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12080076CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 3 RESULTS WAY CONTRACTOR: XL CONSTRUCTION PERMIT NO: 12080076 OWNER'S NAME: ECl TWO RESULTS LLC 851 BUCKEYE CT DATE ISSUED: 12/14/2012 OWNER'S PHONE: 4084901641 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 LICENSED CONTRACTOR'S DECLARATION i � BUILDING IO� (0 Lf Y PERMIT INFO: BLDG ELECT PLUMB License Class�,7 Lic. # ( j— MECH RESIDENTIAL COMMERCIAL Contractor � �ilt+V S�+G�r�t - � ate G.� I hereby affirm that I am licensed under the provisions of Chapte 9 JOB DESCRIPTION: APPLE -2ND FLOOR-COMM.T.I (12,824 SQFT),NEW (commencing with Section 7000) of Division 3 of the Business & Professions INTERIOR PARTITIONS, DOORS, FINISHES, CEILINGS, Code and that my license is in full force and effect. LIGHTING, M/E/P'S 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 Sq. Ft Floor Area: Valuation: $1560000 Section 3700 ofthe Labor Code, for the performance ofthe work for which this permit is issued. APN Number: 35720042.3 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. diti ally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -p int our egu ions per the Cupertino Municipal Code, Section 9.18. Issued by: Signature Date L 2 ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner ofthe property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 ofthe Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain ompliance wit the upertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health Safety Code, do 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions ofthe Labor Code, I must Ow r r uthorized e : forthwith comply with such provisions or this permit shall be deemed revoked. Date: 12 - CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of vwrk's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives ofthis city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. l understand my plans shall be used as public records. Signature Date Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION X❑ ALTERATION/TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECTADDRESS 3 Results Way ,2h(�;ilc�/I APN# 357 20 042 OWNERNAME EC'I TWO RESULTS LLC PHONE' E-MAIL Lim W10STREET ADDRESS 1301 SHOREWAY RD STE 250 -64 CITY, STATE, ZIPBelmont CA 94002 FAX CONTACT NAME Marco Innocenti PHONE 408.240.6000 E-MAIL minnocenti@X1COT1St.COm STREET ADDRESS 851 Buckeye Court CITY, STATE, ZIP Milpitas, CA 95035 FAX 408 .240.6001 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT M CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Marco Innocenti LICENSE NUMBER 6 4 7 4 8 0 LICENSE TYPE B BUS LIC # 21836 COMPANYNAME XL Construction E-MAIL minnocenti@X1const.com FAX 408.240.6001 STREETADDRESS 851 Buckeye Court CITY, STATE, ZIP Milpitas, CA 95035 PHONE408.240.6000 ARCHITECTENGINEERNAME David SabalVaro LICENSENUMBER C-015925 BUS LIC# COMPANYNAME Studios Arch E-MAllcrossman@studiosarch. com FAX 415 .398 .3829 STREET ADDRESS 4 0 rj Howard St Suite 588 CITY, ST TE, ZIP San Francisco, CA 94105 PHONE 415 . 398 . 7575 DESCRIPTION OF WORK New interior partitions, doors, finishes, ceilings, lighting, electrical, mechanical, and plumbing. EXISTING USE Business Group BBusiness PROPOSED USE CONSTR. Group B III TYPE NR 1 # STORIES 2 USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA 12 , 824 NEW FLOOR AREA 1 2, 824 DEMO AREA N/A TOTAL NET AREA 12 , 8 2 4 BATHROOM N/A KITCHEN N/A OTHER N/A REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAG$ AREA: DETACH N/A N/A N/A N/A ❑ATTACH # DWELLINGUNTFS IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES N/A BEING ADDED? ® NO ADDITION? NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # (RNO PLANNING APPROVAL LETTER EICHLER HOME? W NO f�- / $ 1 5 6 0 , 0 0 0 By my signature below, I certify toe h o the following: am the erty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I h pr ided is correc I have re the Description of Work and verify it is accurate. I aree to comply with all applicable local e ordinances and state laws relating bui ng constructs I author tepresentatives of Cupertino to enter the above-iden sed pro erty for inspection purposes. Signature of Applicant/Agent t I Date: SUPPLEM AL FORM ON REQ IRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW New SFD or Multifamil dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. El EXPRESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1 STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. /❑ LARGE )p FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ submittal of Building Permit application. MAJOR SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp 201 ].doe revised 06/21/11 CITY OF CUPERTINO NO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 3 Results Way FLR AREA s.f. DATE: 08/07/2012 REVIEWED BY: Sean BP FEES APN: 357-20-042 BP#: II-B,(11-B,IV,V-B "VALUATION: 1$1,560,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 1BTHNSP /��D� `� / PENTAMATION 1B TI �PERMITTYPE:_ WORK Tenant Improvement on second floor 12824 sq ft). SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,(11-B,IV,V-B 12,824 $2,659.76 IBTIPLNCK $7,114.06 1BTHNSP hrs $0.00 PME Plan Check: $0.00 Permit Fee: $7,114.06 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 TOTALS: F 12,824 $2,659.76 $0.00 $7,114.06 MECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY 0 Yes 0 No NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District. ate 1_ These feet are ha.ced on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E f 7'1."11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,659.76 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: (j)Reg. 0 OT 10.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $7,114.06 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 E) 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 $327.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $63.00 SUBTOTALS: 10,164.42 $0.00 TOTAL FEE: 1 $10,164.42 Revised: 07/01/2012 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:3 Results Way _ PERMIT # 12080076 OWNER'S NAME:ECI TWO RESULTS LLC PHONE #408-240-6000 GENERAL CONTRACTOR:XL Construction BUSINESS LICENSE #21836 ADDRESS:851 Buckeye Court CITY/ZIPCODE: Milpitas, CA 95035 *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: - --- Signature Please check applicable subcontractors and complete the following information: Date ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # x Cabinets & Millwork Mission Bell Casework 25336 x Cement Finishing m n . x Electrical Redwood Electric Group .21108 Excavation Fencing x Flooring / Carpeting R.E. Cuddie 1429 Linoleum / Wood x Glass / Glazing Silicon Valley Glass 26943 x Heating Unite Mechanical 27361 X Insulation Accurate Firestop 34279 x Landscaping Jensen Corporation 9697 Lathing Masonry x Painting/ Wallpaper Pyramid Painting 25999,' Paving Plastering x Plumbing United Mechanical 27361 x Roofing Statewide Roofing 23509 Septic Tank x Sheet Metal United Mechanical 27361 x Sheet Rock Bayside Interiors 25898 x Tile - t--- Rinaldi Tile 27336 5/28/13 Owner / Contractors ature x' A� Date M CUPERTINO PURPOSE HAZARDOUS MA'rERIALS CHECKLIST 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 • buildinq(@cupertino.org To minimize possible delays that would result for the Fire Department plan review, please complete the following checklist to determine if an additional level of Hazardous Materials plan review will be required. MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING? PLEASE MARK YOUR ANSWER WITH AN `X' IN THE YES OR NO BOX ON THE SIDE BELOW. YES NO 1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases, hazardous materials, etc. 2. Battery back-up rooms or racks. 3. Propane tanks. 4. Gasoline stations with underground tanks. 5. Installation or replacement above ground or underground storage of liquid petroleum products, liquefied petroleum gases, compressed natural gas, explosives or other regulated hazardous materials. 6. Gas rooms for dentist, doctors or veterinarians. 7. Generators with back-up diesel or other fuels. 8. Large refrigeration systems. 9. Fuel cell systems. 10. Commercial pool systems. 11. Chemical Storage areas. 12. Flammable liquid storage. 13. Compressed Gases. 14. Dry cleaners. 15. Print Shops. 16. Auto Repair and Auto Body Shops. 17. Research and Development. �( For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa Clara County Fire Department, at (408) 378-4010. HasMat 2011.doc revised 03/07/11 TESTING ENGINEERS, INC. 2811 Teagarden St. 510-835-3142 San Leandro, CA 94577 800-660-3142 PROJECT # 55637 PROJECT: Results Way Apple Campus Buildings Cupertino, CA DATE Permit # 12080076 10/19/12 HOURS 1 pr INSPECTOR J. Souza 9 G T M � NOV 20T' San Leandro • San Jose • Martinez INSPECTION REPORT MY g: 10/19/12 Reported to Mike of XL Construction at the jobsite as requested. TYPE OF INSPECTION: Epoxied Dowels PLACE OF INSPECTION: Jobsite, Building 3 Inspected predrilled holes for proper diameter and depth. Observed the cleaning of holes and the injection of Hilti Hit Re 500 SD epoxy (exp. 8/13). Witnessed the proper insertion of eighty (80) # 4 reinforcing steel bars, 24" in length, embedded 4" for footings between lines 3 and 5 and 3-D, 3 and 4 at 3-C and on line 3-C from 3 to 2. The preceding work was, to the best of my knowledge, in compliance with approved plans and specifications, including revisions by engineer. Reviewedby: avi p e Special Inspection Division Manager 1cc: Apple, Inc. / J. Rickard XL Construction Structural Engineers, Inc. / J. Fishpaw� Studios Architecture / K .Crossman City of Cupertino / Bldg. Inspection Dept. This report can be reproduced only in its entirety unless written permission from TEI is obtained. Page 1 of 1