating p GGc> a\*3ea-Q-�NG. Insulation Landscaping Lathing Masonry Painting / Wallpaper D. Ze I ��s �, 5osys Paving Plastering Plumbing Roofing Septic Tank Sheet Metal L.ec�S 1rpe��AL W2��tNc� to Sheet Rock Tile Owner / Contractor Signature -2-- / \z /t�, Date