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10100085I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10431 N DE ANZA BLVD OWNER'S NAME: APPLE INC OWNER'S PHONE: 4089744876 ❑ LICENSED CONTRACTOR'SgDECLARATION License Class -P' Li.. 0 3 ` 16 3 ContractoDl!/VCD L( ate 111/10110 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. 1 hereby affirm under penalty of perjury one of the following two declarations: t. 1 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. 2. 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 1 certify that 1 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 al I non -point squ9m regulations per the Cupertino Municipal Code, Section 9.18. //// U/io ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. I, 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: t. 1 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. 2. 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 permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued, 1 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. Date CONTRACTOR: DEVCON PERMIT NO: 10100085 CONSTRUCTION INC 690 GIBRALTAR DR DATE ISSUED: 11/10/2010 MILPITAS, CA 95035 PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ FLOOR 3 - COMMI, TI FOR EXISTING OFFICE BUILDING CONSISTING OF NEW CONFERENCE ROOMS, OFFICES, FINISHES & ACCESSIBILITY UPGRADE(20,491SQ), NO Sq. Ft Floor Area: I Valuation: $1300000 APN Number: 32633114.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM L CALLED INSPECTION. Issued by:/YtT Date: v 0— RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Ow}lergr authorizpLoopt: "__- Date: �\/6 o CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO CITY OF CUPERTINO TENANT IMPROVEMENT PERMIT APPLICATION FORM I. c)j C)0 v k APN # 2,� Date: 32 - 10.1-.. I Building Address: 3 tcxor- Mailing Address (if different from buildingaddress): i Tenant F1 (If tenant please provide a letter from the building owner approving the tenant improvement.) Building Owner ❑ Are Hazardous Materials being used as part of this project? YesEl No to Tenant/Building Owner's Name: Phone #: �{ IrAc.21 Contractor: P,LE-T TE Phone #:Q -o$ _ 519 , 6437 Fax #: p 2 , Cupertino Business License: State Contractor License #: l Contact: Phone #: 660 . 65.06©0 X 12 L Fax #: - Landscape Ordinance Compliance: in ft. irrigated (� Landscape area sq. (includes all areas): • /"` If 2,500 sq. ft. or less, compliance with the Landscape Water -Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Method: 0 Plant Type 0 Water Budget -Compliance Job Description (be specific): TC W �;oR Tr1r=- Tr41CZ > rl-ooR OF P4-1 r-_X1STtNC-t aFF=1G1= BUILZ>It4U C0tIS►S-nKr--1 OF KL -w m�L ICS RMS OFFICE=S, F1NtS►-��S �IxTi11Z�-� •SND P.CL>= tg�uTY c IPIai D� . o y� Tenant Improvement Includes Re -Roof. Yes ❑ No N] If yes, number of squares Tenant Improvement Includes Structural Yes ❑ No Q% Type of Construction (Usage Class): Occupancy Type: t5 1-A, 1-B ❑ HAII/V-A © IT/I1T B, IV -HT, V -B ❑ Valuation: 1 . Project Size: Express Standard V Large LJ Major LJ Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved 6�- *** For Office Use Only*** Over The Counter ❑ Revised 05/18/10 CUPER'fINO 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: j p 9 31 Ni g(y d PERMIT # Q f d Of-- r OWNER'S NAME: v2 PHONE # -5119 q 3 Q GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: (j ! („rA/,�, CITY/ZIPCODE: 111A 0 S 1 S 6 3S *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: -i S Signature Please check applicable subcontractors and complete the following information: Date V 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 Owner K6n'tractor Date Enforcement Agency: Permit Numb Fi Id echnician' ignat e: Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. Enforcement Agency Use: Checked by/Date FIELD TECHNICIAN'S DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance (Field Technician). • I certify that the construction/installation identified on this form complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NAT • I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. Company Name: Field Technician's Name: Fi Id echnician' ignat e: AJ Responsible Person's Name: Hand-held amperage and voltage meter Date S'ned: Position With Company (Title): G t� TI2E-__r(-J e rtC3 (( FO RESPONSIBLE PERSON'S DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, that I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this form. • I am a licensed contractor, architect, or engineer, who is eligible under Division 3 of the Business and Professions Code, in the applicable classification, to take responsibility for the scope of work specified on this document and attest to the declarations in this statement (responsible person). • I certify that the information provided on this form substantiates that the construction/installation identified on this form complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NAT • 1 have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. • I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. 1 understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: c T -M I C (&J C, Construction Inspection Phone: Responsible Person's Name: Hand-held amperage and voltage meter Responsible Pe 's Sig y G t� TI2E-__r(-J License: Date Signed- Position With Company (Title): _e_ -to 3 18 -,f3-3 t t C3 ( I -1-D e a J& c- T NSI ^ f -d ACx�� Sensor, Manual Daylighting Control, and Automatic Time Switch Control -Occupant Intent: I Lights are turned off when not needed per Section 119(d) & 131(d). Construction Inspection I Instrumentation to perform test includes, but not limited to: a. Hand-held amperage and voltage meter b. Power meter continued on next page 2008 Nonresidential Acceptance Forms August 2009 CERTIFICATE OF ACCEPTANCE LTG -2A Lighting Control Acceptance Document (Page 2 ofIL Project Name/Address: System Name or Identification/Tag: System Location or Area Served: 2 Occupancy Sensor Construction Inspection Occupancy sensor has been located to minimize false signals Light meter Ultrasonic occupancy sensors do not emit audible sound (I I9a) 5 feet from source 3 Manual Daylighting Controls Construction Inspection If dimming ballasts are specified for light fixtures within the daylit area, make sure they meet all the Standards requirements, including "reduced flicker operation" for manual dimming controls stems 4 Automatic Time Switch Controls Construction Inspection a. Automatic time switch control is programmed for (check all): 15( Weekdays Weekend Holidays b. Document for the owner automatic time switch programming (check all): rg- Weekdays settings Weekend settings Holidays settings Set-up settings Preference program setting ([ Verify the correct time and date is properly set in the time switch Verify the battery is installed and energized 1p Override time limit is no more than 2 hours Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in accordance with the applicable provision in Section 119 of the Standards, and model numbers for all such controls are listed on the Commission database as Certified Appliance and Control Devices A. Select Acceptance Test (Indicate lighting control systems Names/Designations by the applicable tests below) I Occupancy Sensor 2 Manual Daylighting Controls 3 Automatic Time Switch Controls B. Equipment Testing Requirements Check and verify those items applicable to selected system: Applicable Lighting Control Systems Occupancy Sensor - Step l: Simulate an unoccupied condition 1 2 3 a' Lights controlled by occupancy sensors turn off within a maximum of 30 minutes from start of an unoccupied condition per Standard Section l 19 d (ON �` JJ Y / N Y / N b The occupant sensor does not trigger a false 'on" from movement in an area adjacent to the controlled space or from HVAC operation I, N Y / N Y / N c. Signal sensitivity is adequate to achieve desired control / N Y / N Y / N Occupant Sensor - Step 2: Simulate an occupied condition a. Status indicator or annunciator operates correctly N Y / N Y / N b Lights controlled by occupancy sensors turn on when Immediately upon an occupied condition OR this requirement is mutually exclusive with Step 2.c. ®/ N Y / N Y / N C. Sensor indicates space is 'occupied" and lights turn on manually / N Y / N Y / N continued on next page 2008 Nonresidential Acceptance Forms August 2009 CERTIFICATE OF ACCEPTANCE LTG -2A Lighting Control Acceptance Document (Page 3 of 3 Project Name/Address: System Name or Identification/Tag: System Location or Area Served: Occupant Sensor - Step 3: System returned to initial operating conditions N Y / N Y / N Occupant Sensor - Step 4 - Sensor is also a multi -Level Occupant Sensor used to qualify for a Power Adjustment Factor in Section 146(a)2D of the Standards. If yes, then `a,' `b,' and `c' must also be yes. (0/ N Y / N Y / N a The first stage activates between 30 to 70% of the lighting either manually ory automatically. N I C Y / N Y / N b. A reasonably uniform level of illuminance is achieved by dimming of all lamps or luminaires; or by switching alternate lamps in luminaires, alternate luminaires, or alternate rows of luminaires. C / N Y / N Y / N C. After the first stage occurs, manual switches have been provided to activate the alternate set of lights, activate 100% of the lighting power, and manually deactivate all of the lights. �Y,// N Y / N Y / N Manual Daylighting Controls - Step 1: Manual switching control a. At least 50% of lighting power in daylit areas is separately controlled from other lights Y / N N Y / N b. The amount of light delivered to the space is uniformly reduced Y / N <YY N Y / N Manual Daylighting Controls - Step 2: System returned to initial operating conditions Y / N 41' Y N Y / N Automatic Time Switch Controls - Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch Y / N Y / N / N b Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located Y / N Y / N N Automatic Time Switch Controls - Step 2: Simulate unoccupied condition a. All non-exempt lighting turn off per Section 13l(d) l Y / N Y / N N b. Manual override switch allows only the lights in the selected ceiling height partitioned space where the override switch is located, to turn on or remain on until the next scheduled shut off occurs Y / N Y / N ®/ N C. All non-exempt lighting turns off Y / N Y / N &/N Automatic Time Switch Controls - Step 3: System returned to initial operating conditions Y / N Y / N ON Note: Shaded areas do not apply for particular test procedure C. PASS / FAIL Evaluation (check one): PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive Y - es ❑ FAIL: Any applicable Construction Inspection responses are incomplete OR there is one or more negative (N - no) responses in any applicable Equipment Testing Requirements section. Provide explanation below. Use and attach additional pages if necessary. 2008 Nonresidential Acceptance Forms August 2009