12080186 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR:XL CONSTRUCTION PERMIT NO: 12080186
OWNER'S NAME: MISSION WEST PROPERTIES LP IV 851 BUCKEYE CT DATE ISSUED: 10/04/2012
OWNER'S PHONE: 4087250700 MILPITAS,CA 95035 PHONE NO:(408)240-6000
LICENSED CONTRACTOR'S DECLARATIONr
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
}� MECH r RESIDENTIAL F COMMERCIAL�
Contractor /�� �_ dm si+rLA . iyl Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SITE IMPROVEMENTS TO INCLUDE:ACCESSIBILITY
(commencing with Section 7000)of Division 3 of the Business&Professions UPGRADES,ASPHALT/CURB
Code and that my license is in full force and effect. REPA[R,LANDSCAPISCAPING,IRRIGATION AND 12 EV CHARGING
I hereby affirm under penalty of perjury one of the foll6wing 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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1400000
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
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. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date ® kz-
0 -1
Issued bye lJ Date;/l/i I'
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:
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: 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. 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(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,I 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 of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Own"r ar rizedent: �b /Z
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and state that the above information is [hereby affirm that there is a construction lending agency for the performance of wrk'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. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CONS RUC17 0H PERRflff QPPUcQmm
COMMUNITY DEVELOPMEMT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO.CA 95014.3255
�MI?CeL340HOO (408)777-3328'FAX(408)777-3333-buildin{faupgrtino.om
®NF.W CONSTRUCTION ❑ ADDITION ®ALTERATION/TI ❑ REVISION 1 DEFERRED ORIGINAL PERMIT K
PROJECT ADDRFSS APN# Sk(a _Z-2 - 0I
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OWNER\AME IL
I PHONE Loa.-41-5.
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STRLLT ADDRESS �.h CITY.STATF,ZIP FAX
AT2wfl� � WPER�l w o (A 0)5C*t
CONTACT NAME PHONE F MAR.
STREET ADDRESS 2,550 `,LV2 CITY,STATE.ZIP „, M , _1 "�-50% FAX c
❑OV14U 13 0WNER-I1CILDER ®OL'JNP.R AGENT Cl CONTRACTOR 0 CONTRACTOR AGENT a ARCHITECT 9ENOINEER (3 DEVELOPER 13TENANT
cGrrRAcroR NAME-r, ��L� s Ltcr 1Q, 0 15
Ltcl;Ns r��r Dus.LIC n
COMPANY NAML' E-MAIL t6 FAX l
CCL LSA rjl ou ->r�0 a7 YL GOU517JUC)W•6
_ SrREFTADDRFSS �4\
; CITY,STAI'E,ZIP PIRINLL0
A F4W &§1FNGINEFR NAME •,L LICEVSE NUMBER BUS.LICA
COMPANY NAME � E-MAIL
NAIL l �^ FAX
STREET AUURhSS ���V ,V•`/W17��
CITY,STATE,7.IP ,+ � � PHOTF. -6 �
DESCRIPTION OF WORK V 10
sv" nus t;vts U9�E- a lu
txdrINGUJE PROPUJLDtSI, comrK.-YI'li STOWES
USE TYPE UCC. SgIrT. VALUATIONS)
EXISTO NEW FLOOR DEMO TOTAL
AREA ARL•'A / ARhA / NErAREA
UAIIIRUOM KITCHEN 01111R
RENODELARFA J REMODEL AREA REMODFLARFA /
POROLVIII'A OLLh ARhA IU IALDEALK PURVIIARIA I GARAG1:ARLA Oh TAL11
ATTACII
O DWELLMG UN 15 A SECOND I YES BEING ADDIIDNIT NOS AODIIIONTORY 'PNO
Pitt-APPLX'A I IUv 13 IS IF YFS,1•RUVIDF'COPY OP IS THE BLDG AN 13 YES RECEIVED 'TOTAL VALUATION:
PL1NSP.UAPPLb W V(AN%NGAI'. OVALLL'IIIH EICHLERHONE:' NO
ay my signature below,I certify to each of rhe following: I ant the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the infonnation I have p&d�i e re criptionof Work and verify it is accurate I agre to tom ly with all applicablelocal
ordinances and state laws relating to buhorizc resentatives of Cupenino to toter the above- tiff y for inspection purposes.
Signature of ApplicanVAgent:_ Date:
SUPPLEMWrAL INFORMATION QUIRED PLANCIIECKTVPE ROUTI,NGSLIP
_Nzw SFD or Multifamily dwellings: Apply for demolition permit for ❑ oYER.THE{ODPITER C3BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ muntass ❑ PLAUNNING 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 ❑ MA.10a ❑ SANITARY SEWER D1S'TR=
submittal of Building Pcrmit application.
❑ F.NVIRONMENTALHEALTH
BldgApp 2011.doc revised 06/21/11
LTERH1QME EMERGY PERRM QPPLI]C ATI]OM
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO,CA 95014-3255 /AL�
(408)777-3228 o FAX(408)T77-3333^building0-cupertlrl2M.
PRO1L'CTADDRESS 1v5vo 14. 1�9 44-IA b APNp
vt�-
OWNER NAh1E IAII
�,�CU ? 1 PHONEkca. a26• D-}0O CSE(,D I.A`�_ Cil-tom• l�?''�
M.FETADDRESS 1 05gr;) Vf, CITY,STATE,ZIP G+s� T1�t D1 L� 1�501 FAX
vl 1 �•_4'Xr7• t VA,
CONTACT NAMEFI[ONE .L•LL� E-MniL � .•� �R
STREET ADDRESS 2>s5c, CITY,ST. 71P C FAX
®OWNER 10 OWNER-BUILDER ❑OWNER AGENT ® cm-raACToa ❑Co\.RACroR AGENT ❑ ARCHITECT ❑ENoINEER ❑ DEWLOPER 13 TENANT
CONTRACTOR NAME AA O i.ICENSENU\IUER LICE.NSE1'YPE BUS.LIC 4
-ri
COMPANY NAME 1�� �'y� F•MAIL t�•� ������y¢; FAX
�W&MI�Lt�X1W _5�0 6�kt..CC-'LL`�1 "'ld�-/A
STRE[I r ADDRESS CITY,,'(A M LI P PI IONF.
ARCHITF.CM-%IGINL-ER NAME LICENSE NUMBER i 50 `I ''1'•'t BUS.UC A
COMPANY NAME G�- ] 1•� t � E-MAIL.
^� � FAX
S'fRF.F.TAODRESS V �W r v�• L'17Y,SS11A-KKN �I An -1 G �1 � rnoN
USE OF ❑ SFD or Duplex C Multi-Family PROJECT IN WILDIANn CA-AP
7 PROJECT IN
STRUCTURE: Commercial URHAV INTF.RFACEAREA ❑ Yes t`ff No FLOOD ZONE ❑ Yes No
❑SOLAR PANELS V ELECTRIC VEHICLE CHARGING STATION TO SOLAR WATER HEATING ❑ OTHER: ._,____ _
FORSOLARPANEWk Nti.MBFROFPAPIELSIUNITS: nt 0KOLOWAT7S: TOTAL VALUATION;
DESCRIPTION OF WORK Q,* 1L f J
RECEIVED BY:
By my signature be]ow,l certify fo eaPtherollowia ' 1 atn the propcny owner ur authorized agent to act un the property owner's behalf. 1havereadthis
application and the infoetJationi haveed is co c scription ofWork:Did verify it is accumte, tage to con ly with all applicable local
ordinances and state lawsrelating to bconstnico I au ri resentatives of Cupcnino to enter the abov ofd e y rinspection purposes.
Signature of Applicanl/Aprit: Date:
SUPPLEMENTAL INF RMATION REQUIRED OFFICE USE ONLY
00 ❑ OVRR-THF COUNTER
C6
F' ❑ EXPRESS
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96
❑ A1A.IOR
PV.4pp_201?.doc revised 06/20112
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10500 N. De Anaa Blvd DATE: 08/16/2012 REVIEWED BY: Sean
APN: BP#: `VALUATION: 1$1,400,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
]PRIMARY Commercial Building PENTAMATION 1 BOFF
USE: PERMIT TYPE:
L�S
®R C Site im rovements to include: site accessibilit as halt/curb re air site li htin landsca in and
COPE irrigation, (12) EV charging stations, installation of pre-fabricated bus shelter.
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Offices) II-B,III-131N,V-B 0 $0.00 $0.00
U (Private Gar/Ag Bldg) II-B,III-B,IV,V-B 70 $0.00 1 UIPLNCK $1,199.00 1 UIINSP
TOTALS: 70 $0.00 $1,199.00
MECH,HOURLY 0 Yes (j) No PLUMB,HOURLY O Yes E) No ELEC,HOURLY 0 Yes (D`No
Mech. Non Check I hcnih. Plan Check Elea.Plan f;heckt
Mech. Permit Fee: Pldrnh.Permit Fee: Elec.Permit Fee.
Odles•Atech.Insp, L] 01he r Phrmb Insp. LJ Other Eke. Insp. E1__L_
A-lech. Map. Fcze: Phanh. Lisp. Fee: Elx:c.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 . TheseLees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l in o.
FEE ITEMS (Fee Resolution 11-053 UL 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? C)Yes (F) No $0.00 12 # Alternative Energy System
Suppl. PC Fee: ) Reg. () OT L91 hrs $0.00 $1,224.00 ICHRGSTa EV Charging Station
PME Plan Check: $0.00 =1 # Awning/Canopy(Support'd by Bldg)
Permit Fee: Hourly Only? 0 Yes Q No $1,199.00 $0.00 I Canopy
Suppl. Insp. Fee-0 Reg. 0 OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consioletuon Tax:
,ldIninistrutiveTee: 6 hours Inspections
Work Without Permit? 0 Yes E) No $0.00 $798.00 1 ISTINSP Inspection,Hourly 0
Advanced Planning Fee: IPLLONGC $18.20 ® hours Plan Check,Hourly G
Travel Uoeumentudon Fees: $532.00 1STPLNCK C)
Strong Motion Fee: IBSEISMICO $294.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $56.00
SUBTOTALS: $1,567.201$2,554.00 TOTAL FEE: 1 $4,121.20
Revised: 07/01/2012
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
MDDRESS: 10500 N. De Anza Blvd DATE: 0811612012 REVIEWED BY: Sean
PN: BP#: *VALUATION: $1,400,000
°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1BOF
WORKSite improvements to include: site accessibility, asphalt/curb repair, site lighting, landscaping and
SCOPE irrigation, (12) EV charging stations, installation of pre-fabricated bus shelter.
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (offices) II-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY Yes (F) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY 0 Yes Q No
,kfee3i. Plan Cbuck P11E111b. Plan C'hec„ 17— Elec.Plan Cheek
V1i>clr. P€>rmit Fee: Plum/). Permit Fee: Elec. Permit l ee:
7-
Otho'-.W.,uh.lnsj�. Cather Plumb Insh. I I llttyc�r E1ec.Inch. El
ech. lay/). Fite: Plumb. lusp.FElec.lnsh..Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution I1-053 Elf. 7/1,11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 12 # Alternative Energy System
Suppl. PC Fee: � Reg. () 0T=0-0 hrs $0.00 $1,224.00 1CHRGSTA EV Charging Station
PME Plan Check: $0.00
Permit Fee: Hourly Only? ()Yes (F) No $0.00
Suppl. Insp.Fee-.0 Reg. Q OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Adlininistrative Fee: 6 hours Inspections
Work Without Permit? C) Yes E) No $0.00 $798.00 1STINSP Inspection,Hourly 0
Advanced Planning Fee: $0.00 ® hours Plan Check,Hourly
Trtrvel Documentation Fees: $532.00 1STPLNCK 0
Strong Motion Fee: 1BSEISMICO $294.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $56.00
SUBTOTALS: $350.001$2,554.00 'TOTAL FEE: 1 $2,904.00
Revised: 07101/2012
PROJECT DATA - COMMERCIAL )
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIIS O �J
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPEItTINO (408)777-3228 e FAX(408)777-3333•building(ftupertino.oM
r
PROJECT ADDRESS 10500 N. DE ANZA BLVD. "N"316-22-017
OWNERNAMEMISSIONWEST PROPERTIES, L.P.I. PHONE408.725.0700 E-MAILceb@mISSlonweSt.com
STREET ADDRESS 10050 BANDLEY DRIVE CITY, STATE,ZIP CUPERTINO, CA 95014 FAX408.725.1626
CONTACT NAME PHONE NOORI PHONE 408.727.66657E-MAILjnoori@kierwright.com
STREETADDRESS3350 SCOTT BLVD. #22 CITY,STATE, ZIP SANTA CLARA, CA 95054 FAX408.727.5641
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT 0 ENGINEER ❑ DEVELOPER ❑TENANT
TENANT CONTACT NAME JACKI HORTON PHONE 408.862.8234 E-MAIL jaCki@apple.Com
BUSINESS NAME
APPLE INC. SUBMH
FAX AA I
BUILDING OR TENANT SPACE DIMENSIONS uU 1
N/A u
DESCRIPTION OF WORK
SITE ACCESSIBILITY IMPROVEMENTS, ASPHALT/CURB REPAIR IN PARKING LOT,
SHUTTLE STOP PRE-FAB SHELTER, SITE LIGHTING & E.V. CHARGING STATIONS.
EXISTING USE(S>'COMMERCIAL PROPOSED USE(S):N 0 CHANGE
OCCUPANCY(S):NIA OCCUPANT N/A TYPE OF NIA
LOAD: CONSTRUCTION
AREA OFA I FLOOR(S) HAZARDOUS
REMODEL SPACE:I V A OF REMODEL SPACE:N A '",°,MATER ALSO Y N
FIREY N WUI Y N FLOOD Y N: ;.`-i S>ESMIC �,�}Y( �►
OSPRINKLERS: AREA: AREA: a "! AREA: futldlfi r I ent
NUMBER OF CHILDREN<2 YRS 0LD.1
NUMBER OF STUDENTS>='2 YRS O.L6 UpaCaT Aft
LEARNING CENTERS AND 24 HOURS CARE? Y N NUMBER OF ADULT CLIENTS:
EDUCATIONAL OPERATIONS: NUMBER OF EMPLOYEES: ,'�'"EU FOR COBE E
TOTAL OCCUPANTS: 3,;
Governing Codes: 2010 California Building Code(based on the 2009 International Building Code)
2010 California Residential Code(based on the 2009 International Residential Code)
2010 California Plumbing Code(based on the 2009 Uniform Plumbing Code)
2010 California Mechanical Code(based on the 2009 Uniform Mechanical Code)'
2010 California Electrical Code(based on the 2009 InternationaalElElectricl'Code�'-�
2010 California Energy Code ��
2010 California Green Building Standards CodeGG
Cupertino Municipal Code
e
ProjectData-Commercial.doc revised 12101111
l n p
PROJECT DATA - COMMERCIAL
--RWAIN ON
COMMUNITY DEVELOPMENT DEPAR� fl IV'I6
10300 TORRE AVENUE•CUPERTIN O 3 LL TIMESDURIN4 G
CUPERTINO (408)777-3228•FAX(408)777-3333•buildin cue ' STRUCTI0
PROJECT ADDRESS 10500 N. DE ANZA BLVD. APN#316-22-017
OWNER NAME MISSION WEST PROPERTIES, L.P.I. PHONE 408.725.0700 E-MAILCeb@mISSIOnwest.com
STREET ADDRESS 10050 BANDLEY DRIVE CITY, STATE,ZIP CUPERTINO, CA 95014 FAx408.725.1626
CONTACT NAME JOHN NOORI PHONE 408.727.6665 1 E-1 AILjnoori@kierwright.com
STREETADDRESs3350 SCOTT BLVD. #22 CITY,STATE, ZIP SANTA CLARA, CA 95054 FAx408.727.5641
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT N ENGINEER ❑ DEVELOPER ❑TENANT
TENANT CONTACT NAME JACKI HORTON PHONE408.862.8234 E-MAIL jacki@apple.com
BUSINESS NAME APPLE INC. SUM ffTAL
FAX
BUILDING OR TENANT SPACE DIMENSIONS
N/A :