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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