B-2017-1367n
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1367
10475 BANDLEY DR CUPERTINO, CA 95014-1912 (326 33 111)
MILROY
CONSTRUCTION INC
MOUNTAIN VIEW, CA
94043
OWNER'S NAME: DPT BANDLEY DRIVE LLC
DATE ISSUED: 08/17/2017
OWNER'S PHONE: 650-625-0300
PHONE'NO: (650) 625-0300
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 5 Lic. #579832
Contractor MILROY CONSTRUCTION INC Date.10/3112017
X BLDG —ELECT —PLUMB
MECH RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under theprovisions 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.
JOB DESCRIPTION:
APPLE - LAB 115; T.I. - INSTALL SEISMIC BRACKETS PLUMBING
I hereby affirm under penalty of,perjury one of the following two declarations:
AND POWER FOR 2 TOOLS
r. I have and will maintain a certificate of consent to self -insure for Worker's
Com enation, as provided for by Section 3700 of the Labor Code, for the
• rformance of the work for which this permit is issued.
I
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
Sq. Ft Floor Area:
Valuation: $50000.00
is issued.
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
32633 111
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the ntingof this permit.
Additionally, the applicant understands and will c ply ith all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulation der the,,Cupertino Mun cipa ode ection 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
s'
Sign ure Date 8/17/2017
Issued by: AbbyAvende
Date: 08/17/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any'roofmg material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business &' Professions Code)
2. I, as owner -of the property am exclusively contracting with licensed
Signature of Applicant:
contractors.to construct the project (Sec.7044, Business & Professions Code).
Date: 8/17/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A!' OR BETTER
1. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's`Compensation Insurance, as provided for by
I have read the hazardous materials -requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or,devices which emit hazardous
air contaminants as defined by the Bay Area Air' Quality'Ma6gement District I'
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cup . ' ino Municipal Code; Chapker 9.12 an
exemption, I become subject to the Worker's Compensation provisions of the
P J P P
the Health &Safety Code, tion s 25505, 25533; and 25534.
Labor Code, I'must'forthwith comply with such provisions or this permit shall
be deemed revoked.
O , r or authorized ag t:
CERTIFICATION d&
ate.811712017
,APPLICANT
I certify that I have read this'application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to'comply'"with all city and county ordinances and state laws
I hereby affirm that there is a construction lending'agency for the performance
relating to building construction,. and hereby:authorize representatives of this city
of work's for which this permit is issued; (Se6.13097,'Civ C.)' I
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify'and keep harmless the,, City of Cupertino against liabilities,
judgments, costs,"and, expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source 'regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION ;
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 8/17/2017
Professional
k1«�i7-
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �J
(408) 777-3228 • building@eupertino.org PEMIT #B -
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION 2"T.I. E MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
'R
APN#
�-f
OZADDRESS
10475 Bandley Dr., Cupertino, CA
OWNER NAME PHONE
Apple Inc
650-625-0300
E-MAIL
dmarconi@apple.com
STREET ADDRESS
CITY, STATE, ZIP
1 Infinite Loop
Cupertino, CA
CONTRACTOR NAME ❑ OWNER -BUILDER
COMPANY NAME
LICENSE NUMBER
LICENSE TYPE
Sam Milroy
Milroy Construction
579832
B
STREET ADDRESS ____7CITY,
STATE, ZIP
897 Independence Ave, Ste 5A
Mountain View, CA 94043
E-MAIL
PHONE
BUS. LIC # ((�-
smilroy@milroyinc.com
650-625-0300��"l��
❑ ARCHITECT ❑ OWNER [I OWNER AGENT CONTRACTOR AGENT ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
Sam Milroy
E-MAIL
smilroy@milroyinc.com
STREET ADDRESS
CITY, STATE, ZIP PHONE
897 Independence Ave, Ste 5A
Mountain View, CA 94043
65-280-0456
DECRIPTON
vS s a s act C_ Ca-
r � 2�
❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL VCOMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SF,
NEW FLOOR SF I
i
I
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
EXLSING ❑ YES
ME SPRINKLERS [I NO , �
E' CHLER ❑ YES.
� ❑ NO �
SECOND STORY ADDITION ❑ YES
❑ NO
DWELLING
SECOND DWELLING I . ❑ YES ATTACHED❑ DETACHED OTHER
UNIT'S #
UNIT ADDITON: ❑ NO' S F
POOLS ❑ FIBERGLASS I.❑ 41NYL-LINED 1 ❑ GUNrrE ❑ PREFABRICATED
POOL - SF SPA LSF L SPA'ATTACHED ❑ YES ❑ NO TOTAL - SF
I� L
Commercial or Multi-FamilKBuildingswith Public Swimming Pools requires Devartment of Environmental Heath arroroval
REC ED BY:
TO AL VALUATION:
RE -ROOF
EXISTING RO,OP ,TYPE: []BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD SHINGL S E]TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
,IF NO
PLYWOOD ❑ 1h" ❑ 3/8"
PLYWOOD TYPE:
PITCH:
, 2
ROOF CLASS
El YES
11,#?FLAYERS__�THICKNESS
❑ 5/8" OTHER
[:]OSB F]CDX OTHER
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF! ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertirio's Tear -Off Policy SF #of SQUARES
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 the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above -identified property, for ' ection purposes. I acknowK0 and authorize all information c taine on this application form
to be made available for public record.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Mv ltiiamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval, from the Home Owner's Association
I
B1dgApp 2017.doc revised 08/01/17
Quality Assurance Services
Materials Consulting
ma TESTING ENGINEERS, I C .'._t ' . i,
`_ since 1954
••.Lir
�-' Page of
Date: 9/8/17 .-D AS 'ile#: DSA App.#:
Project#: 65824 OSHP'D- :
Project Name: ',10475 Bandley dr 'ermit/SF App..#C B-2017-1367
Address: ' '10475 Bandley dr To, Code: \\ 127
City: . ;Cupertino Start ' e:
Requested by: Hours: '
Reported to: John of(Company Nam .- Milroy con
EPDXIED DOWELS 125 EPDXIED ANCHORS 126 X EXPANSION ANCHORS 127
I— Witnessed the drilling of holes of proper diameter and depth.
or
X Inspected predrilled holes for proper diameter and depth. Expiration Date of Epoxy
X Observed the cleaning of holes and the injection of Epoxy.
MPII(Manufactures Printed Installation Instructions ICC-ES#
X Witnessed the proper insertion of:
Qty. Bar#1 Type Length, Embed., Location
Dia,in. in. in.
8 5/8 Hilti kbtz 4 3/4" 3 1/8 (2)CS2 chambers at lines C&5-6
.
Notes: -
F y
Showup; Stand-by time; Job Cancelled; Re-inspection;Hours:
The work X was was not tested in accordance with the Building Department or DSA or OSHPD approved does.
The work tested X' met did not meet the requirements of the Building Department or DSA or OSHPD approved docs,
except as noted above.
Drawings Dated City DSA ,Shop
Inspector Signature / Certification# 509923249 Date: 9/8/17
Printed Name: Michael S.Ardizzi.-'/ Received by: Date:
Corporate Office–2811 Teagarden Street–San Leandro,California 94577–(510)835-3142–FAX(510)834-3777
www.Testinq-Enoineers.com
4.1.;
TESTING ENGINEERS, INC.
/a-z - l
2811 Teagarden St. 510-835-3142 2: : 510-83 3777 fax
San Leandro,CA 94577 • 800-660-3142
San Leandro • San Jose • Martinez .
• INSPECTION RE ORT Week Ending: 9/8/17
PROJECT# 65824 TYPE OF SPECTION:
Exp sign Anchors
PROJECT: PLACE OF INSPECTION:
10475 Bandley Drive Jobsite
BA05 Area 51 Tool Install
Cupertino,CA
Permit# B-2017-1367
DATE 9/8/17
HOURS 4
INSPECTOR M.Ardizzone
Reported to John of Milroy Construction at the jobsite as requested.
Inspected predrilled holes for proper diameter and depth. Observed the cleaning of holes and witnessed the proper insertion
of eight(8)5/8"dimeter expansion anchors,4-3/"in length,embedded 3-1/8"for two(2)CS2 chambers on line C from 5 to 6.
The preceding work was,to the best of my knowledge,in compliance with approved job plans and specifications,including
revisions by engineer.
Reviewed by: _
P: i. Chippero
Special Inspection Division Manager
1cc: Milroy Construction,Inc./S.Milroy RECEIVED
Apple,Inc./D.Marconi
Hitech Construction Mgmt./D.McCauley SEP 21 2017
CRJ Structural Engineers/M.Jordan
City of Cupertino/Bldg.Inspection Dept.
BY }/,dit.../
The results presented in this report relate only to the item(s)tested/inspected and
may be reproduced only in its entirety unless written permission from TEI is obtained.
Page 1 of 1
•uality Assurance Services
Materials Consulting
‘ 11; TESTING ENGINEERS, INC. ( Since 1954
J2 " 1-1` 17
,,PI
November 27, 2017
17', v
L j �(--..a ' 3
® TEI Project No 65824
City of Cupertino
Building Inspection Department Permit No B-2017-1367
10300 Torre Avenue
Cupertino, California 95014
__. —Subject:—-= -_ 4 -MAL L-REPORT- -----_,
Project: 10475 Brindley Drive
BA05 Area 51 Tool Install
Cupertino, California
Gentlemen.
In accordance with Section 1705 of the California Building Code,we have provided special inspection of: 1
- Installation of expansion anchors in existing concrete.
These inspections were performed by personnel under the general supervision of a Registered Civil Engineer in
the State of California. Based upon our inspections performed and our substantiating reports,the inspected work
requiring special inspection was,to the best of our knowledge, in conformance with the approved plans and
specifications,the applicable workmanship provisions of this Code, and any changes by the Engineer of Record.
Details of our work on this project are •1 ned in our testing and mspection reports that were submitted during
the progress of construction. ,--19:0 _ _ _ ,
- - — - -- - — /.4,, ,,,_ff.i.,e, -
TESTING ENGINEERS I e,: `: t04
i r-4 i
,.3 i RECEIVED
TerryL Egland, ' '
� P'' . 11 1t ti DEC 0 1 2017
CE# 34132, Exp. 6/30/194A'® CAM)
cc Milroy Construction, Inc. /S Milroy
Apple, Inc. /D Marconi
Hitech Construction Mgmt. /D McCauley
CRJ Structural Engineers/M. Jordan
Corporate Office—2811 Teagarden Street—San Leandro,California 94577—(510)835-3142—FAX(510)834-3777
www Testing-Engineers.com