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12050047CITY OF CU PIEIfBTINO BUILDING PERMIT BUILDING ADDRESS: 18920 FORGE DR CONTRACTOR: DEVCON PERMIT NO: 12050047 CONSTRUCTION INC OWNER'S NAME: FORGE DRIVE INVESTORS, LLC 690 GIBRALTAR DR DATE ISSUED: 06/26/2012 OWNER'S PHONE: 4152845700 MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El❑ COMMERCIAL License Class � Lic. 4 lq � q-2 TI-AIPIPLIE INTERIOR IOR OIF1FICIE AND LAB SPACE, /C7 �, 2 � Contractor, C, � Date (2( / STRUCTURAL, INCLUDES MUIE'S-PHASE 5 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 Sq. Ft Floor Area: Valuation: $455000 performance of the work for which this permit is issued. 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 permit is issued. APN Number: 31609030.18920 Occupancy Type: 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 WIT�� ® �� OF PERMIT ISSUANCE �� 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 DAB'S FROM (LAST CALLED INSPECTION. P]ECTI ON. 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 u ers ds and will comply Issued by: Date: with all non- t s rce regulations r the Cup no nicipal Code, Section 9.18. v 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 al I new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 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). 1 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 1 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 II performance of the work for which this permit is issued. will maintain compliance with t ertino Municipale, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S ion 550 633, and 534. q Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen . V-�" Date: /C - permit is issued. 1 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 AGENCX 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 ofthis 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 (CUPERTINO CONSTRUCTION PER MIT APPLICAT110H COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 ^ build ingta'�-cupertino-ora ❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECTADDRESS 18920 Forge Drive, Cupertino,CA 95014 APN# 31609030.18920 OWNER NAME Forge Drive Investors , LLC PHONE 415.284.5700 E-MAIL CIO Divco West RE Svcs.Inc. STREET ADDRESS 575 Market St, 35th F1r. CITY, STATE,ZIP San Francisco, CA 94105 FAX CONTACT NAME John Rickard, Apple, Inc. PHONE 408 .974 .5662 E-MAIL jrickard@apple.com STREET ADDRESS 1 Infinite Loop CITY, STATE, ZIP Cupertino, CA 95014 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER tm TENANT CONTRACTOR NAME ,Jim Le i bo ld _T LICENSE NUMBER 399163 LICENSE TYPE B BUS. LIC # 11068 COMPANY NAME Devcon Construction,Inc. E-MAIL jleibold@devcon-const.com FAX 408.262.2342 STREETADDRESS 690 Gibraltar Dr. CITY,STATE,ZIP Milpitas, CA 95035 PHONE 831 . 212 . 9676 ARCHITECT/ENGINEER NAME David Saba 1 va ro LICENSE NUMBER C 15 9 2 5 exp . 3 . 31 . 13 BUS. LIC # COMPANYNAME Studios Architecture E-MAILaclemenza@studiosarch. com FAX 415 .398 . 3829 STREETADDRESs 405 Howard St . , Ste 588 CITY,STATE,ZIP San Francisco, Ca 94105 PHONE415. 732 .5332 DESCRIPTION OF WORK Interior tenant improvements (Phase V) to include new labs, office space,& listening rooms. EXISTING USE Office/Labs PROPOSED USE Office/Labs CONSTR. TYPE III -B # STORIES 1 USE TYPE OCC. SQ.FT. VALUATIONS) EXISTG AREA NEW FLOOR AREA 6, 4 0 0 I DEMO AREA TOTAL NET AREA 1� Vile $455 1 000. 00 BATHROOM REMODEL AREA KITCHEN OTHER REMODEL AREA N/A REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH N/A N/A N/A N/A []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES N/A BEING ADDED? ®NO ADDITION? ®NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER 1S THE BLDG AN ❑ YES EICHLER HOME? ® NO RECEIVED BY: /+ TOTALVALUATION: 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 vi,4d is correct. Dave read the Desc 00 r oi of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin uildi constructi I orize repre nta " es of Cupertino to enter the abov�de tified ro rty for inspection purposes. Signature of Applicanl/Agenr. Date: SUPPLEMENTO INFO QUIREDPLAN CHECK T1TE 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 1:1 STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGF. ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BtdgApp-2011.doc revised 06121/11 .f'1TfrrrlR7 lfh" .f' T1fTlTl TT�T. OCCUPANCY TYPE: FEE ESTIMATOR 41..11 Jl 11 %L.YRI 4L 1U Jr lrjiM 1L 1Li q %Ly — BUILDING DMSRON PC ]FEES ADDRESS: 18920 forge dr. DATE:`REVIEWED BY: bobs. BP (FEES APN:5 3 1BP#: S� *VAI UATION: $455,000 *PERMIT TYPE: Building Permit IBTIPLNCK PILAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building Eice. Insp. hc"C: Suppl. Insp. Fee -(F) Reg. OT0,0 PENTAMATION 1 B TI USE: $0.00 PME Unit Fee: PERMIT TYPE: ., WORK U. comm office and labs ace structural include M E no Ps. Phase 5 SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FILR AREA s.ff. PC ]FEES PC FEE ID BP (FEES IBP ]FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 6,400 $2,285.76 IBTIPLNCK $4,761.20 /BTIINSP Eice. Insp. hc"C: Suppl. Insp. Fee -(F) Reg. OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conti -notion Tax: 11dininistrative .Fee: Work Without Permit? ® Yes No $0.00 Advanced .Plannin Fee: TOTALS: F 6,400 $2,285.76 $4,761.20 $95.55 MECH, HOURLY C Yes (D No PLUMB, HOURLY ()Yes 1E) No ELEC, HOURLY Q Yes G No :i lech. Plan Check Plumb. Plan Check Elea. Plan (:hack .Tech. Permil Fee: Plumb. Permil Fec. lilcc. Permit F c Olhcr hlech. Insp. Other Plumb Insp. Other Elec. Insp. 01 tart./i. Insp. Fee: Plumb. lisp. Fee: Eice. Insp. hc"C: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn1l info. EEE ITEMS (Fee Resolution 11-053 Eff 7/1/.11) FEE QTY/FIEE MISC ITEMS Plan Check Fee: $2,285.76 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. OT0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,761.20 Suppl. Insp. Fee -(F) Reg. OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conti -notion Tax: 11dininistrative .Fee: Work Without Permit? ® Yes No $0.00 Advanced .Plannin Fee: $0.00 Select a Non -Residential G or Structure d Travel Documentation Fees:Building Strong; Motion Fee: 1BSEISMICO $95.55 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $19.00 SUBTOTALS: $7,161.51 $0.00 TOTAL FEE: $7,161.51 Revised: 04/01/2012 CMPER TIIN® CONTRACTOR / SUBCONTRACTOR LEST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: �,'-n PERMIT # OWNER'S NAME: . o PHONE # P A GENERAL CONTRACTO : BUSINESS LICENSE # ADDRESS: �y -�� `� CITY/ZIPCODE: §-� L;D & , *Our municipal code requires all lnu4nesses working in the city to have a City of Cuupen-tin® hnnsiness license. NO BUILDING (FINAL OR ]FINAL, OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UN7M 7H E GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CU IEIE�I i]IY0 BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: c� SUBCONTRACTOR 3USRNIESS NAME 3USENIESS ILECIENSIE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile O wne ntractor Sign-ataure Date