12060046CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 12060046
INC
OWNER'S NAME: SI 50 LLC 690 GIBRALTAR DR DATE ISSUED: 08/16/2012
OWNER'S PHONE: I MILPITAS, CA 95035 I PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DEJCLARATION
License Class Lic. # /
Contractor // 'moi % Date
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.
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. Addition Ily, the applicant understands and will comply
with all non -point source re mons per the Cupertino Municipal Code, Section
9.18.
Signature Date���������
❑ 6WNER-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.
Signature.
Date
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: APPLE- PHASE 13- COMM T.I 8,864 SQ FT- TO INCLUDE
NEW CONS. SLABS, NON LOARD VEARING PARTITIONS,
CEILING AND ASSOCIATED FINISHES OFFICE/LAB SPACE 10/16/12 DEFERRED #2 -
REACH IN CHAMBER -STRUCTURAL -11/7/12 DEF#2 ISS'D
Sq. Ft Floor Area: I Valuation: $900000
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 b _ � Date• �.- / '
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.
Owner r ifliorized�
Date:
CONSTRUCTION LENDING AGENCY
I ,by affirm that 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.
Licensed
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
20650 Valley Green Dr
DATE: 10/16/2012
REVIEWED BY: SYLVIA
JI fech. Per mit Fee:
-_APN:
BP#: n oO
*VALUATION:
$0
*PERMIT TYPE: Building Permit
PLAN CHECKTYPE: Tenant Improvement
PRIMARY Commercial Building
USE: g
Elec. Insp. Fee:
PENTAMATION 1GENCOM
PERMIT TYPE: A
WORKDEFERRED
#2- REACH IN CHAMBER
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitarysewer tnsirtci, acnuuc
n:..._:..• � T/.non/.,..,,. f',. ,.,.,, 1 n., Ma nroliL[LiLLnn� bifnrn/ntinn availahla and arP. on1v an estimate. Contact the Dept for addn'l info.
cLLJL/[ell. . 1I(G .. (((c (i 1. c.0 v.a s•... .....••......•
FEE ITEMS (Fee Resolution 11-053 E : 7ff /1112)
Xfech. Man C7reck
Plnnrb. Nan Check
Elec, Plan Check
JI fech. Per mit Fee:
Phnnb, Permit Fee:
Elec. Permit ree:
Other Alech. hasp.
Other Phnnb Insp,
Oilier Elec. Insp.
/Meeh. Irrsp. Fee:
Phnnb. Insp, Fee::
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitarysewer tnsirtci, acnuuc
n:..._:..• � T/.non/.,..,,. f',. ,.,.,, 1 n., Ma nroliL[LiLLnn� bifnrn/ntinn availahla and arP. on1v an estimate. Contact the Dept for addn'l info.
cLLJL/[ell. . 1I(G .. (((c (i 1. c.0 v.a s•... .....••......•
FEE ITEMS (Fee Resolution 11-053 E : 7ff /1112)
.•. ... ............... ......___
FEE
_.____ ___ _
QTY/FEE
____
MISC ITEMS
Plan Check Fee: Hourly Only? ® Yes (F) No
$0.00
® hours Plan Check, Hourly
$532.00 ISTPLNCK
A
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
COnS17Y1C6017 Tax:
T-7
Adinh istrotive Fee:
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Plannin& Fee:
$0.00
Select a Non -Residential
Building or Structure
G
i
Tlywcl Docrnnentotion Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg, Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$532.00
TOTAL FEE:
$532.00
Revised: 10/01/2012
M3
CITY OF CUPERTINO BUILDING PE _. t s.
BUILDING ADDRESS: 20650 VALLEY GREEN DR
OWNER'S NAME: SI 50 LLC
OWNER'S PHONE:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class tom_ Lic. # 2 (�, 7 �//
Contractor .1 iL/Clsn) L"Cs S% _ Date
I hereby affirm that I am licensed under the provisions of C apter 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. Add' �i�9nally, the applicant understands and will comply
with all non -point source gblations 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:
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
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.
Signature Date
CONTRACTOR: DEVCON CH4 ftWCTrO29_ —PERMIT NO, 12060046
INC
690 GIBRALTAR DR DATE ISSUED: 08/16/2012
MILPITAS, CA 95035 PHONE NO: (408)942-8200
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: APPLE- PHASE 13- COMM T.I 8,864 SQ FT- TO INCLUDE
NEW CONS. SLABS, NON LOARD VEARING PARTITIONS,
CEILING AND ASSOCIATED FINISHES OFFICE/LAB SPACE 8/28/2012- DEF#1-
DEFERRED CHAMBERS 3 RELOCATE 2 NEW STRUCTURAL- 9/17/2012 DEF#2 ISS'D
Sq. Ft Floor Area: I Valuation: $900000
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: ��—O�,1a,
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(x) 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.
agent:
Date: '
CONSTRUCTION LENDING AGENCY
I hereby affirm that 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.
Licensed
,���,���� CITY OF CUPERTINO
I9?'�-.'Y/fil FEE ESTIMATOR — BUILDING DIVISION
imlADDRESS:
20650 valley green dr.
DATE: 08/28/2012
REVIEWED BY: bobs.
l-fech, PcoWl Fee
APN:
BP#: te wlo*VALUATION:
Iso
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
Commercial Building
Plumb, Insp. Fee:
PENTAMATION
1GENC0
USE:
Permit Fee:
PERMIT TYPE:
WORK
deferred chambers 3 relocate 2 new structural.
SCOPE
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sever District, School
District. etr.) The.ce fees are haced an the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711111)
Xfvch. Pion Check
Plunrb, Pkm Check
Elec, Plan Check
l-fech, PcoWl Fee
Phonb. Permit Fee:
E'lec. permit Fee:
Other Alech. In.V?,
Other Phrnrb Insp,
Other Elce, Insp.
Alech. brsp, Fee:
Plumb, Insp. Fee:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sever District, School
District. etr.) The.ce fees are haced an the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? (F) Yes C) No
$0.00
® hours Plan Check, Hourly
$532.00 ISTPLNCx
Suppl. PC Fee: (F) Reg. Q OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
0
G
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure
A
TOWC/ DOcntnentafion Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
1
Bldg Stds Commission Fee:
$0.001
SUBTOTALS:
$0.001
$532.00 TOTAL FEE:
$532.00
Revised: 07/01/2012
CITY OF CUPERTINO
&W FF.F FgTI1%4AT0R — RIIILDING DIVISION
LkADDRESS:
20650 Valley Green Dr
DATE: 06/08/2012
REVIEWED BY: Sean
PC FEE ID
APN:
BP#: j 2�0
*VALUATION: $900,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
1BTIPLNCK
PENTAMATION 1 B TI
PERMIT TYPE: i
WORK
Tenant Improvement 8864 sq ft
SCOPE
PME Plan Check:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,111-B,IV,V-B
8,864
$2,409.26
1BTIPLNCK
$5,612.45
IBTIINSP
Elec. Insp, Fce:
$0.00
PME Plan Check:
$0.00
Permit Fee:
$5,612.45
Suppl. Insp. Fee:Q Reg. 0
OT
070
hrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
8,864
$2,409.26
$0.00
$5,612.45
MECH, HOURLY 0 Yes G No
PLUMB, HOURLY 0 Yes '(F) No
ELEC, HOURLY 0 Yes Q No
Xkch, Ploir Chcck
Plrumb, Plmr C hec/,
Elec. Flan Crock
m'ch. Permit Fee;
—L—
Phnnb, P:9`rmit Fee:
Elec. Permit Frye:
L'(1111(111111,A'kch. Irish.
Other Phimb hasp.
Other Elec, Lzsp, Lj
Insp. Free:
Plumb. hasp. Feta:
Elec. Insp, Fce:
NOTE: This estimate floes not include fees titre to other Departments (i.e. Planning, Pubnc works, Fire, Sattuary Sever msirici, amour
L 1 ,,., .t.Contact the Dent for addn'l info.
— J{!!4!, G!ln • 1!l cJc. va.0 ,,. ,. vuu,... v .. ... .. ..............
FEE ITEMS (Fee Resohttion 11-053 E . 7ff 11111)
... .........._._ _.. _________
FEE
-
QTY/l
1;
MISC ITEMS
Plan Check Fee:
$2,409.26
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$5,612.45
Suppl. Insp. Fee:Q Reg. 0
OT
070
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
CCnsirmc ion Tn.A:
tichnini%wotive Fee:
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
i
Travc/ Doctttri�enloo.on Fees:
Strong Motion Fee:
IBSEISMICO
$189.00
Select an Administrative Item
Bldg Commission Fee: IBCBSC
$36.00
SUBTOTALS:
$8,246.71
$0.00
TOTAL FEE:
1 $8,246.71
Revised: 06/05/2012