B-2017-1647 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1647
20650 VALLEY GREEN DR CUPERTINO,CA 95014-1763(326 10 053) BARRON BUILDERS
INC
SANTA CLARA,CA
95054
OWNER'S NAME: SI 50 LLC DATE ISSUED:09/27/2017
•
OWNER'S PHONE:510-491-8424 PHONE NO:(650)964-4493
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#916366 ,
Contractor BARRON BUILDERS INC Date 07/31/2019 X BLDG _ELECT _PLUMB
MECH_RESIDENTIAL X COMMERCIAL
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. JOB DESCRIPTION:
T.I.-APPLE-(N)PARTITION;(N)DOOR;REPLACE ACOUSTICAL
I hereby affirm under penalty of perjury one of the following two declarations: WALL PANEL;REPLACE CEILING(T-BAR 78 SF)
i. 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.
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
1. permit is issued. Sq.Ft Floor Area: Valuation:$74120.00
APPLICANT CERTIFICATION
I certify that I have readthis 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 326 10 053 A(Tenant Improvements),A(Tenant Improvements),A
representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A
inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A
City of Cupertino against liabilities,Judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A
may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),A
Additionally,the applicant,understands and will comply with all non-point (Tenant Improvements)
source regulations per the Cupertino Municipal Code,Section 9.18.
a
7/27/2017 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER- LDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that lam exempt from the Contractor's License Law for one of the
following two reasons: Issued by:Jasmine Archbold
1. I,as owner of the,property,or my employees with wages as their sole Date:09/27/2017. -
compensation,.will do the work,and the structure is not intended or offered for
sale(Sec.70,44,'Business&Professions Code) RE-ROOFS:
2. I,as owner of the property,;am exclusively contracting with licensed
All roofs shall be inspected prior to any roofing material being installed.If a roof is
contractors to construct the'project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm under,penalty of perjury one of the following three declarations:
inspection.
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 Signature of Applicant: `
performance of the work foi•which this permit is issued. Date:7/27/2017
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will
exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health&Safety Code,;S ions 25505,25533,and 25534.
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 0 authorized agent:
to save indemnify and keep harmless the City of Cupertino against liabilities, to, 2 i
judgments,costs,and expenses which may accrue against said City in CONSTRU'' ION LENDING AGENCY
consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a onstructionjlending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is Issued(Sec.3097,Civ C.)
Code,Section 9.18. Lender's Name
Lender's Address
Signature Date 7/27/2017
ARCHITECT'S DECLARATION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •
(� BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CO�5�.t,ss (408) 777-3228 • building@cupertino.org PEMIT#B- iO 1 -1 ! q
CUPERTIND REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ,❑ALTERATION 0 T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA ,
PROJECT ADDRESS APN# '-2 2
20650 Valley Green Drive Cupertino,CA 95014 3 - / 0--®, 3
OWNER NAME PHONE E-MAIL
• Apple,Inc.
STREET ADDRESS CITY, STATE,ZIP
❑r CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
�arV.o.,-Nc4,>A: A. .rC c \b1/4o�p
I STREET ADDRESS CITY,STATE, ZIP I
2-SLk,`� CWAG. 'fl 0.A. Vim.,1..%AtO Or• .%c v.i.r c‘160.1-•(-4, } caw Cli.5SL�
E-MAIL 1 PHONEBUS.LIC#
U.So- C,Y.•-1-�11.�r. I 401336.
0 ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
Josh Reginelli jreginelli@barronbuilders.com
STREET ADDRESS CITY,STATE,ZIP PHONE
2346 Calle Del 1VIundo Santa Clara,CA 95054 650-690-6356 , . ,
DECRIPTON
Minor tenant improvements to an existing occupied space.Includes minor demoliton and new non-oad bearing partition,
new door and associated finishes. , , ;
['SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL ❑x COMMERCIAL 1 I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN I REMODEL OTHR GARAGE ❑ATTACHED bAlc< pr s h. C7 f9 ) Ø- !-- 4/., /20
0
BATHROOM SF SF SF SFDETACHED 1" f//S (/(� /
EXISING 0 YES EICHLER ❑YES SECOND STORY ADDmON 0 YES I '
FIRE SPRINKLERS 0 NO 0 NO 0 NO , i 1
DWELLING 1 SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER
UNrrs# UNIT ADDITON: , ,
❑NO SF
- ,0 FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED I
POOL-SF SPA-SF SPA ATTACHED �i
' � ❑YES 0 NO TOTAL-SF
REO L ALUTIOI�
Commercial or Multi-Familu Buildings with Public Swimming Pools requires Department of Environmental Heath anproaal .
� //AT
n r'EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES❑WOOD SHAKES 0 WOOD SHINGLES 0 TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD 01" ❑3/8" PLYWOOD TYPE: PITCH: I''I, ROOF CLASS
El 1.Es I #OF LAYERS THICKNESS El 5/8" OTHER El OSB 0 CDX OTHER 12 I A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER' {
*Provide a signed copy of the Cupertino'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 isaccurte. I agree
to comply with all applicable local ordinances and state laws relating to building construction. I authorize_ representatives;Of,I
to
enter the above-identified property for inspection pu .• es. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: , Date: 2-z5"' 1
SUPPLEMENTAL INFORMATION R ' IRED ✓ I• 'I
*New SFD/Second Dwelling Units/Multifamily 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 oft"s��°'"oject.
*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 Association01;--
B1dgApp_2017.doc revised 08/01/17