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13010049CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18920 FORGE DR CONTRACTOR: DEVCON PERMIT NO: 13010049 CONSTRUCTION INC OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED: 01/08/2013 OWNER'S PHONE: 4088624397 MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class ,� Lic. # -319 J APPLE- T.I PHASE 6- CONSTRUCT HARDWARE Ib�OIIDIEIL y� Contract�� uJ'��t Date "Z0� SHOP 301 SQ FT 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: $80000 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 APN Number: 31609030.18920 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 building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA F ®M 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: /�73 with al l non- ' s urce regulations per the Cu no Municipal Code, Section 9.18. Signat Date&RE-ROOFS: Signat 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 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(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 E performance of the work for which this permit is issued. will maintain compliance with tyeVupertino 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, do 25505, 25533, and 34. 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 CONSTRUCTION LENDING AGENCY 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 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 CUPERTINO. P NFW rnNSTRIIr' CONSTRUCTION PERMIT APPLICATION �'A CA, COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION 0 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 u\ (408-) 32 777-28 • FAX(408)777-3333 = building a(-cupertino.orq \� 710NI I Ar)1)ITION IVl AITFRATION/TI I 1 RFVISInN/r)FFFRRFh ORl(:TNA1.PFRMITii PROJECT ADDRESS ' Q O� -L<) t!®.m117La c ype �� l" v' `mob APN # ��/ _ ®� OWNER NAME �� ue— , I pq' 0 (P14,21 E-IMAIL.................. STREET ADDRES r a �.9 CITY, STATE, ZIP l FAX CONTACT NAM r ,1J � � L �i� �a Il PHONE464i e A �C� E -MAI ��-� ��o k leo c� STREET ADDRESS CITY, STATE, ZIP /" p lA ` (..dam a b FAX ❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGE r ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMB-, ,.®, - QW i _ " � �`j J� LICENSE NUMBER LICENSE TYPE BUS. LIC K ��+�.1 � COMPANY NAME E MA�6 � � � , y � FAX STREET ADDRESS Loo CITY, STATE, ZIP �,�� ` PIN. o PHONE ARCHITECT/ENGINEERNAM LICENSE NUMBER�\ BUS. LIC # COMPANY NAME C,per E-MAIL,��®��,�e�o� FAX 'C•C a®q STREET ADDRESS 401S \) o o a CITY, STATE, ZIP Y p o ,(LI o :;rPHONEA_��o "6tAATLb��6 DESCRIPTION OF WORK —j Q� o Ca,% W� o X EXISTING USE omcat r .q'S° tiL ��45 PROPOSED USE CONSTR C p� l 611 TYPE s09 # STORIES 1 USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA '—S ®\ DEMO AREA TOTAL NET AREA �� l, 3 ®, BATHROOM5 REMODEL AREA � I A KITCHEN REMODEL AREA 1� OTHER REMODEL AREA PORCH - I Y DECK AREA I ` TOTAL DECKIPORCH AREA , 6 . 1❑YES GARAGE AREA: DETACH P ot/ [] ATTACH #DWELLI GUNITS: IS A SECOND UNIT SECONDDSTORY []YES ti p BEING ADDED? 0 ADDITION? &No ^❑ PPE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN YES RECE� TOTAhVp'N: PLANNINGAPPL# []NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO M By my signature below, I certify to each of the following: I am the property owner or authorized(agIL4 to act on the property owner's behalf l have read this application and the information I have a is correct. I have read the Desc .on of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin uildi constructs . 1 thorize repres to 4es of Cupertino to enter the abo -i�r i£iedyprroperty for inspection purposes. Signature of Applicant/Agent: ---+ Date: ri(� SUPPLEMEN L 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 ❑ STANDARD ❑ 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. 1 ❑ ENVIRONMENTAL HEALTH Bfdg4pp_2011.doc revised 06/21/11 A/ lTr"NN T ATTrl A/ 4Tr TTrhTrlTT rrMTrT AT. MECH, HOURLY 0 Yes G No 1-11 ll A `LYW %L. LV ll 1L' 110 ll Al N AL1/ EEE ESTIMATOR - BUff LDffNG DffVffSffGN TYPE OF CONSTR. ADDRESS: 18920 Forge Dr DATE: 01/08/2013 REVIEWED BY: mendez PC FETES APN: BP#: 007 'VALUATION: 1$8o,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building $1,954.90 PENTAMATHON 1B -I -I USE: IBT11NSP PERMIT TYPE: WORK A le- T.I Phase 6- construct hardware model shop 301 sq ft SCOPE MECH, HOURLY 0 Yes G No OCCUPANCY TYPE: TYPE OF CONSTR. F]LR AREA s.f. PC FETES PC FEE Hn HSP FLEES HSP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-e 301 $1,954.90 IBTIPLNCK $610.57 IBT11NSP Strom Motion Fee: 1BSEISMICO $16.80 Select an Administrative Item Bldg: Stds Commission Fee. 1BCBSC $4.00 SUBTOTALS: $2,586.27 $0.00 TOTAL FEE: $2,586.27 TOTALS: 301 $1,954.90 $610.57 I MECH, HOURLY 0 Yes G No PLUMB, HOURLY 0 Yes 0 No ELEC, DOURLY Q Yes 0 No "Vech. flan Check Plumb. Plan Cheer Flee. Plan Check Fleck Pc.rrnit Fee: Plumb. Permit Fae: Flec. Permit Fee: Other kkch. Insp.. Oncer Plumb Insp. Orlier Elcr. Insp. 'Ell I Voch, Insp. Fee: Plumb. hal). Fee Bloc. lnsp. Fec: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc. . These ees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l in o. FEE ITEMS (Fee Resolution 11-053 Efl..' 7/1/12) FEE I�USC ITEMS Plan Check Fee: $1,954.90 Select a Misc Bldg/Structure Suppl. PC Fee: (j) Reg. OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $610.57 Suppl. Insp. Fee,0 Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tae Administrative Fee: 0 E) Work Without Permit? 0 Yes C) No $0.00 Advanced Plannin& Fee: $0.00 Select a Non -Residential Building or Structure 71 ,a 0 z Travel Documentation f Fees: Strom Motion Fee: 1BSEISMICO $16.80 Select an Administrative Item Bldg: Stds Commission Fee. 1BCBSC $4.00 SUBTOTALS: $2,586.27 $0.00 TOTAL FEE: $2,586.27 Revised: 10/01/2012