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12030071CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR: DEVCON PE NO: 12030 1 CONSTRUCTION INC ` a OWNER'S NAME: SI 50 LLC 690 GIBRALTAR DR 1, E ISSUED: 05/18/2012 OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION License Class �� Li.. # 3 c1 n APPLE-PRASE 10-COMMERCIAL TENANT IMPROVEMENT ContractorDate _ (3112SQFT)INTERIOR AND EXTERIOR WORK, INTERIOR Jr' I hereby affirm that I am licensed corder the provisions of Chapter 9 DEMOLITON WORK IS UNDER PERMIT #12020013.SCOPE (commencing with Section 7000) of Division 3 of the Business & Professions OF Code and that my license is in full force and effect. REV #1- T.I. TO INCLUDE NEW LOAD BEARING PARTITIONS, CEILING AND ASSOCIATED FINISHES ON A PORTION OF THE I hereby affirm under penalty of perjury one of the following two declarations: IST FLOOR OF (E) OFFICE- ISSD 7/13/12 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: $400000 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 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.�crue against said City in consequence of the Issued by: Date: granting of this permit. A djt'oi nally, the applicant understands and will comply with all non-point sour regulations 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. ❑ 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 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 constrict 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(x) 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 2550 5533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: " Date: 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 CONST UCTION 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 3 CONSTRUCTION PE IT ;APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDI - -( 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1� I (408) 777-3228 • FAX (408) 777-3333 • buildingAcupertino.org CUPERTINO FJ NFw rnNrcTR I IrTmN n ADDITION ALTERATION/ TI /REVISION / DEFERRED ORIGINAL PERMIT # L- �3��1�, ✓ 71 PROJECT ADDRESS � to srh �• - 0* , V (sem APN # I) / • (®• 3 G• f/ OWNER NAME PHONE E-MAIL STREET ADDRESS ' t�J�r� CI FAX CONTACT NAMES' _+, i/z�o G.®(• PHON ab • Z'7 - f27 y E-MAIL CCO ��N /� ree n6,µ aN STREET ADDRESS CITY, STATE, ZIP 1®�f� 1 1 f FAO, A �� !/ 4 ,016, N SI�CgJ pj J • ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTO NAME LICENSE NUMBER LICENSE TYPE BUS. LJ # COMPANY AME CP E-MAIL V*W 6VK tw- W`Y,Co N `®C9Asf*, 1*,j FAX —if dogs n STREET ADDRJSOLO &1 L 1 lr.� PR+f Vim" Y, S CIT�A,TOT �Y� S PH E • / j !i • �SPV ARCHITECT/ENGINEERNAIvfE LICENSE NUMBER BUS. LIC# COMPANY NAME E N 0 11Sroi &01.1 FA t08 ZV V. o09 74!F(e , STREET �SS N. i1 /p ��- CITYS,`TATE, ZIPI..rF S119 CA PHONE • -' . DESCRIPTION Of k WORK Vrm P TO I M- WN f1. ChO11 OFofj O) G -'1N VIS ACC A -a L*0 Su*. EXISTING USE �I?(A PROPOSED USE CONSTR. �co TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG AREA „� NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA. • KITCHEN REMODEL AREA ` )•.i , IKIPPORR�CH OTHER REMODEL AREA PORCH AREA N.h DECK AREA P. A, TOTAL DEC AREA u1• GARAGE AREA: DETACH ❑ U ATTACH # DWELLING UNITS: `' A- • IS A SECOND UNIT ❑ YES BEINGADDED? []NO SECOND STORY ❑ YES ADDITION? [:]NOPRE-APPLICATION El YES IF YES, PROVIDE COPY OF PLANNING APPL # RNO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HONIE? ANO RECEI BY: �-":: e v ('. �to TOTAL V N: By my signature below, I certify to each of the following: I am the property owner or authorized agent act on the property owner's behalf. I have read this -rrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local application and the information I have rovid5.uction. ordinances and state laws relating to a 'n I authorize representatives of Cupertino to enter the above -I ri i d prope for inspection purposes. Signature of Applicant/Agent: Date: p SUPPLEMENTAL INFORMATION REQUIRED PLAN c$ECIi TYPE ROUTING SLIP ❑ OVER-THE-COUNTER �/�. BUILDING PLAN REVIEW New SFD Or Multifamily dwellings: Apply for demolition permit for 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 EIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ DZAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BidgApp 201 Ldoc revised 06121111 ON __ _ CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION Vd,ADDRESS: 20650 Valley Green Dr DATE: 06/01/2012 REVIEWED BY: Sean AXlech. Permit Fee: APN: 326-10-053 BP#: 12030071 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building Tlrrmh. lay, F'ec: PENTAMATION PERMIT TYPE: 1GENC0 i WORK #1: Construction of n non load bearingpartitions, ceilingand associated finished on portion SCOPE Ovission firt floor of (e) office/lab building. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt_ ntr_)_ Those fao.c are haced nn the nreliminary information availahle and are on[v an estimate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resohition 11-053 &.. 7/1/11) "Voll, Plmr CYrce% Plumb, Plcnr Check Dec. Platt Che,% AXlech. Permit Fee: P/rnnh. Pelmit Ecce: EYec, P13711it FCC. other Alo 'h. 117s r. Other Phimb 17sh. Usher Elec. [resp, Mcch, lmp. Fcc: Tlrrmh. lay, F'ec: Elec. Insp, Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt_ ntr_)_ Those fao.c are haced nn the nreliminary information availahle and are on[v an estimate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resohition 11-053 &.. 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building i Suppl. PC Fee: Q Reg. 0 OT O,Q Ihrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 his $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 COilSIOIC60i7 /41l': 11dini17tsU'_r' ih, Fec" 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Travc l Docitincitloticm 1{rtes: Strong Motion Fee: $0.00 # $783.00 Revision IREVCOMTI Tenant Improvement Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $783.00 TOTAL FEE: $783.00 Revised: 05/01/2012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR: DEVCON PERMIT NO: 12030071 CONSTRUCTION INC OWNER'S NAME: SI 50 LLC 690 GIBRALTAR DR DATE ISSUED: 05/18/2012 OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # APPLE -PHASE 10 -COMMERCIAL TENANT IMPROVEMENT Contractor tri �,� ) (fC- A 1�jf _ Date (3112SQFT)INTERIOR AND EXTERIOR WORK, INTERIOR I hereby affirm that I am licensed under the provisions of Chapter 9 DEMOLITON WORK IS UNDER PERMIT #12020013.SCOPE (commencing with Section 7000) of Division 3 of the Business & Professions OF 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 Sq. Ft Floor Area: Valuation: $400000 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 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/°� � s l Issued byi_ 41 Date: granting of this permit. Additionally, the applicant understands and will comply f < with all non -point source regulations 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. ❑ 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, 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 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 whichthis 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25W, 25533, and 25534. �j Owner Da permit is issued.te or authorized agent 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 CON UCTION 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(o-)cupertino.org n tJPAV (nNCTRT IC'TInN n ADDITION 15 ALTERATION/TT n REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS OZ06 5 V L --Y 6? e �.I APN# � m ��y .- 4153, ,J - OWNER NAME Em 4� PHONY j�.-r ,. MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME pp PHONE } r� �7 E-MAIL STREET ADDRESS _ 7 CITY, STATE, ZIP o� 1 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEt LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME f �' , p E-MAIL (_ULM g -.,/,e V 4 m E FAX STREET ADDRESS CITY, STATE, ZIP ®, PHONE /+ -6 40 -6506 ARCHITECT/HNGINEER NAME X40 "(-7' C� LICENSE NUMBER BUS. LIC # COMPANX NAME &MAIL FAX STREET DRESS _ b Z S 7 CITY, STATE, ZIP ,�yl 1t1 S j PHONE f DESCRIPTION OF WORK t F .. C�- L' f I A%C/A) " 4 t P s I -(c-i2-(o A 1`2,10 �v' O/-.4 EXISTING USE - PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) .- EXISTG i NEW FLOOR DEMO TOTAL AREA 3 € 1 7 $ AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA r REMODEL AREA ,. LL REMODEL AREA PORCH AREA i_ DECK AREA TOTAL DECK/PORCH AREA e 1'¢ GARAGE AREA: DETACH p p dq ❑ AT A . dSTORYl7 # DWELLING UNITS: IS A SECOND UNIT LYES SECOND []YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING ADPL# 13NO PLANNING APPROVAL LETTER EICHLERHODIE? ;NO 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 is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin construction. I authorize, representatives of Cupertino to enter the above -identified property for inspection purposes. i4 /A! Date: �1 6 Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for 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 ZSTANDARD ❑ 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 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20650 valley green drive DATE: 03/15/2012 REATIEWED BY: larry s ME INE BP#: `-PERMIT TYPE: Building Permit PLANCRECKTYPE: Tenant Improvement PRIMARY Cmmercial Bulding PENTAMATION oi• 113T USE: PERMITTYPE: atennant improvement 3112 sq. ft. interior and exterior work. interior demolition work is under permit ll, 12020013. scope of this permit includes interior non bearing partition walls, finishes and exterior patio — --------- AREA TYPE OF FLR A OCCUPANCY TYPE: PC FEES PC F BP FEES BP FEE ID CONSTR. s.f. . ...... .... B (Tenant Improvements) 11-B,111-B,IV,V-B 3,112 -$2,174.601 IBTIPLNCK $2,532.48 IBTIINSP NOTE. This estinude does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School hhi�wi ora i Thavo fave imo havad n" 410 filml."Padn" alyfli'llyh1pand are nn1v aii pvtimalp. Cawarithe Dow for addn'linfo. FEE ITEMS Fee Resohetion 11-053 & 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,174.60 L Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 his $0.00 PME Plan Check: $0.00 Permit Fee: $2,532.48 Suppl. Insp, Feer Reg, C OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 0 Work Without Permit? 0 Yes No $0.00 Adyance,d Planning le—',$0.00 Select a Non -Residential Building or Structure G 0 S t iLo �a _jvlo I tp i Fee,, IBSEISAffCO $84.00 Select an Administrative Item Bldg Stds Conimissjon Fe.e: IBCBSC $16.00 SUIBTOTALS: $4,807.+08 $0.00 TOTAL 1 $4,807.08 Revised: 1/19/2012 511, 1 ' . 1 • 1 1 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: �(� [ •� ""(- PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: / `' BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: ' 'Our municipal code requires all businesses vrorking in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: / Contractor Signature /ate SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork p� - c� • �._ „- Cement Finishing ,� � - 1 �% �,)Z 2, l A� �4 -11 Electrical l Excavation Fencing Flooring / Carpeting�� Linoleum / Wood Glass / Glazing Heating( - Insulation Landscaping Lathing Masonry Painting / Wallpaper 12, Zp"�2��,A Paving Plastering Plumbing , Roofing " Septic Tank Sheet Metal Sheet Rock Tile / Contractor Signature /ate