13110127 CITY OF CUPERTINO BUILDING PERMIT =
BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR:DEVCON PERMIT NO: 13110127
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED:12!0912013
O ER'S PHONE: 5103316719 MILPITAS,CA 95035 PHONE NO:(408)942-8200
JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
LICENSED CONTR�CTOR'S DECLARATION
License Class CA Cl G/ • Lie.# �9q (P J APPLE-COMM.T.I TO FITNESS LAB 12,858 SQ FT TO INCLUDE M,E,P'S
&ntractorDeycm 6644, N[. "Date 12 q (1!5--
If
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 aWrn nirder 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.' Sq.Ft Floor Area: Valuation:$4500000 -
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfbrmance of the work foi which this
APN Number:35720020.00 Occupancy Type:
permit is issued. '
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK ISNOT STARTED
correct.1 agree to
tr comply with all city and county ordinances ofthis.c'state laws relating WIT OF PERMIT ISSUANCE OR
to building construction,and ticreby authorize representatives of this.city to enter
upon the above mentioned property for_inspection purposes: (We)agree to save 1$4 DA S FROM LA T 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 r�.
granting of this permit. Additionally,the appli ant understands and will comply Issued by: Date:
with all non-point source re lations upertino Municipal Code,Section
9.I8.
REPROOFS:
Date �Z q 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:gffered 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.I2 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 M_ unictpal e,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 55 , 5 534.
Section 3700 of the Labor Code,for the performance of the work for which this �= Q
permit is issued. •• u hg Date•
I.certify that in the performance of the work for which this permit is issued,I shall
nofemploy any person in any manner so as to become subject to the Worker's
Compensation laws ofCalifomia. K after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subjeet 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(See.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 cqunty 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- BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 \`
CUPERTINO (408)777-3228• FAX(408)777-3333•building()cupedino.org \�1
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROECI ADDRESS D 00 lb 10
W• APN;, 7- gzD .Q�O
�(
OWNa NAME 1 .O�/ PN • • F.MML y
EET
STRADDRFSS '^� C S P � FAX
CONTACT NAME `
Michel
ichel ^,•ove � `OP05-5.71e-IP4J
EtvfAtl,omici _cimpr,,G!AeV
STRM DREi_ CIT ATE. P O
FAX
r •
0 OWNER ❑ OWNER-BUILDER 17 OWNER AGENT CoN-nucTOR ❑CONTRACTOR AGENT ❑ ARCHITECr ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME `,�� �Air
D t rCENSENUM B LICENSE�ft BUS.LIC
,MM
COMPANY NAME rt'1 C Yl{�a L K E ARAIL FAX ID
STREET ADD Sc1� -4142 -yY1
ARCHITECTlENGINEERNAME , LIM'SENUMBER /��n Q BUS,LICE VLLJIJ
COMPANY NAME E-MAIL v wTf jJ FAX
STREET ADDRESS C STATE ZIP • ' PHONE
V1�Y3 ' C Z
DESCRIPTION OF WORK I-T I h/ I 1�L r, 1 I^ �Pie r
1 `�.�� .►r�[,�J r
EXISTING USE PROPOSED USE CONSTR-rali #STORIES
USE TYPE OCC. I SQ-FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH
0 ATTACH
#DWELLING UNITS: ISA SECOND UNIT []YES SECOND STORY [:]YES
BEING ADDED? ONO ADDITION? []NO
PRE-APPI-ICATION ❑YES EF YES.PROVIDE COPY OF iS THE BLDG AN ❑YES RECE VED BY: "" -"''' - �TTAVALUATION:
PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑No
y/)/t ®O0
(/til
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 t e D ' 'ption of Work and verify it is accurate. i agree to comply with all applicable local
ordinances and state laws reAatgbu'ld' construction. I a o 'z pr en trues of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/,A. Date:
SUPPLEMENT&INTFORMA'F NREQUIRED r . vPLANCHEcxTre _ _ RourINcsiTP
_New SFD or Multifamily dwellings: Apply for demolition permit for p' ovEii-TIW COuN-rkR% ❑ BUIL15ING PL AN,iiEiZEw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. iiPRIfSS, kL NNiNGPLAN'ItivifW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure J'1 srnRVn
foAR ❑ rut3�tC:n'oRiZs:;w
Tor— if any Hazardous Materials are being used as part of this project. ,acs' FIHE Deer
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Pcrmit application. '� ;iWOR Y,SEAVER,DISTRICT'
z❑_hNT%'IRONTIENTALHEAI.TII'' __
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 103Q0 bubb rd DATE: 11119/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$4,500,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 113 TI
WORK apple-comm t:i to fitness lab 12,585 sq ft
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) 11-B,111-B,IV,V-B 12,858 T,,94 1BTIPLNCK $7,426.94 IBTIINSP
TOTALS: 12,858 $2,776.94 $7,426.94
MECH�$OURLY' 0-Yes (F) No 'PLUMB,HOURLY Q Yes E) ,No ELECT MOURLY Q Yes, E)No
Xfech,Plan Check Plumb. Plar;Check Flee.Plan Check
F,L9ech, Permit Fee': Plump.Permil Fee: Elec.Permit Fee:
Other:11ech. Insp. Other Plumlr Insp. Other lace. Insp.
Afech, Insp,Fee: Plumb. Insp, Fee." flee, Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(ac Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . TFiese ees are based on'thereliridina information available and are only an estimate Contact the Dept-for WWI info.
FEE ITEMS(Fee Resolution 11-053 E . 711113) FEE QTYIFEE MISC ITEMS
Plan Check Fee: $2,776.94 Select a Mise Bldg/Structure
Suppl,PC Fee: Q Reg. Q 07 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $7,426.94
Suppl. Insp.Fee-0 Reg. Q OT F0_.01hrs $0.00
PME Unit Fee, $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee:
Work Without Permit? 4 Yes E) No $0.00 0
Advanced Planning Fee: $Q.00 Select a Non-Residential 0
Trcn,el Documentation Fees: Building or Structure 0
Strong Motion Fee: IBSEISMICO $945.00 Select an Administrative Item
B1dp-Stds Commission Fee: . IBCBSC $180.00
StJBTOTALS: 11,328.88 $0.00 TOTAL FEE: a19P32 8 tea.
Revised: 10101/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR:DEVCON PERMIT NO:13110127
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 12/09/2013
OWNER'S PHONE: 5103316719 MILPITAS,CA 95035 PHONE NO:(408)942-8200
f
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL Ll COMMERCIAL
APPLE-COMM.T.I TO FITNESS LAB 12,858 SQ FT TO
License Class Laic(.#. p y } INCLUDE M,E,P'S
Contractor C?N r ' ll 1' � �6� I .14
1 REV#1 CHANGE LAYOUT,ADD MECHANICAL
1 hereby affirm that I am licensed under the provisions of Chapter 9 EQUIPMENT WITH STRUCTURAL UPGRADES TO
(commencing with Section 7000)of Division 3 of the Business&Professions SUPPORT.-ISSUED 119114
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
erformance of the work for which this permit is issued. Sq.Ft Floor Arca: Valuation:$4500000
. I? ave 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 APN Number:35720020.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above informal ion is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and stale 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 180 DAYS F T C ED 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 �r/7
granting of this permit. Additionally,the applicant understands and will comply Is ate: I
with all non-point saurc egulation er th ertino Municipal Code,Section
9.18.
/)'} l� RE-ROOFS:
Signature Date t/ l 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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 HAZARDOU MATERIALS DISCLOSURE
construct the project(See.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25S33,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 unicipapcvdc,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Seeti ns 5 ,2553 ad 55
Section 3700 of the Labor Code,for the performance of the work for which this :.: `p
permit is issued. Owner or authorized age Da e:
1 certify that in the performance of the work for which this permit is issued,I shall (J
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,
casts,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.
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERT[NO (408)777-3228•FAX(408)777-3333•building a�cuoertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT#I Citi
PROIECTADDRESS I -7 ,^ Yjy I ^` APN!! /L S -3-
OWNER
3- ^7 r1
OWNERNAMB � E/V lJl PHONEi{tea 5!_�. 2 EMAIL VC EC's � no�
STREET ADDRESS ) ffi nil wO CITY,STATIE�ZVIA(f��{J,..� /I �� FAX coy)J
CONTACT NAME f 1 n `CJ ]yi t VR'e I 1 I :� e PHONE�I 0?)-5[C}- {},�� E-MAIL '1 O V e: V U Y'�O `'�"
STREETADDREiSS rot l Ul l �`� C , TATE ZIP 1 FAX
i QA C7
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT II ENGINEER ❑ DUVELOPER ❑TENANT
CONTRACTORNAMEy hi� 1 LICENSENUMBER LICENSE TYYE BUS.LICA
COMPANY NAMEmrA4it+vl I E-MAIL FAX
N X1(1 rn i ch elaY�@de�r�0[n �o>�} cum
STREETDRESS b CITY, ,ZS ^A Tso� 2-.5�0
HI
ARCTECTlENGINEERNAME DOM LICENSENUMBER (� BUS.LIC 4
COMPANY NAME �\/V
E• AI4, FAX
V' P vI wh #� O r) (.)D
STREET ADDRESS CITY,STATE,ZIP PHO
`b5 MQ [coCA CITY, ��50 07— •may{ 2_5
DESCRIPTION OFWORK
VTViRA OLVOLtL ��I �`Y1e(, 1GiV1i CQ� -I P ' a e
EXISTINGUSE PROPOS SE CONSTR-TYPE lFSTORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG--7 NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELAREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH
ATTACH
DWELLING UNITS: ISASECONDUNIT []YES SECONDSTORY []YES
BEING ADDED? [3NO ADDITION? ONO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES VED TOTAL VALUATION:
PLANNINGAPPL9 E]NO PLANNING APPROVAL LETTER EICHLERTIONIE! �N
By my signature below,I certify to each of the following: I am the property Owner or authorize ent to act perry 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 JT-1s accurate. I agree to comply with all applicable local
ordinances and state laws relating Jo b ildi construction I au 'ze rep sentatives of Cupertino to enter the above-identified property for inspection purposes.
5ignaturc of Applicant/Agent; Date;
SUPPLEMENTkt INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TH6COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PL,-,N REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD PUBLIC WOWS
form if any Hazardous Materials are being used as part of this project. [] LARGE ❑ FIRE DEPT
_Copy ofPlanning Approval.Lctter or Meeting with Planning prior to ❑ MA.IOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
E1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR:DEVCON PERMIT NO: 13110127
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 12/09/2013
OWNER'S PHONE: 5103316719 MILPITAS,CA 95035 PHONE NO:(408)942-8200
OxI LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
p� 4 ( APPLE-COMM. T.I TQ - T 2 858_SQ FT TO
License Class Lie.9 __ .' 1 1 003 INCL.
CvntractorNyyY L1' u"'`rh Date , ; REVISION#2-CHANGES TO PROPOSED ELECTRICAL
I hereby affirm that I am licensed under the provisions of Chapter 9 RM &I.D.F.RM(SERVER RM)-2/27/2014
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my hceuse is in full force and effect.
I hereby affirm under penalty of perjnry one of the following two declarations:
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. Sq.Ft Floor Arca: Valuation:$4500000
�[have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Cade,for the performance of the work for which this APN Number:35720020.00 OccupancyT
pennit is issued. 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 WITFIIN 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 180 DAYS 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations er a Cupertino Municipal Code,Section
9.18.
11 RE-ROOFS:
Signature Date '[� 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.
O'YVNER-BUILDER DECLARATION
I hereby affirm that I am exempt From the Contractor's License Law for one of Signature of Applicant: Date:
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 sale 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.I2 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 eontamivants 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 Guile,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' ns 5 ,2 3z, d 2 3
Section 3700 of the Labor Cade,for the performance of the work for which this
Owner-or authorized agent: ate
permit is issued.
1 certify that in the performanee,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.)
Leudcr's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this eity 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 1 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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 BUBB RD CONTRACTOR:DEVCON PERMIT NO: 13110127
CONSTRUCTION INC
OWNER'S NAME: M WEST PROPCO X LLC 690 GIBRALTAR DR DATE ISSUED: 12/0912013
OWNER'S PHONE: 5103316719 MILPITAS,CA 95035 PHONE NO:(408)942-8200
! ltllkJ# LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
p� rte, APPLE SCO AB 12,858 SQ FT TO
License Class Lie.tt I If/ DE M,E,P'S
Contractor rDaTe r DEFERRED#1 -INSTALLATION OF ENLARGED
I hereby affirm that I am licensed under the provisions of Chapter 9EXERCISE ROOMS-ISSUED 2/27/2014
(commencing with Section 7000)of Division 3 of the Bnsincss&Professio c
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: —
1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance of lite work for which this permit is issued. Sq.Ft Floor Arca: Valuation:$4500000
have and will maintain Worker's Compensation Insurance,as provided for by
('' y Section 3700 of the Labor Code,for the performance of the work for which this
APN Number:35720020.00 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 180 DAYS 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
granting of this permit. Additionally,the appl,canrti Mderunstands and will comply Issued by: Date:
with all non-point source regulations peri Cup icipal Code,Section
9.18.
RU-ROOFS-
Signature r alc r ' �§dq "� All roofs shall be inspected prior to any rooting material being installed.Lf a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner ofthe 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 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 Arca Air Quality Management District I
performance of the work for which this permit is issued, will maintain compliance with the Cupe InoRlunici 1 de,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect, ns 05,25533,al5 3 .
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent '- Dat
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,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 l 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the 1 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 tlrc Cupertino Municipal Code,Section Licensed Professional
9,l 8.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION-
10300 TORRE AVENUE•CUPERTINO, CA 950'14-3255
CUPE6tTIN0 (408) 777-3228•FAX(408)777-3333•building@cupertin_o.org rr Q r
•❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTFRATION I TI ® REVISION 1 DEFERRED ORIGINAL PERMIT#
PR078CTADDRESS 10,;Dry JZLbb Ed.— 'APN#
OWNER NAMEy e PHONE t >s cAO Q 1'-•
LTJ � Lpir
STREETADDRESS 1 k, l/ ynt � CITY. ATE Z[P ' C1�01 4- FAX
CONTACT NAME ASIS J 1 M,` geLm(-)Ke PHS 09-'?)40 nvl:e G 40VcC$n +
STREET ADDRESS U9 c) r!t,r (�Jr C M ATE,- FAX w1
❑ OWNER ❑ OWNER-BUILDER r/1❑ OWNER AGENT�• CONTRACTOR ❑COMMACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVFIOPER ❑ TENANT
CONTRA R l O LICENSE NUMH �+^ LICENSETYPE HUS,LIC#
COMPANYNA iE E-MAR �!/ FAX
yV
Goin 01n m, o� clpycoh
STREET ADD S tttvi � WQIclk
ryOGPHO '5�ARCHITECTlENGINEERNAMB ' LICENSENUMBERZIP $p HUS.LIC#
O Q
COMPANYNAMEwPA1MAn FAX
STREET ADDRESS CITY,STATE ZIP PHO
DESCRIPTION OF WORK r n JI I���D}ti {'
flQor rV o m
oyuo '
EXISTING USE PROPOSED USE CONSTRTYPE #STORIES -
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA ARP.A NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIFORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLDQG UNITS: 1S A SECOND UNIT L]YES SECOND STORY YES
BEINGADDED? ANO ADDITION? [:]NO
FRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN L]YESf'REGEIVEB _ . TOTAL VALUATION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LEITER EICHLERHOME? I-]NO � M :;:�;,
11�O1
By my signature below,I certify to each of the following: I am the property owner o ed agent o act on the pro owner's behalf. I have read this
application and the information[have provide is correct I have r d the ription of Work and verify it is accurat . agree to comply with all applicable local
ordinances and state laws relating to u'1 a myction. I auth rep ese tat' es of Cupertino to enter the above-identified properly for inspection purposes,
Signature of Applicant/Agent: Date:
SUPPLEMENT ORMATIO REQUIRED ` "
s+.--_,.e�..PLAId,CH7'(�CiT1TL.,•:sw� .>y�x.� 3�^;�a�OUTIIV"GS��+tS,.�w _``��t:
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ nr �
l] OVER TA1iCOU14TER BUILDINGPLAN REYiEW 3 s c
exist[ build] s . Demolition permit is required r-i r t0 issuance of building n` '� v e"� r " k �` r� N _arc w
��) p q P g r
permit for Dew building. ❑ �
�' �' �- a`S�-eF � i� aSC��,YLANNT`It�'GPr.AItiREV1EW �^
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure =1] rusLrCwRxs r '
form if any Hazardous Materials are being used as part of this project. yp �I gin, 9 F7 -rl �
• �y�l L�RGE�k�Gak„r� I$�*��'�t��� ��� E-�Di. � �� "� ;� 7� wr�s ��
Copy of Planning Approval Letter or Meeting with:Planning prior to �s s
) 711A,JOR �'-a"�'.y�'�I ; "" ,, Q1- ANITARX.SER'ER DISTRI • '� R`
submittal of Building Permit application. �y�* 4,r ,�.�„ � •�� �,, �„�,�,, � ,r,��,;,�� ar �;I�s r,
SldgApp 2011.doc revised 06111/11
CONSTRUCTION PERMIT APPLICATION
-COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIO
10300 TORRE'AVENUE•CUPERTINO, CA 95014-3255
GUI'ERTINO (408) 777-3228•FAX(408)777-3333•huilding@cupetfino.org r1
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVIS 1 DEFERRED ORIGINAL PERMIT#
PROJECT-ADDRESS y D/L�o f�� APN#
OWNER NAME / t e (7� PH NE &MAII
r�r Z- a. e•
STREET ADDRESS CITY,STATE,ZIP �ClI FAX
CONTACT NAME I) EMAIL
STREET ADDRESS(J /J � CITY SF TE, ZI S O FAX
❑OWNER ❑ OWNER•BUU.DER ❑ OWNERAGENT XCONTRACrOR CONTRACTOR AGENT ❑ ARCHITECT 1:1 ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR N I V I�_ LICENSE NUMBER,1,I ,^ LICENSE E BUS.LIC#
COMPANYN 1 , E-MAIL f�/✓ .J nn r/ I}�� FAX
Ar COn/ I/I1 ` �IS�`_
STREET S CITY STA ZIPQT q34 0 P O 2•.n6l0
ARCHITECT/ENGIIQEERN V�t� LICBNSENU&LItC_� �J pL� BUS.LIC#
COMPANY NAMEE-MAIL ` �� f�j FAX
Aaii
STREET ADDRESSd C�ZI+V s 1��j�C Z1�1CCOd OD ' CP1Y,STATE P 613 4 S� S-[S4 PF' 0
Q �n-gsz3
DESCRIPTfON OF WORK ^,_�, ird
,,�fll p/I [� .
EXISTINGUSE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM - KITCHEN OTHER'
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DVIELUNGUNUS: IS A SECOND UNIT ❑YES SECOND STORY []YES
BEING ADDED! []NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES "RM�IIPK _ TOTAL VALUATION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LEITER PICHLERHOME? []NOZZ
By my signature below,[certify to each of the following: I am th roperty o er ora o ' o❑ roperty owner's behalf. I have read this
application and the information I have provide correct I have e d the D c ption of V r v it is curate. I agree to comply with all applicable lova[
ordinances and state laws relatin to Mild' g on(ruction. I au pre a tiv s of C rtino to enter the above-identified prop rty for inspection purposes.
Signature of Applicant/Agcnt: Date: Q 2'20 P I a
SUPPLEMENT ORMATION QUIRED C> c1c ` '' � � SLs r��
s. w a -s �.. ROfITING_ &o-X
r'r;r"'" y • 'z7 _
New SFD or Multifamily dwellings: Apply for demolition permit for
c 1r
e" ty; t f
���O�ER TH�CO�UI�TER�� 17 s x� 6U'A
existing building(s). Demolition permit is required prior to issuance of building � "� r � i� ,
permit for new building. �� E7cPI2ES$ "f " '}� ^�'�iYI:AINI1\IG kLr�NAEYIEi�i`fi p'^ x �`•
ra
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D sTarinnxn ', g�a� C3rlsl �vnxxs � r+=
�.c r. aL�yK r � #
form if any Hazardous Materials are beim• used as part of this project.
Copy of Planning Approval Letter or.Meetirig with.Planning prior to
submittal of Building Permit application. `� oR T YSE4VEIt DISTRICzr• z r"
. 01+.IMEN'I?'i . AL.rTHvsa.w
BldgApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR---BUILDING DIVISION
ADDRESS: 10300 BUBB RD DATE: 02/27/2014 REVIEWED BY: MELISSA
APN: 357 20 020 BP#: 13110127 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1GENC0
WO l V, I! CHANGES TO PROPOSED ELECTRICAL RM & I.D.F. RM SERVER RM -
SCOPE 2/27
Mech. flan CheckT-T Phimb. Plan Check Flec. Plan Check
AKA-.11. Perini!Fec': Phimb,Permit Fec'; Elea. Pcrmft I ece
Other;41,'e1t. Insp. 0"Jvr Plumb Imp. Lj 01her Insp.
.Nech.In.af. Fe . Phru11). hasp, Fee: Elet,Insp,_[""C:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the preffinina information available and are onl an estimate. Contact the Dept./or addn'I info.
FEE ITEMS (Fee Resolution 11-05.3 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes ) No $0.00 0 hours Plan Check,Hourly
Supp!. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $139.00 ISTPLNCK
PME Plan Check: $0,00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. Q OT 0,0 tus $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cons-notion Tax
Administrative Fee:
Work Without Permit? ® Yes Q No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
Tr(-.wel Documentation Ftres: Building or Structure
A
Strom Motion Fee: $0.00 Select an Administrative Item
Bld.g Stds Commission Fee: $0.00
`SUBTOTALS: $0.00 '$139.00 , TOTAL FEE: $139.00
Revised: 01/15/2014
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10300 BUBB RD DATE: 01/09/2014 REVIEWED BY: MELISSA
APN: 357 20 020 BP#: 13110127 "VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION
USE: I I PERMIT TYPE: A
WORK REV# 1 - 119114 - CHANGE LAYOUT ADD MECHANICAL EQUIPMENT WITH STRUCTURAL
SCOPE UPGRADES TO SUPPORT.
Afech. Plan Check Phoub.Platt Check Dec.Plan Check
Xfech,Perrrlir Fee: Fee: It-lee.Pennir Fee:
Ocher Afech,Insp. Other Plumb Insp. Other Elec.Insp.
ilech.Insp. Fee: Plurnh./chap. Fee: Elec.Insp.Fee.
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelimina information available and are only on estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ef1.' 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. O OT0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp, Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consouction Tax:
Admini slrative Fee:
Work Without Permit? Yes E) No $0,00
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Tiarel Doewnentalion Fees: Building or Structure 0
1
Strong Motion Fee: $0.00 F1 # Revisions
Bldg Stds Commission Fee: $0.00 $834.00 IREYCOMTI Tenant Improvement
SUBTOTALS: $0.00 $834.00 TOTAL FEE: 1 $834.00
Revised: 01/01/2014
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
aDDRESS: 10300 BUBB RD DATE: 02!2712014 REVIEWED BY: MELISSA
PN: 357 20 020 BP#: 13110127 'VALUATION: Iso
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE: A
WORIC�!`.EE3k - 'INSTALLATION OF ENLARGED EXERCISE ROOMS
SCOPE
itfc,h Man 'her k plrmrb plow(:'bre.d Elec.flan( 7,ck
mere) Perrna Fee 1'lnmh. permit Fce, ltle•c pcnnrr Fre,
01-11t 0Ile r h. In-tipLi 01,1 r Plumb In%1; Lj Other Elec Imp Lj
,41c°eb lnsp F,..I. plumb My. Fee: Elec.Insp. herr"
NOTE: This estimate does not include fees(lite to other Departments(i.e.Planning,Public Works,Fire,Sanitary Server District,School
District, eta). Thesefees are based on the preffinina. information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resohrlion 11-053 Efl.' 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 t^!J # Deferred Submittal
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $278.00 IDEFSUBM
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: T-F $0.00
Con+'1r uclion Tux:
Adminiatrutive Fee: 0
Work Without Permit? 0 Yes 0 No $0.00 0
Advanced Planning- Fee: $0.00 Select a Non-Residential 0
Ti•wel Dociem nturion Fes: Building or Structure 0
Strom Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $278.0a TOTAL FEE: $278.00
Revised: 01115/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone:408-777-3224
C U P E RT I N O CONTRACTOR
7�77 y� ff'��m / SUBCONTRACTOR
�Y T f n T Fax: 408-777-3333
ST
JOB ADDRESS:10300 Bubb did• PERMIT#13110127
OWNER'S NA1bIE:Apple PHONE#408-942-8200
GENERAL CONTRACTOR:Devcon Construction BUSfNESS LICENSE#11068
ADDRESS.-690 Gibraltar Dr. CITY0PCODE:Milpitas 195035
''°Our municipal code requires all bllSinCSSC5 W01-1 lig in the oily to hnvc a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THL
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. °i°�"'°x'141 " "a'°'°eB
Ashley Michelmore
wing °"° """°°°--0---0- 04-03-14-14
oti a•wLan�],oI�.�E..m�m�SmtioU9
• ...?Old 04M 09:10.95 4Rb'
I am not ng any subcontractors: - ..
--- -.- ---- --- --
Signature Date
Please ebeelc applicable snbcontr:rc•tors nstd complete the following information:
✓ SUBCONTRACTOR BUSINESS NANIIE BUSINESS LICENSE 9
X Cabinets & Millwork Mission Bell aS`j3
Cement Finishing
X Electrical Redwood Electric Group 21108
Excavation
Fencing
X Flooring/Carpeting DFS 28664
Linoleum 1 Wood
X Glass/Glazing Walters & Wolf 25601
X Heating j �' AS` QL —45,js3
Insulation
Landscaping
Lathing
Masonry
X Painting/Wallpaper C&OG9-- cj�
Paving
Plastering
X Plumbing Castro 25296
Roofing
Septic Taal:
Sheet Metal
X Sheet Rock Magnum Drywall 25212
X Tile De Anza Tile 25127
DigueOy signed 6y Ashley Michol—
Ashley Michelmore DN:cn=AsMelmcreg more,-movicem,cnslnlction,9u, 04-03-14
emalV.amirhelmoro�tlevcomoonsl,com,c.115
Dela:2014.04.05 097249-DT00'
Owner/Contractor Signature Date