15050010•
CITY OF CUPERTINO BUILDING PERMIT I
1 BUILDING ADDRESS: 10460 BANDLEY DR I CONS R CTIOON INC CON I PERMIT NO: 15050010
OWNER'S NAME: CUPERTINO INDUSTRIAL ASSOCIATE 1 690 GIBRALTAR DR 1 DATE ISSUED: 05/04/2015 1
OWNER'S PHONE: 4089742131 1 MILPITAS, CA 95035 1 PHONE NO: (408)942 -8200
tri LICENSED CONTRACTOR'S DIECLARATION
License Class // Lic. # Ir1 l /3 G
Contractor a\,r.D'4 CbC t* LIGh t PP Date
I hereby affirm that 1 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
performance of the work for which this permit is issued.
I 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 is issued.
APPLICANT CERTIFICATION
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,
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 Datel 7 1 i s
❑ OWNER- BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
performance of the work for which this permit is issued.
I 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 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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
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.
JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL E]
APPLE - T.I. FOR REMODEL & RECONFIGURATION OF 2
(E) LABS 3,329 S.F.)
REVISION #1: REVISE STRUCTURAL FOR HVAC UNITS
ON ROOF. ISSUED 5- 21 -15.
Sq. Ft Floor Area: I Valuation: $300000
APN Number: 32633105.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:, 11" J-7 Date: %
RE- ROOFS:
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 of
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: Dated 21 ��
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • B 8014 #
10300 TORRE AVENUE • CUPERTINO, CA 95014- "F)
(408) 777 -3228 • FAX (408) 777 -3333 • buildinq(a)cupertino.orq
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI Tft REVISION /DEFERRED
ORIGINAL PERMIT #
PROJECf ADDRESS
® bQ 0./ r1Ck � "Qr2.1- _
APN #
OWNER NA C A PZ `� +' Ui�v PHON(4 � ) q-7 -Z 1 �
E -MAIL
\VVW Ga` \ �
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
PHONES M ��`, �7-
+1 �/ �
E -MAIL
I
_
e kn
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ANANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E +�
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEERN E
� U
LICENSENUMBER
BUS. LIC #
COMPANY NAME
ts C-Acawe i- a
E -MAIL
a �vVAU y<1 A he, r co
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK h `
Vim' V ls� G�1 1 LL 1ti% l
EXISTING USE
PROPOSED USE CONST
TYPE
# STORIES
`J
`� A
`
USE
TYPE
OTC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
[]ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY C] YES
BEING ADDED? []NO
ADDITION? ❑NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIV Y y 3
TOTAL VALUATION:
PLANNINGAPPL# [-]NO PLANNING APPROVAL LETTER
EICHLER HOME? []NO
?w
3bv o 00
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 local
ordinances and state laws relating to building constructio I authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: Date: 5 ' 7-1
SUPPLEMENTAL INFORMATION REQUIRED
PLANGHECK TYPE . >.,
ROUTINGsLlP <`
_ New SFD or Multifamily dwellings: Apply for demolition permit for
OVER THRCOUhTER
BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
„
p
permit for new building.
❑ EXPRESS' i
PLnNN>NGrr ANREViEyv ';
Disclosure
4ti -
`
Commercial Bldgs: Provide a completed Hazardous Materials
,
PUSLICwoRKS
form if any Hazardous Materials are being used as part of this project.
❑ �
❑�
Copy of Planning Approval Letter or Meeting with Planning prior to
,LARGE , -��
FIRE DEPT' � .,
,-
_
r
❑ °MAJOR
❑ SANITARYSEWERDISTRIC�
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BIdgApp_2011.doc revised 06121111
FEW CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
10460 Bandley Drive
DATE: 05/21/2015
REVIEWED BY: Sean
MISC ITEMS
APN:
BP #:
*VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
0.0
PENTAMATION 1 GENRES
PERMIT TYPE:
WORK
Revision #1: Revise structural for HVAC units on roof.
SCOPE
E17--
_E17- El
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
nictrirt otr ) . Thoco foot nro hacod nn tho nroliminary infarmatinn availahlo and nro aniv an o0imato_ rantart the Dont for addn'l info_
FEE ITEMS (Fee Resolution 11 -053 Eff. 717/13)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
2 hours Plan Check, Hourly
$286.00 ISTPLIVCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:O 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
i
StronpMotion Fee:
$0.00
Select an Administrative Item
Bldg *, Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$286.00
TOTAL FEE-T-$286.00
Revised: 05/07/2015
CUPERTINO
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408- 777 -3228
Fax: 408-777-3333
JOB ADDRESS: k02i(ob 8k1Jmybj b�1ye ,tapr„t. -��.Tp C*V
PER 4
OWNER'S NAME:
PHONE #
GENERAL, CONTRACT R: 'C�2vco^r� w ,fl,n
BUSINESS LICENSE # CP
ADDRESS:
CITY /ZIPCODE:
*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
Please check applicable subcontractors and complete the following information:
Date
✓
SUBCONTRACTOR
Cabinets & Millwork
BUSINESS NAME
BUSINESS LICENSE #
Cement Finishing
Electrical
C� c, V-1e G'� axc.•
Excavation
Fencing
�
✓
Flooring / Carpeting
V-F-
�7
Linoleum / Wood
f
Glass / Glazing
C- �,ap,NO 'per L•i ��cs
5-(V
Heating
{l,vact e+� F�.c.�+�- aw.�c.,� / C-
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
C IL Q
Paving
Plastering
Plumbing
Roofing
S} AV— %N; V Ci b
Septic Tank
Sheet Metal
,l
Sheet Rock
iii► '-I—
Tile
Date
Owner Contractor Signature
w
I CITY OF CUPERTINO BUILDING PERMIT I
1 BUILDING ADDRESS: 10460 BANDLEY DR I CON TRUCT ON INC CON I PERMIT NO: 15050010
OWNER'S NAME: CUPERTINO INDUSTRIAL ASSOCIATE
690 GIBRALTAR DR I DATE ISSUED: 05/04/2015
OWNER'S PHONE: 4089742131 1 MILPITAS, CA 95035 1 PHONE NO: (408)942 -8200 1
/p LICENSED CONTRACTOR'S DECLARATION
License Class_ Lic. # '30191 CJ_�
Contractor V2.yCOA C6%5�'((1(4 ► M Date F-)L41 5
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
performance of the work for which this permit is issued.
I 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 is issued.
APPLICANT CERTIFICATION
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,
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.
Date 5 '"f / 1, `
Signature �L�/`'i`J
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
performance of the work for which this permit is issued.
I 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 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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
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
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
APPLE - T.I. FOR REMODEL & RECONFIGURATION OF 2
(E) LABS 3,329 S.F.)
Sq. Ft Floor Area: I Valuation: $300000
APN Number: 32633105.00 1 Occupancy Type:
PERMIT EXPI RK IS NOT STARTED
WITHIN PERMIT ISSUANCE OR
180 D INSPECTION.
Date: S
v RE- ROOFS:
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 of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent :�S r:�f�^ -e'�'� Date:�`�l IS
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profess
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPNIENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 - 3228• FAX (408) 777 -3333 • building (c)cupertino.org
O�
n�
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION/DEFERRED ORIGINAL PERMIT 4
PROJECf ADDRESS 1101460 r
APN # v ��
r r
OWNER NAME J, C
P ONE
Z' /Y
E -MAIL
L/G AJ G as `
'
STREET ADDRESS
CITY, STATE, ZIP FAX
/ Al t N
O
PHONE Goa 7 7l 21.E / MAIL
CONTACT NAME O & I E
PWS "16/A/10 I
STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER- BUILDER 40 O'ANERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT El ENGINEER ❑ DEVELOPER OfTFNANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME R I. �
(� a7, emu& yDw
E MAIL &
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
WO /91 b4 - 5 6'1S
ARCHITECT/ENGINEER NAME N U 3 CENSE NUMBER
BUS. LIC #
COMPANY NAME
�j L n._
E -MAIL Qsk @ G �`�/
/
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK "R ~T Im "ri "EN o p (2-2 Ou s r N b U-Pv r
NErV /Nv L10X W T111,0#( JLJJrE 0 &*7 Cell' (NA)
It
l�'Ir�i1�F'AN 1 GK.. �G 1KIGM.
EXISTINGUSE
PROPOSED USE
I CONSTR TYPE
# STORIES
It
USE TYPE
OCC,
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR,
AREA
DEMO
AREA
TOTAL
NET AREA
f I I A
2 A
.7 00 �r o ,
BATHROOM
KITCHEN. OTHER.
REMODEL AREA
REMODEL AREA REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKfPORCH AREA
GARAGE AREA: LJDETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT [DYES
SECOND STORY ❑YES
BEING ADDED? NO
ADDITION? NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
� ; -� - -
� '±rte � € ;
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ N
By my signature below, I certify to each of the following: I am the property 6%mer or au orize e property Ov, al£ I have ead this
application and the information I have provided is correct. I have read the Description of I it is acc mply wit applicable local
ordinances and state laws relating to buildi construction. I authorize representatives of Cupertino to enter the above- identified property for inspection purposes.
Signature of Applicant/Agent: Date: Of- 0Q.
SUPPLEMENTAL INVORMATION REQUIRED
$ riArrc>�cxrsPE
o_uzmcsliP '
❑ OVER TH><COUI�TER'
'�
DING REXiE4v
New SFD or Multifamily d%vellinQs: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
C� �XPI:ESS +sz
0,B PLAN
m
❑PLAAIILVGPLUVREyIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
k❑ .STANDARD � �
P
gmfi PUBLTCV+oRxs�
_
form if any Hazardous Materials are being used as part ofthis project.
�� � � sr ��.� -_
..�r,�� 4 u IN
_ Copy of Planning Approval Letter or Meeting with Planning prior to��
fC� - MA70R
TI
S �
A1�'AKYY s 'ER ISTRI
submittal of Building Permit application.
s� ?;�?
_E'EIaYiRO7i114ENT�L'IiEAITH`7
r..z
BldgApp_2011.doc revised 06121111
&J 0"
FM_7 CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
1A
ADDRESS: 10460 BANDLEY DR
DATE: 05/04/2015
REVIEWED BY: MELISSA
PC FEE ID
APN: 326 33105
BP#: �5_0 /D
`VALUATION: $300,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1BTIPLNCK
PENTAMATION 113 TI
PERMIT TYPE:
WORK
APPLE - T.I. FOR REMODEL & RECONFIGURATION OF 2 E LABS 3,329 S.F.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II- A,111-A,V -A
3,329
$2,990.08
1BTIPLNCK
$3,675.88
1BTIINSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,675.88
Suppl. Insp. Fee-0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
3,329
$2,990.08
$3,675.88
MECH, HOURLY 0 Yes 0 No _ PLUMB, HOURLY 0 Yes 0 No ELEC HOURLY 0 Yes 0 No
E3
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt_ otr_ ) _ Thoco fooc aro ha.cod nn tho nroliminary infnrmatian available, and are only an intimate- Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 E ..' 7./1/13)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$2,990.08
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
F0.01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,675.88
Suppl. Insp. Fee-0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
Strong Motion Fee: IBSEISMICO
$84.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$12.00
SUBTOTALS:
$6,761.96
$0.00
TOTAL FEE:
1 $6,761.96
Revised: 04/01/2015
CUPERTINO
STATEMENT OF SPECIAL INSPECTIONS, 2013 CBC
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 " building6cuoertino.ora
SITE
ADDRESS 10430 Bandley Drive, Cupertino, CA
APN sP#
Apple, Inc.
Owner... ............................._........................................... ..........._...................
Devcon
Contractor.........,..........,.................................................. ...............................
Address 1,.Infini,te Loop ...... ............................
Address 690 Gibraltar Drive ..........- ....... ...............................
cityistCupertino ............... Zip 95Q1.4............Phone 408 -974-
1 t1 Milpitas zip 95Q35 Pr,one.408 -519 -8
Applicant .... ... Apple, ,.Inc. (debbie robinson
..., ...... ....
En ineer /Archilect...SW Structural, Inc.
. ..........I ....................
Address.1.,�nfinite Loop ...... .. ..........
Address 17582 San Benito Wa
........ ............................... . ...............................
cityrstCupertino, CA Zip 95014 phone 408 -974-
131 Monte Sereno CA 95030 408.399.0623
City/ St ............................. .............Zip............... Phone ....................
PROJECT DESCRIPTION:
This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This
form is structured after and used by permission from the Structural Engineer Association of Northem Califomia's (SEAONC) mode
statement of Special Inspections. Also, included with this form is the following:
❑ "LIST OF SPECIAL INSPECTION AGENCIES (page 2). A list of testing agencies and other special inspectors that will be
retained to conduct the tests and inspections for this project
❑ "SCHEDULE OF SPECIAL INSPECTION" (page 3 — 6). The Schedule of Special Inspections summarizes the Special
Inspections and tests required. Special Inspectors will refer to the approved plans and specifications for detailed special
inspection requirements. Any additional tests and inspections required by the approved plans and specifications shall also
be performed.
Special Inspections and Testing will be performed in accordance with the approved plans and specifications, this statement and CBC
Sections 1704, 1705, 1706, 1707, and 1708. Interim reports will be submitted to the Building Official and the Registered Design
Professional in Responsible Charge in accordance with CBC Section 1704.1.2.
A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in
the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704.1.2). The Final Report will
document:
• Requited special inspections, COPY
• Correction of discrepancies noted in inspections. E E I C
The Owner recognizes his or her obligation to ensure that the constru ion complies with the approved permit documents and to
implement this program of special inspections. In partial fulfillment of these obligations, the Owner will retain and directly pay for the
Special Inspections as required in CBC Section 1704,1.
This plan has been developed with the understanding that the Building Official will:
• Review and approve the qualifications of the Special Inspectors who will perform the inspections.
• Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their
duties as called for in this Statement of Special Inspection.
• Review submitted inspection reports.
• Perform inspections as required by the local building code.
I have read and agree to comoly with the terms and conditions of this statement
Prepared By:
V
Project Engineer ❑ Architect
R istered Des Professional In Charge
Signature .... .............`"`............
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Owner Name:
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Owner's Authorization
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.......... r.,- �,+,.,..,.,,....... ........ ............ - ........ ....... .,,......... Date: w..,. L....
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Inspection Agency / Inspector Name:
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Signaturei
... ...... . ....... ........ ........... Llc.# ........ ...............................
Building Otficiblbr de ' ee:
Signature
.... .. ..... ............................... Date:
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