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14120072 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR:DEVCON PERMIT NO: 14120072 CONSTRUCTION INC OWNER'S NAME: MISSION WEST PROPERTIES LP IV 690 GIBRALTAR DR DATE ISSUED: 12/15/2014 OWNER'S PHONE: 4087129856 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL APPLE; T.I 3RD FLOOR-ADD(N) 100 AMP SUB PANEL IN License Class CA 611C- Lic.# (E)ELECTRICAL ROOM Contractor G-mc,", 5 Date Z �� 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. 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. Sq.Ft Floor Area: Valuation:$20000 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 APN Number:31622017.00 Occupancy Type•. permit is issued. APPLICANT CERTIFICATION I certify that l have read this application and state that the above information is PERMIT EXPI IF WORK IS NOT STARTED correct.l agree comply with all city and county ordinances and state laws relating WITHIN 1 QFRMIT ISSUANCE OR to building construction, uction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA F M LAST CALLED INSPE TI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the f2, granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: / with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date (2-It �� 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, wil I do the work,and the structure is not intended or offered 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. I will 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se on 25533,an 34. Section 3700 of the Labor Code,for the performance of the work for which this Q Owner or authorized agent: Date: l jf l 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,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 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 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 19- COIs MMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION (� 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 �`/►vvv C U PE RTI NO (408)777-3228•FAX(408)777-3333•building(a>.cupertino.org 1 V ❑NEW CONSTRUCTION ❑ ADDITION 0 ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 10500 N. De Anza Blvd 7APN# 3/4 r Z - r /S OWNER NAME Apple, Inc. ass< PHO E-MAIL E-MA'Lanh_vu@apple.com STREET ADDRESS 1 Infinite Loop CITY, STATE,ZIP Cupertino, CA FAX CONTACT NAME Kevin Irwin PHONE408-712-9856 E-MAILkirwin@devcon-const.com STREETADDREss690 Gibraltar Dr. CITY,STATE,ZIP Milpitas, CA 95035 FAX408-262-2342 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Kevin Irwin LICENSE NUMBER 399163 LICENSE TYPE CA GC BUS.LIC#11068 COMPANY NAME Devcon Construction, Inc. E-MAILkirwin@devcon-const.com FAX408-262-2342 STREETADDRESs690 Gibraltar Dr. CITY,STATE,ZIP Milpitas, CA 95035 PHONE408-942-8200 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS ,/ CITY,STATE,ZIP PHONE DESCRIPTION OF WORK,Q.//S//zli— �jf (/ New subpanel for added electrical capacity. EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) B B I-A 4 EXISTG NEW FLOOR DEMO TOTAL B20,000 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 #DWELLING UNITS: 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 EIV TOTAL UATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized agent to ac t roperty owner's be-f. I have read this application and the information I have provide Erre I have read the Description of Work and verify i accurate. I agree to comply ith all applicable local ordinances and state laws relating to buil co, ctlon. I authorize represe ivesrof Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ✓ Date: �S SUPPLEMENTAL INVORMATIWREQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for VER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance 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 B1dgApp_201 Ldoc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10500 N DE ANZA BLVD DATE: 12/15/2014 REVIEWED BY: MELISSA APN: 316 22 017 BP#: Ca�Z} `VALUATION: 1$20,000 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY Commercial Building PENTAMATION 10EAP2 USE: PERMIT TYPE: 19 WORK APPLE T.I. - 3RD FLR-ADD N 100AMP SUB PANEL IN E ELECTRICAL ROOM SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ECT<200 100 Amps $48 TOTALS: $48.00 Elec. Plan Check 0.0 1 hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elea Insp. 0.0 hrs L $48.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the greliminar information available and are only an estimate. Contact the Dept/or addn'l info. FEE ITEMS (Fee Resolution 11-05.3 Eff 7,1131 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 F71 Administrative Fee: IADMN $45.00 Work Without Permit? © Yes ) No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 i StronP Motion Fee: IBSEJSAIJCO $5.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $195.60 $0.00 TOTAL FEE: $195.60 Revised: 0812012014