14010152 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 14010152
INC
OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED:01/28/2014
OWNER'S PHONE: 4083933929 MILPITAS,CA 95035 PHONE NO:(408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION (r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class___ Lic.# 9 9r r
MECH RESIDENTIAL COMMERCIAL
Contractor De V('OIC— Date /
I hereby affirm that I am licensed under the provisi sof apter 9 JOB DESCRIPTION:APPLE T.1.500 SQFT NORTHWEST CORNER 2ND FLOOR.
(commencing with Section 7000)of Division 3 of the Business&Professions REMOVAL OF TWO(E)WALLS TO CEILING HEIGHT MAKING
Code and that my license is in full force and effect. THEM INTO SOFFITS,REMOVING SLIDING DOORS&
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.
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 Sq.Ft Floor Area: Valuation:$25000
permit is issued.
APPLICANT CERTIFICATION APN Number:31622017.00 Occupancy Type:
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
pon 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. Additionally,the applicant understands and will comply 180 DAYS FROM4ASTCALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date Issued by: Date:
❑ 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,1 agree to remove all new materials for
I,as owner of the 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:
1,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: HAZARDOUS MATERIALS DISCLOSURE
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 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. 1 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(a)should I store or handle hazardous material.
Additionally,should I 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,1 shall maintain compliance with the Cupertino 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,Sections 25505,25533,and 25534.
Compensation laws ofCalifomia. If,after making this certificate ofexemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Own r o yeti at:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: J ��
APPLICANT CERTIFICATION TRUCTION LENDIN AGENCY
I certify that I 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 work'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 of this 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. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•buildingna,cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION Lel ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESSh"« �V�• APNN �// c� 7 Q,�
OWNER NAME VV PHONE (�l E-oMA(IL
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STREET ADDRESS CITY, STATE,ZIP F AQ
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CONTACT NAME R N`t r PHONE
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STREET ADDRESS CITY,STATE, ZIP AX �e
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC d
COMPANY NAME E-MAIV FAX
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STREET ADDRESSCITY,STATE,ZIP rd/ PHONE �A
.` J -.394
ARCHTTECT/ENGWEER NAME re/t.1 LICENSE NUMB BUS.LIC d
COMPANY NAMEf V'CO 1o�l- E-MAIL ` FAX
STREET ADDRESS 1 CITY,STATE,ZIP PHONE
bf + 4 w0, „3 .39,19
DESCRIPTION OF WORK
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EXISTING USE PROPOSED USE CONSTR TYPE NST RIES
V N„
6 W V t� 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 ARE TOTAL DECKIPORCH AREA GARAGE AREA: U DETACH
❑ATTACH
-i-DWELLING UNITS: IS ASECOND UNIT ❑YES SECONDSTORY El YES
BEPl,ADDED? []NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:
PLANNING APDL N ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
Suva
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 behal . 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 co I auth representatives of Cupertino to enter the above-ide ified pr erty for inspection purposes.
Signature ofApplicant/Agmt: Date: SSC /
SUPPLEMENTAL ION UIRED PLAN CHECK T 'E ROUTING SLIP
New SFD Or Multifam pply for de Olit10 efmlt for OVER-TAE-COUNTER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to Is ce of building
permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE FIRE DEPT
_Copy of Planning Approval Letter or Meeting with.Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10500 N DeAnza Blvd DATE: 01/28/2014 REVIEWED BY: Sean
APN: BP#: , Svc 'VALUATION: $25,000 I
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 16 T�
WORK Apple Tenant Improvement 500 sq ft Northwest Corner Second Floor
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE 1D BP FEES BP FEE 1D
CONSTR. s.f.
B (Tenant Improvements) II-B,111-B,IV,V-B 500 $2,046.22 1BTIPLNCK $703.74 IBTIINSP
TOTALS: 500 $2,046.22 $703.74
MECH,HOURLY ® Yes (F) No PLUMB,HOURLY Q Yes Q) No ELEC,HOURLY Q Yes E)No
U;clr. I'Icrr�('i7c:ckFT
1'hultia. Flc+t U;'cl .ie . r'i;rn
Meeh. Permit Fee: Plumb. Permit Fee: Flec. Permit Fee:
Other•.,Uech.Insp. E1__L_ Other Plumb Insp. Other Elec. Insp. Lj
Alexh, Insp. Fee: Phunh. Insp,Fee: Fiec.Insp. Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,046.22 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $703.74
Suppl. Insp.Fee:Q Reg. Q OT To,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Ta.Y:
,1 dintnistrative Fee: 0
Work Without Permit? 0 Yes 0 No $0.00 ''
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Trac cl 0octnnentution Fees: Building or Structure
A
Strong Motion Fee_ IBSEISA17CO $5.25 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2,756.21 $0.00 TOTAL FEE: $2,756.21
Revised: 01/15/2014