11120018i
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18920 FORGE DR
CONTRACTOR: DEVCON
PERMIT NO: 1 1 120018
CONSTRUCTION INC
OWNER'S NAME: FORGE DRIVE INVESTORS, LLC
690 GIBRALTAR DR
DATE ISSUED: 01/06/2012
OWNER'S PHONE: 4152845700
MILPITAS, CA 95035
PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION
I- I—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.N
r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm that 1 am licensed under theprovisions of Chapter 9
JOB DESCRIPTION: APPLE - PHASE 3 - COMM. T.1 STRUCTURAL(9300SQfi)
(commencing with Section 7000) of Division 3 of the Business & Professions
ADD NEW OPEN WORK SPACE, LABS, VENDOR, AND LOBBY;
INCLUDES MECHANICAL & ELEC"rRICAL
Code and that my license is in full force and effect.
1 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: $651000
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: 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
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,
1
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
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:
hereby affirm that 1 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)
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. 1 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 which this permit is issued.
will maintain compliance with t pertino 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, S ion 5505, 5 and 25
permit is issued.
I�
Owner or authorized agent: Date//�LJ�
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
CONSTRUCTION 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 so ce regulations per the Cuperto Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CUPERTINO
( J 12 -
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(&cupertino.orq
❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION/11 ❑ REVISION/ DEFERRED ORIGINAL PERMIT is
PRO=ADDRESSy/18922 Forge Drive, Cupertino, CA 95014
APN# 316 9030.18920
OWNER NAME Forge Drive Investors, LLC
PHONE 415. 284. 5700
E-MAIL
O Divco West RE Svcs.Inc.
STREET ADDRESS 575 Market St, 35th F1r.
CITY, STATF,ZIP San Francisco, CA 94105
FAX
CONTACT NAME John Rickard, Apple, Inc.
PHONE 408 . 974 .5662
7E -L j rickard@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 29 TENANT
CONTRACTORNAME Jim Leibold
LICENSE NUMBER 399163 7
LICENSE TYPE B
BUS.LICN 11068
COMPANY NAME Devcon Construction, Inc.
E-MAIL j leibold@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 Sabalvaro
LICENSENUMBER C15925 exp.3.31.13
BUS. LIC N
COMPANYNAME Studios Architecture
E-MMLaclemenza@studiosarch.com
FAX 415.398.3829
STREETADDRESS 405 Howard St . , Ste 588
CITY,STATE,ZIP San Francisco, Ca 94105
PHONE415 . 732 . 5332
DESCRIPTIONOFWORK Interior tenant improvements to include new open workspace,
vendor rooms, & labs,,,
EXISTING USE
Office/Labs
PROPOSED USE CONSTR
Office/Labs
TYPE
III -B
p STORIES
1
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA 9, 3 0 0
DEMO
AREA
TOTAL
NET AREA
�r+�
$
51, 0 0 0.00
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA N/A
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTA L DECK/PORCH AREA
GARAGE AREA: DETACH
N/A
N/A
N/A
N/A ❑ATTACH
N 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 H ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ® NO
' • • • • '•' •• •k•'• "
' •k: �• : ;•'
TOTAL VALUATION:
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 prpwided-if correct. I have read the Deseript' Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to Ilding struction. 1.4mWon represent IV f Cupertino to enter the aboypi4entifiep property/ for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED%%
rf ' ;: •:, : :• : ; ,; ; r k.:..r . ,; ,. : • ..:....: : • ::
New SFD or Multifamily dwellings: Apply for demolition permit for
f 'r' °; % ?' ''''' ' '''` '?' '?'''' "` ' l'' •?•
[i.:'..;rl ;;><TlQIl&�ti:':':''%:rl:
� sr
it'spriort i n ofbuilding:;"
existing building(s). Demolition perm t required o issuance
permit for new building.
3Js;?l ','.' '? :r' '?'{ i' °r,l!A1�i'e»svJ:,:.:::'r:•::'
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
"' 'l' ' '' ::.:"' :.`• :. •'•'
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.'k
•: k::.
BldgApp_2011.doc revised 06/21/11
ffi�,� CITY OF CUPERTINO
1 FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 18922 forge dr.
DATE: 12/02/2011
REVIEWED BY: bobs.
PC FEE 1D
APN:
BP#:
"VALUATION:
1$651,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
$5,748.65
PENTAMATION 1131-1
PERMIT TYPE:
WORK
t.i. commercial structural add new open works ace labs vendor, and lobby, includes M.E.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE 1D
BP FEES
BP FEE 1D
B (Tenant Improvements)
II-B,111-B,IV,V-B
9,300
$2,429.02
IBTIPLNCK
$5,748.65
IBTIINSP
PME Plan Check:
$0.00
Permit Fee:
$5,748.65
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
9,300
$2,429.02
$5,74$.65
::.: .:'::.'.':':.:.:....
b? ':;fes::
NOTE: This estimate does not Include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Divtriet. etc.). These tees are hated an the nrelininary information availahle and are only an estimate_ Contact the Dent for addn'1 info.
FEE ITEMS (I,ee Resolution II -053 Eff. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,429.02
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. ® OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$5,748.65
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Pla�lee:
$0.00
Select a Non -Residential
Building or Structure
0
Strong Motion Fee: 1BSEISAfICO
$136.71
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$27.00
:.::::.......... ....... >`1<`$8,341.38
$ :..:::.:.;:.:::..:.:.::.
0.00 :::Q:
$8,341.38
Revised: 10/01/2011
CUPERTINO
�alz(q6 err
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: IS 5 Z, L-0
PERMIT #
OWNER'S NAME: l%fo -ZNz-.
PHONE # 4-6'9— l — C2
GENERAL CONTRACTOR: V60' -N LV ".5-P +
BUSINESS LICENSE #
ADDRESS:6701 �'p(i�l-'(�,DrL
CITY/ZIPCODE:M iLk CA. 9b3
*Our municipal code requires all businesses working 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 NTRACTO HAVE O AINED A CITY OF CUPERTINO
BUSINESS LICENSE. n�i/
I am not using any subcontractors:
1.11 Signat\u-re Date
Please check applicable subcontractors and complete the following information:
s/
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Pjaajering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
ner / ConIT15'etor Signature
Date
X41