13100104CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 MARIANI AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 13100104
OWNER'S NAME: MISSION WEST PROPERTIES
851 BUCKEYE CT
DATE ISSUED: 10/15/2013
OWNER'S PHONE: 4157103063
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
❑ LICENSED C NTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Fic. #
APPLE- COMM. T.I 1400 SQ FT INTERIOR
IMPROVEMENTS
ContractorDat
M,E,P'S
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: $130000
formance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance, as provided for by
F
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 31622018.00 Occupancy Type:
permit is issued.
. APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT 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
180DA FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
`
/a
i /3
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source re ulations per the Cupertino Municipal Code, Section
117
9.18.
RE -ROOFS:
Signature Date �l N
All roofs shall be inspected prior to any roofing material being installed. If a roof is
_
installed without first obtaining an inspection, l 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. ➢ 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(x) 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, tions 255 5:,.I;;33,
Section 3700 of the Labor Code, for the performance of the work for which this
t
permit is issued.
Owner or authorized age to
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
l 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
1 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
MV
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 MARIANI AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 13100104
OWNER'S NAME: MISSION WEST PROPERTIES
851 BUCKEYE CT
DATE ISSUED: 10/15/2013
OWNER'S PHONE: 4157103063
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
I LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic. #
APPLE- COMM. T.I 1400 SQ FT INTERIOR
j /
Contractor X,Gp9rvL�, a� Date 1 /
IMPROVEMENTS
M,E,P'S
I hereby affirm that I am licensed under the provisions of Chapter 9
1 �-t It ...Ls D It l
97
(commencing with Section 7000) of Division 3 of the Business & Professions
Pe
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two decI iA .
14,1
I have and will maintain a certificate of consent to self -insure for W y d ��
Compensation, as provided for by Section 3700 of the Labor Co JD r tu
performance of the work for which this permit is issued.��,,�
Sq. Ft Floor Area:
Valuation: $130000
I have and will maintain Worker's Compensation Insurance, as prodided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31622018.00
Occupancy Type:
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 OF PERMIT ISSUANCE OR
building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYf LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
70M
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature 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.
❑ 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, 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, Sections 25533
Section 3700 of the Labor Code, for the performance of the work for which thisOwner
.25505,
or authorized agent: ;Mate:
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT'-SUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPERTINC I (408) 777-3228 - FAX (408) 777-3333 - build in cu erti
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TIREVISION E E
ORIGINAL PERMIT # 1.710014V
APN #
PROJECT ADDRESS rpt/ -�7 � U� �-
�G/IO/11
/
OWNER NAME �yp� l 0n L
fit! fi
PHONE �� C • ? 74. .0/ 0
G�/ /QO//O
E-MAIL
STREET ADDRESS /
CITY, STATE, ZIP /1 e�Ii FAX
CONTACT NAME �lmv / C/t
,!6/S U
PHONE qDr.9I
E-MAIL dye e /4' /g Y_It-0N.i7•J GDa°?
STREET ADDRESS [_ /•
CITY, STATE, ZIP 1/J�� AX q00P. 6L1O• / 001
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME /� �
✓
LICENSE NUMBER(
99
LICENSE TYPE �f
sc7
BUS. LIC#
r!/O
COMPANY NAME /
�[ �r�I�rvG7/D✓1
AI
E-MAIL/ /
y�l'L�iae�[i�.> �Gd✓1J .CODs"
FAX %�U1•(o�/O. �dr��
STREET ADDRESS ysl / / Lr
CITY, STATE, ZIP /1. / _ _ I� / ,!j f��d 3S
Y Ciro /
PHONE
ARCMTECT/ENGINEERNAME e��%R a• l�d3Y
LICENSENUMBER Z_
BUS. LIC#
COMPANY NAME / �y� v
E-MAIL f �a J/_ d n d �y �� . G0ro1
!�
FAX
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
/yaa Sr �n��ppler�ov� l./1. ��•�` �'a/vPrR.C�r9J'/
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (i)
AREA % NO V
EX1STBATHROOM
AREA BOOR
AREA moi/
`�
/1/0-%
NEfTOTAAREA /�
KITCHEN
OTHER
REMODELAREA AIA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DEC ORCH AREA
GARAGE AREA DETACH
N-4
� //
rf
Aw
. /❑ ATTACH
# DWELLING UNITS:
1S A SECOND UNIT El YES
SECONID[/STORY []YES
11A
BEING ADDED? RNO
I
ADDITION? _WO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
REC E i '. .. TOTAL VALU N:
PLANNING ADPL P. )RLNID PLANNING APPROVAL LETTER
EICHLER HOME? JONO
S
By my signature below, I certify to each of the following: I am the property owner or autho' gent to act on the property owner's behalf. I r d this
application and the information I have provided is correct. I have read the Description of Wo k and verify it is accurate. I agree to comply wi all AVplicable IocaI
ordinances and state laws relating to building construction. I authorize r prese at of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:ar
SUPPLEMENTAL INFORMATION REQUIRED
Q
�.
UT LI
New SFD or Multifamily dwellings: Apply for demolition permit for_¢
❑ THE COUNTER
❑q BUII.DINGPLAI\ REVIENV
existing building s). Demolition permit is required prior to issuance of building
4 l z
PeII171t for new building.
❑aPI2Ess r",»
❑ PLA'�NTI�GPLANItEVIEW�'`
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
p
❑ STANDARD"
❑ PUBLIGORLS `
_ o
form if any Hazardous Materials are being used as part of this project.
r
x #
LARGE
FIR DEP1
Copy of Planning Approval Letter or Meeting with Planning prior to
: #e
}
�❑ s lz mr
7,5
❑
submittal of Building Pen -nit application
MAJOR, £
� y �
SANJTARY�EWj�.RllI�TRICT3 rx;
ux XI 7`.
`;?' � a� . x��,, , '�
t❑s'P,3�VIROIY11'IENTAtiHEALTH >,
B1dgApp_2011.doc revised 06/21/11
CONSTRUCTION PERMIT APPLICATION 161A
13 COMMUNITY DEVELOPMENT DEPARTMENT ° BUILDING DIVISION 6�
10300 TORRE AVENUE • CUPERTINO. CA 95014~3255
CUPERTINO (408)777-3228 • FAX (408) 777-3333 • buildinata�cuoertinp4m
❑ NEW coNSTR cam ❑ ADDITION M ALm&-nON 117 ❑ REVISION / DwEut I) ORIGINAL PERmrr #
PROIECT ADDRESS 20400 Mariani Ave.
APN a 316-22-018
OWNER NAME. Apple Inc. _ Mt-,-N0N
IvtoNs 415.710.3083
z.mAx jackirMapple.com
S EffrADaRM 1 Krde Loop
Cm. STAT% Cupertino, CA 95014
FAx
cDNrAcT N"ffi Jason Holleb
PAON6 650.365.0600 x I IB-MAII. Jhoileb@thehayMmup.com
SMW Am= 2657 Spring Street
carr, srAIX tF Redwood City, CA 94063
FAX 650.365.0670
❑ Owm ❑ owm-K=ER ❑ owtm Aww 13 CoN7maos 13 aaw crow f oir N %Romwr 13 BNOA! m O Dsvmma ® nmAw
comAcroxNAmB Chad Hamilton
LKMMNUMM u HIA 4 &)
tMNSETYPE �,
EUS.Idso
cOMPANrNAMB XL Construction, Inc.
uum chamilton@xbonsbuctlon•onm
Fax
STREETADDRBSS 651 Buckeye Court
MY. 17A'tE.?>s Milpitas, CA 85035
PHOIVB 408.240.6322
ARC 0TWrlMn4MNAMB Ken Hayes
L[C0m NtrMl m C-15562
BUS, = a
c016ANYNAms Hayes Group Architects, Inc.
khoyes@theheyesgroup.com
FAX 650.365.0070
SntasT ADDRsss 2657 Spring St.
crr" srATB. z'P Redwood City, CA 94063
PHONE 650.365.0600
D890"PmNOF wORI Interior Tenant Improvements with associated mechanical and electrical work.
NO change of use, NO landscape work NO rooftop equipment work, NO worts in the public right of way
EKISIM USE
Office
PROPOSED=
Office - No Change
CONBIR.TYPE
V-8
aSIOM
1
Most 111007
AM 107,564 SF
NMFIADRD8M0
AReA 0 SF
AD 0 SF
TOTAL
I MARPA
SAMIDOM
AM 0 SF
REMOD ARBA 0 SF
�ODELARRA 0 SF
PWtlCaAtm
NA
DBCxAM MAL M=NORMAREA I WACMARIA. I] =AM
NA I NA NA 0 ATTACH
801FUSX46100M
NA
DASCOMMUT 13YB9
NUMAao;or ®fro
secoxPRORY 13 YES
Aeofltow low
-
MEA"LICATOK ❑ Yes
RAremmAlrr.e ® m
vvatreovmaconrop
PLm mmArmvALwr=
n4vomsmw PTALVALUAUft -
NA
By my eine below. I cadfy to each of the following: I am tho pmperty owner or ser t toad on the property owner's behalf. 1 bane read ilia
application and the information I have provided is oomect. I bave read the Description of Wolk afid verily it is accurate. I agree to comply with all applicable local
wdiosoces and state Iowa relating to building Y of Cupattino to colt the above -identified property for inspection pmposm
Sigoatms of Appticant/Agcnt Date: 10. 0
SUPPLEWMAL INFO #IATION
fm
exisft building(s). Demolition permit is required prior to issuance of building
permit for new building.
_
form if arty Hazardous Materials are being used as part of this project.
submitral of BuRding Permit application
rLANCH=TVn
RotrrtrresLEP
:rte ooextaat
❑ tt"M
❑ SrANDAW
❑ L4r3G8
❑ MAXOR
atm Dnrc rrrw nttvaaw
❑ Prd+rrWc rLM
❑ Puarrcwowm
❑ Hs DEPT
®sAxlrAretrsstvxxnDrsrBe
❑ t NYMONMENTAL t$AL1H
SldgApp 10d I.doa reWsed 031161J]
A"IArTPR7 ATT A"ITr TTrb1n1MriPTFWTAT
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 based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113)
�.IL ll ]1
O.D.lI' �l. lLa ll Il� liO 11 111 `l �ll
Elee:. Plan Check
Teck Pertnil Fee:
FEE ESTIMATOR - BUILDING DRVISIGN
rlec. Permit Fee:
Other Afech. Insp.
ADDRESS: 20400 mariani ave
DATE: 11/19/2013 IREVIEWED BY:
Mendez
Plumb. Tnsp, Fee:
APN:
BP#:
$0.00
ILUATIION:
$0
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
Permit Fee:
$0.00
PENTAMATIION
1 GENCOM
USE:
$0.00
PERMIIT TYPE:
WORK
deferred #1 -Site accessibility
PME Permit Fee:
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 based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113)
Mech. Plan (:'heck
Phunb. Plan Check
Elee:. Plan Check
Teck Pertnil Fee:
pi mb. Permit Fee:
rlec. Permit Fee:
Other Afech. Insp.
Other Phimb Insp. C
011ier Elco. Insp. C
dfech. Insp. Fee:
Plumb. Tnsp, Fee:
Elec. Insp. Fee:
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 based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113)
FEE
QTY/FEE
la RSC ITEMS
Plan Check Fee:
$0.00
= #
$278.00
Deferred Submittal
IDEFSUBM
Suppl. PC Fee: (F) Reg. 0 OT
Eflhrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. COT
Q,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction .Tax:
Adininistrative .Fee:
0
E)
Work Without Permit? ® Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
ol
A,
Travel Documentation Fees:
Strong; Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$278.00
TOTAL FEE:
L$278.00
10101/2013
CITE' OF CUPERTINO
FM --,7 FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
20400 mariani ave
DATE:
REVIEWED BY: Mendez
PC ]FEE ID
APN:
BP#: 13100159'*VALUATION:
B (Tenant Improvements)
1$130,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
$1,301.07
PENTAMATION 1131-1
PERMIT TYPE:
WORK
a le- comm. t.i 1400 sq ft interior improvements M E P's
SCOPE
0.0
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC ]FEE ID
BP FEES
BP ]FEE IIS
B (Tenant Improvements)
II-B,111-B,IV,V-B
1,400
$2,092.21
1BTIPLNCK
$1,301.07
1BTIINSP
f'le '. 1rr.c J. pore:
Permit Fee:
Suppl. Insp. Fee:) Reg. 0 OT
0.0
hrs
$0.00
$0.00
PME Unit Fee:
PME Permit Fee:
$0.00
(,or'1,ilr11(..'?i01,1 TOX:
Lj
Aclnunisrr dli).,! Fee:
$0.00
0
Work Without Permit? 0 Yes (D No
Advanced Planning Fee:
TOTALS:
1,400
$2,092.21
77 _ g
/�P's',�S�E' f.�!)i-i?�r'7i(': d'2CCd z"I cITt F,'t.'S;
/`
$1,301.07
$27.30
$6.00
•
1"MEC11HOURLY Q YesNo
PLUMBI
_ ,HOURLY Q Yes Q No
ELEC, HOURLY � 0 Yes (ED) N®
Alec:i^, 1'lrrz; C'dtee:
F' .rntT>_ 11"an f'IEr<k
!.lice. M"M
A2f -31. ,i UL';
1't!Lit•'tJ, iii:"i37T)t 1'f:'<:';
BeC, POVI i f9
C3tics-r;9tr:<t?, Irsr.
0 F,r:rPlumbInsp,ET_L_
.
0,herElec. Ins!?El
ierl'r. la>..rrJ. Ft>r:
f'r'tQrnh. h»isp, Pee:
f'le '. 1rr.c J. pore:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13
FEE QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,092.21
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
PME Plan Check:
$0.00
$1,301.07
Permit Fee:
Suppl. Insp. Fee:) Reg. 0 OT
0.0
hrs
$0.00
$0.00
PME Unit Fee:
PME Permit Fee:
$0.00
(,or'1,ilr11(..'?i01,1 TOX:
Lj
Aclnunisrr dli).,! Fee:
$0.00
0
Work Without Permit? 0 Yes (D No
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
4
77 _ g
/�P's',�S�E' f.�!)i-i?�r'7i(': d'2CCd z"I cITt F,'t.'S;
/`
Strong Motion Fee: 1BSEISMICO
$27.30
$6.00
Select an Administrative Item
Bldg Stds Conllnission Fee: IBCBSC
SUBTOTALS:
1 $3,426.58 $0.00TOTAL
FEE: $3,426.58
Revised: 10/01/2013
CUP(1=RTONO
CONTRACTOR / SUBCONTRAC70R UST
Building.Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-325.5
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 2 d Y0 D
PERMIT # 13100104
OWNER'S NAME:ze
PHONE # YO F - Zz/a- 6000
GENERAL CONTRACTOR: J-/_ s �ivt io✓i
BUSINESS LICENSE # &Z/7YE'0
ADDRESS: -S/ 'e -e- e' 2'
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 CUP]ERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
d
SUBCONTRACTOR
BUSINESS NAME
]BUSINESS ]LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
C'„ �;�o E/ems �.•
(� 9
Excavation
Fencing
Flooring / Carpeting
,2C G�c�o%�
/4/29
Linoleum / Wood
Glass / Glazing
4A, � All,
7,316 a/
Heating
�4,/ e.
X19671
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
GLS A,
2 fb 41:1
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Cont actor ture Date