14040053-VOIDEDCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20525 MARIANI AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 14040053
OWNER'S NAME: 20525 MARIANI DRIVE LP
851 BUCKEYE CT
DATE ISSUED: 04/21/2014
OWNER'S PHONE: 4087835595
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
Ex LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
7
APPLE - T.I. FOR LOBBY TO RECONFIGURE AREA (1000
License Class Lic. # I v
S.F.)
/
Contractor XY L 460*ff. Date rl •
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: $75000
ce of the work for which this permit is issued.
ill maintain Worker's Compensation Insurance, as provided for by
W37
00 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32656001.20525
Occupancy "l'ypr:
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 IT 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 DAY LED INSPECTION.
indemnify andkeep 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 compl
Date: 21
with all non -point source regulations per the C rtino Municipal Code, Section
9.18.
�
ROOFS:
Signature —Datew/
any r All roofs shall be inspected prior to y 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
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
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. 1 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 5505, 25533, an 534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner
permit is issued.
or authorized agent: Date:
61
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
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
�SS'7ySJ
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building oDcupertino.orq \
F- NEW CONSTRUCTION ❑ ADDITION LTJ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS c Nis4nr+n; /�vCnv�
APN 43 7 /, ^ ,- 1p _OQ
[ �jp
OWNER NAME
/4PpIC Gcm��r�, inc,( r. L
PHONE oc'
(4 �> �b3 .5C6ppie.wM
E-MAIL i7iAWr1iYflC'IGt�'C%
STREET ADDRESS i In inI , LWp, ij/IS—r'3 -'ppC
CITY, STATE, ZIP C t)fe,,lr,,, CA gSo)} FAX
CONTACT NAMEon Ci Se
Bry rvI6rYIrI
PHONE
C 4L'P 240 00, {o
E-MAIL XIGffn�jKtiCY1 .
b iSemann�c� Gcm
STREET ADDRESS 6rj) i3�CICt�IG' li�Y{'
CITY,STATE, ZIP M IPitC15, �+� c1503s
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 3 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER IItNANT
CONTRACTOR NAME ¢ �i SP✓YtOJnn
LICENSE NUMBER (04-7460
LICENSE TYPE C G
BUS. LIC # 2 1 9 :ko
COMPANY NAME xt-
E-MAIL beiSe rn Annr0 SCI 'kA_)3 VU CTcw1. 4^ _^
FAX ( 400 94-0 - k' 06 1
STREET ADDRESS �1 v"
CITY, STATE, ZIPA.Ai]P4Ai �5
PHONE %40Q> Z4G
`#
ARCHITECT/ENGINEERNAME I�On
LICENSE NUMBER C 2,001BUS.
LIC
COMPANY NAME Peel t5kkviprstn
E-MAIL SGvlsonP reeiC3K»6mA4.4flm
FAX (44e) 266 - Oa5I
STREET ADDRESS %, N , �apEL4IU 51`
CITY, STATE, ZIP $ ��, C^ +6113PHONE
40�) Z�
DESCRIPTION OF WORK Ten.4ntM
f p✓cR,eme✓>f" of 10 'Olvy alr4-at to Include c;ErS'iwCi;ari p.F ►J&vv nen i0i461b['Rr+r1c3
artiti0n W�11 S , LGlfre� S, pI h c>1 el sSec-iu�Pd �irn syx�5;,
(spnnlc►�er,1)
EXISTING USE
PROPOSED USE CONSTR
TY
11-0
I # STORIES
3
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG,
AREA I J OOO SP
NEW FLOOR
AREA
DEMO
AREA I, GAO SF
TOTAL
NET AREA 1, 000 SF
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 [3 YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION'. ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
CEIVE
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
O/, O
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the p pe owner's behalf. I have read this
application and the information I have provided is r,D t. I have read the Description of Work and verify it is accur to agree to comply with all applicable local
ordinances and state laws relating -to. uil cons Ion. ut o 'ze representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORN141IONNIQUIRED
PLN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition pen -nit 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
❑ nlAJol
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FF.F. FIRTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 20525 MARIAM AVE
DATE: 04/09/2014
REVIEWED BY: MELISSA
PC FEE ID
APN: 326 56 001
BP#: % O5 3
'VALUATION: 1$75,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
Commercial Building
IBTIPLNCK
PENTAMATION 1 B TI
PERMIT TYPE: i
USE:
$0.00
PME Plan Check:
WORK
APPLE - T.I. FOR LOBBY TO RECONFIGURE AREA 1000 S.F.
SCOPE
Permit Fee:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FIJ ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
1,000
$2,071.77
IBTIPLNCK
$1,035.59
1BTHNSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,035.59
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
1,000
$2,071.77
$1,035.59
MECH, HOURLY O Yes 0 No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY ® Yes Q No
E3--]---
0�t ,_Lj L_
Ui,', -0-1_
F'hrn1lz
I El(,( Insp. kco
NOTE: This estimate does not include fees due to other Departments (i.e. Punning, ,Puauc works, fire, oamrary aewer.,l3lrll:l, .3cisoo!
_ TL t L d .. sA ....,/:...:.,n..r infnimnlinn nvnilnh/o and nry nnty an estimate Contact the Dent for addn7 info.
,Via LrL Ll, Gil=. [!lcJc cW laic v .- --- .— ...........».
FEE ITEMS (Fee Resolution 11-053 Eff' 7_1J
... ... ...—.__._ —.
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,071.77
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,035.59
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
O
O
Work Without Permit? O Yes Q No
$0.00
Advanced Plannin&Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
i
Strona Motion Fee: IBSEISMICO
$15.75
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$3,1267117
$$0.00
TOTAL FEE:
$31126.11
Revised: 04/01/2014
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: Ao Y%
t— PERMIT # I 111WOD
OWNER'S NAME: 1
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires A 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
_Z119 t// �/
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
_Z119 t// �/
Date
ReeiGrobman
June 4th, 2013
Building Department
City of Cupertino
Cupertino, CA
RE: Apple MA -01 Lobby T.I. Permit #14040053
To whom it may concern:
We would like to inform you that Apple has decided to cancel the work for MA -01 Lobby T.I., permit no: 14040053. We are writing
you this letter for purposes of closing out this permit. If you have any questions, please let us know.
Regards,
Scott Colson
Principal
Reel Grubman 96 N. Second Street 408.288.7833 TEL
Architecture + Interiors San Jose, California 95113 408.286.0851 rax