12020131CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 VALLEY GREEN DR
CONTRACTOR: DEVCON i` '
P 1VIIh�20731
CONSTRUCTION INC,
OWNER'S NAME: SI 50 LLC
690 GIBRALTAR DR
DATE ISSUED: 05/01/2012
OWNER'S PHONE: 4089961010
MILPITAS, CA 95035
PHONE NO: (408)942-8200
❑
JOB DESCRIPTION: RESIDENTIAL O COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # �� 23
APPLE - PHASE 11 -COMMERCIAL TENANT
IMPROVEMENT(5400SQFT) CONSTRUCTION OF NEW
Contractor}��%9 C^5� Date
SLAB,
I hereby affirm that I am licensed under the provisions of Chapter 9
NON -REARING PARTITIONS, CEILING & ASSOCIATED
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
5/11/12- REVISION #1- REVISE THE FLOOR PLAN LAYOUT AND
I hereby affirm under penalty of perjury one of the following two declarations:
FINISHES- ISSD 6/8/12
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
Sq. Ft Floor Area:
Valuation: $450000
performance of the work for whichthis 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
APN Number: 32610053.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
.a
Issued by: ✓F�� Date:
granting of this permit. Additionally, the applicant understands and will comply
p ,
with all non -point source re ations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date
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.
❑ WNER-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
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, 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
I 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 I
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, Sections 25 , 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date:
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 tris 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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 12020131
INC
OWNER'S NAME: SI 50 LLC 690 GIBRALTAR DR DATE ISSUED: 05/01/2012
OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
License Class
/b 8 Lie. # F a9 9 A
Contractor � // - /CC 9 f i 11C ate
I hereby affirm that I am licensed under the provisions of ha ter 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.
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
permit 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 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,
costs, and expenses which may/accrue against said City in consequence of the
granting of this permit. A ionally, the applicant understands and will comply
with all non -point urc egulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ ` OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will 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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG 'F ELECT 'r PLUMB r
MECH r RESIDENTIAL Ir COMMERCIAL F_
JOB DESCRIPTION: APPLE - PHASE I I -COMMERCIAL TENANT
IMPROVEMENT(5400SQFT) CONSTRUCTION OF NEW SLAB,
NON -REARING PARTITIONS, CEILING & ASSOCIATED
Sq. Ft Floor Area: I Valuation: $450000
APN Number: 32610053.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Own e r thor' ed agent:
Date:
CONSTRUCTION LENDING AGENCY
I ,,by 7aff,.at there is a construction lending agency for the performance of Nwrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date ' Licensed
R-m7a,
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the prelindnary information available and are on1v an estintate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resohltion 11-053 E . 711111)
ADDRESS: 20650 VALLEY GREEN DR
DATE: 05/11/2012
REVIEWED BY: SEAN
A,fec/,Pesrmil Fee:
APN:
BP#: 12020131
*VALUATION: Iso
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
Thn,rh. hrsp. Feu:
PENTAMATION
PERMIT TYPE: 1GENC0 i
WORK
REVISION #1: REVISE THE FLOOR PLAN LAYOUT AND FINISHES.
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the prelindnary information available and are on1v an estintate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resohltion 11-053 E . 711111)
Afcr. Plurr Checl,
phlmh. Phu„ Check
Elea. Pleur Chcck
A,fec/,Pesrmil Fee:
Phmrh, Penni/ Fee:
Flee, Perwil Fee:
Other Mcch. Insp.
0/11er Phmrh hash,Li
Other Elec. My.
Alc(h. M, p.
Thn,rh. hrsp. Feu:
Elec. InsP, Fce:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the prelindnary information available and are on1v an estintate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resohltion 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
i
Suppl. PC Fee: (F) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construclion Tax.-
r�Clfl7iFt1.1'tl'fIfIVC' �''�[?;
0
G)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning
$0.00
Select a Non -Residential
Building or Structure
0
0
�
Trtrs�el DOf.'irlt7c17£CIl1nPt Te�r�,S:
Strong Motion Fee:
$0.00
0 #
$783.00
Revision
IREVCOMTI Tenant Improvement
Bldg Stds Commission Fee:
$0.00
SUBTOTALS: '
$0.00
$783.00
TOTAL FEE:
1 $783.00
Revised: 04/01/2012
CITY OF CUPERTIN
O
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20650 Valley Green Drive DATE: 02/29/2012 REVIEWED BY:
fO71APN: 326-10-053 *VALUATION: 1$450,000:�
JP#:
1:PERMIT TYPE: Building Permit PLANCHECKTYPE: Tenant Improvement
PRIMARY Commercial Building PENT TION 1B TI
USE: PERMIT TYPE:
wo Tenant Improvement (Phase 11)
SCOPE I
OCCUPANCY TYPE:
TYPE OF
FLR ARE, A PC FEES
PC FEE ID
BP FEES
BP FEE ID
CONSTR.
(SX.)
Select a Misc Bldg/Structure
or Element of a Building
A
Suppl. PC Fee: 0 Reg. 0
B (Tenant Improvements)
11-B,111-B,IV,V-B
5,400 $2,247.20
IBTIPLNCK
$4,176.76
1 B THArSP
Permit Fee:
$4,176.76
Suppt. Insp, Feee Reg.
0 2LLiLlirs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
5,400 $2,247.20
$4,176.76
NOTE: This, estinutte does not incl udefees flue to other Deparinwnts (i.e. Planning, Pubfie Works, Fire, Sanitary Sewer District, School
nhl,lot otr ) TIP~ fpv firo hawd nn tho 111,01i"i"am filmr"I"finip filyffilHallo nwdaro nnh� an pwimatp_ Imilmttho Dont Mraddii'linfa
FEE ITEMS (Fee Pesohi.dw,, 11-053 flL 7/1j1
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,247.20
Select a Misc Bldg/Structure
or Element of a Building
A
Suppl. PC Fee: 0 Reg. 0
$0.00
PME Plan Check:
$0.00
Permit Fee:
$4,176.76
Suppt. Insp, Feee Reg.
0 2LLiLlirs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
E)
Work Without Permit? 0 Yes (D No
$0.00
Adwmced Planning Fee°
$0.00
Select a Non -Residential
Building or Structure
(D
A
0
S1rop,q tvlotion Fee:
IBSEISAECO
$94.50
Select an Administrative Item
E,ldg Stds Commission Fee:
g IBCBSC
1 $18.001
SUBTOTALS:
1 $61536.46
$0.00
TOTAL FEE
6
Revised: 1/19/2012