15010160CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19333 VALLCO PKWY
CONTRACTOR: DEVCON
PERMIT NO: 15010160
CONSTRUCTION INC
OWNER'S NAME: APPLE INC
690 GIBRALTAR DR
DATE ISSUED: 01/28/2015
OWNER'S PHONE: 4089745951
MILPITAS, CA 95035
PHONE NO: (408)942-8200
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
APPLE- BLDG A; ADDITION OF SMALL CHILLER ON
License Class CA t o L Lic. # 3,ggi (
ROOFTOP
Contractor kvcx, Date ( 15
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.
1 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: $50000
performance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 31620075.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXP WO IS NOT STARTED
correct. 1 agree to comply with all city and county ordinances and state laws relating
WITHIN I DAYSOF P 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 DA ROm- 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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source re ions per the Cupertino Municipal Code, Section
9.18.
c
RE -ROOFS:
Signature Date' J
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:
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
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
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 1 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 505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent Date: I / 2 13 l5
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, 1
CONSTRUCTION LENDING AGENCI'
become subject to the Worker's Compensation provisions of the Labor Code, 1 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
U�
10 COMMUNITY DEVELOPMENT DEPARTMENT ° BUILD ING DIVISION
10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255 1�
CUPERTINO (408) 777-3228 ° FAX (408) 777-3333 ° buildingCcDcupertino.org J
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION/DEFERRED ORIGINAL PERMIT #
PROTECT ADDRESS P /� t 6, //LO J APN q //�/ r /),9' 1 6"-16
,
OWNER NAME1_ I (NC` PHONE ,s.IOe)_471,q-05A,5Q E-MAIL ��IIO��,��,�i.L..Cd✓�
STREET ADDRESS lkr 1 CITY, STATE, ZIP 1 FAX
CONTACT NAMEI C) 1{ G PHONE � O 9 E-MAIL ema I
STREET ADDRESS I I lNv CITY, STATE, ZIP FAX
OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHaECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME (
�v. 1tiw,v�
LICENSE NUMBER I 3
LICENSE TYPE�� G BUS. LIC 9 ' t ` (_
90
COMPANY NAME
E-MAILFAX
STREET ADDRESS CITY, STATE, ZIP PHONE
(p��¢�s �� d06-712- q85b
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC H
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK
-,,4-
EXISTING USE
PROPOSED USE
CONS TR TYPE
"STORIES
I I -,
?_USE
TYPE OCC.
SQ.FT.
VALUATION (fi)
EXISTG
AREA
NEWFLOOR
AREA
DEMO TOTAL
AREA I NET AREA
BATHROOM
KITCHEN ''..... OTHER
REMODEL AREA
REMODEL AREA ''..... REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: LJ DETACH
❑ ATTACH
/±DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ONO
ADDITION? ONO
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
REC-,
TOTAL VALUATION:
PLANNING APPL k ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
sMK 211t;44�11_,�.,�a
SQ I vc�
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prop rtyowner's behalf. I have read this
app] ication 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 buildin ns ion. I authori re entatives of Cupertino to enter the above -'dentifle property for inspection purposes.
Signature of Applicant/Agent Date:
SUPPLEMENTAL INFORMATION REQUI D
'PI ANCIIECKT�eE
s';1 r ROUTi1VCSiIP
New SFD or Multifamily dwellings: Apply for demolition permit for
ovEliHE couNTER
svaDlNsrLArlx�yw
existing building(s). Demolition permit is required prior to issuance of building
a; -
permit for new building.
3
LD EXPRESS 3
PLApNING;PLAN REVIEW
Hazardous Materials Disclosure
A ,Na
❑• PUBLIG�YORKs
Commercial Bldgs: Provide a completed
STANDARD
form if any Hazardous Materials are being used as part of this project.
t ,,
❑
s ;' c LARGE
FIRE DEPT -
_ Copy of Planning Approval Letter or Meeting with Planning prior to
AZA to ti+
t € e
❑ ;SANITARY.SEWERblSTRICZ '.
submittal of Building Permit application.
,::EISVIRON11IENTALHEALTtl,." .,.:
BldgApp_2011.doc revised 06121/11
,r'ITF RIX(T if'ITrl .f -I -r TT hTr.lTfTrW'ITT, Trrt
APPLIANCE / EQUIP TYPE
11.1L A ll IlU Il `LY ' �l— AWA. I A N \U
7�
FEE
FEE]ESTIMATOR — ]BUILDING DIVISION
1'Iruub- Plan Chcci,
ADDRESS: 19333 vallco pkwy DATE: 01/28/2015 REVIEWED BY: Mendez
UNITS
APN:
BP#:
'VALUATION: $50,000
'PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY Commercial Building
#
PENTAMATION FURN/AC
USE:
1'�zvnit Fee.
PERMIT TYPE: d
WORK
a le- bldq AN addition of small chiller on rooftop
SCOPE
APPLIANCE / EQUIP TYPE
FEE IID
1'Iruub- Plan Chcci,
QTY
UNITS
BP (FEES
!?•r !' rr;,r:. ,r
Cooling Unit
1MCRAA
1
#
$143
1'�zvnit Fee.
b/sp Fec
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
C onsn-action ."l iar:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes E) No
$0.00
�ar41/JiC Lf Pkcrnun,t% fees:
a,
TOTALS:
$48.00
Strong Motion Fee: 1BSEISMIC0
$14.00
$143.00
Bldg Stds Commission Fee: ?BCBSC
NOTE: This estimate does not include fees clue 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 only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Tee Resolution 11-053 Eff. 7.%03)
Meeh. Plan Check 0.0 hrs $0.00
1'Iruub- Plan Chcci,
Plr Pf�r ;7�ck
Mech. Permit Fee: IMPERMIT
Pltrmb Porno Nc:
!?•r !' rr;,r:. ,r
Other Mech. Insp. HAhrs $48.00
Other Phrrnb trop.Ll
t'kch. Insp. Fce
Phnrrh. lnsp, Fee:
I_icr-
NOTE: This estimate does not include fees clue 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 only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Tee Resolution 11-053 Eff. 7.%03)
FEE
QTY/FEE
MISC ITEMS
Pram ('la��rl Fee:
Napol. PC Fee
PME Plan Check:
$0.00
1'�zvnit Fee.
b/sp Fec
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
C onsn-action ."l iar:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes E) No
$0.00
�ar41/JiC Lf Pkcrnun,t% fees:
a,
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: 1BSEISMIC0
$14.00
hrs Inspections
$0.00 Inspection, Hourly
Bldg Stds Commission Fee: ?BCBSC
$2.00
SUBTOTALS:
1 $300.00
$0.00
TOTAL FEE: $300.00
Revised: 01/06/2015
CUPERi70HO
( (1> \ I I � •� ( I (I► I't � l lig ( (1> IIS •� ( I (1) I". I I � I
Building Dep2rtment
City Of Cupertino
10300 Torre Avenue
Cupertino, C95014-3255
Tele ho : 408-777-3228
ax: 408-777-3333
JOB ADDRESS: Col
Va 1 l co ,9tLwq
PERMIT # 'So 1 O la 10
OWNER'S NAME: E i Lash
f V o ((o A-
PHONE # q c* — '3-7M - 59 S
GENERAL CONTRACTOR:
Qp v cc,., Ccs s d—.
BUSINESS LICENSE #
ADDRESS: (o6�p C7; b ra
1 f-etr r-
CITY/ZIPCODE: b n t C
*Oaur municipal code requires ail businesses working in the city to have a City of Cupertino business 5icense.
NO BUILDING FINAL OR (FINAL OCCUPANCY DNSPIECTD®N(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF C'UP]ERTINO
BUSINESS LICENSE.
D am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the Tollllovwing information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSLIi ESS LRCIENS E #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating cc, 1
C c,p
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper D.-, c2— f
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock 1'
Tile
/ Contract nature Date
Building Department
City Of Cupertino
✓ 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT 0 N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRAC70R LEST
JOB ADDRESS: aj -3 Va
PERMIT # 156 9 00co 0
OWNER'S NAME: Le Ei(Bean ivy c
PHONE # q60 d 'q- 5-q'51
GENERAL CONTRACTOR:4- 1hr,
BUSINESS LICENSE # 110koO
ADDRESS:
CITY/ZIPCODE: IW ; q5a-55
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY IN3S?ECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITE' OF CUP ERTINIO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following inffornmtiona
d
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
M-% 4A )" G r P -"P- I
Cement Finishing
Electrical
Woo �2 �` -7vu✓
Excavation
J05f
Fencing
Flooring / Carpeting
D5
Linoleum / Wood
Glass / Glazing
Heating
A G G O
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
v „vl o,.1%,%I o, i
Paving
Plastering
Plumbing
MU6V11to IAC.
Roofing
5+Ak Wi oCK P "A
Septic Tank
Sheet Metal
Qy v✓c I d
Sheet Rock
- Avni
Tile
(Z==24 9/'7115
Q61h—er / Contract ignature Date