B-2018-2041 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-2041
18880 HOMESTEAD RD CUPERTINO,CA 95014-0721(316 09 037) DEVCON
CONSTRUCTION
INCORPORATED
690 GIBRALTAR DR
MILPITAS,CA 95035
OWNER'S NAME: DATE ISSUED:02/19/2019
OWNER'S PHONE: PHONE NO:408.942.8200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#399
Contractor DEVCON CONSTRUCTION INCORPORATED Date 02/28/2021 X BLDG _ELECT _PLUMB
MECH_RESIDENTIAL X COMMERCIAL
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. JOB DESCRIPTION:
APPLE HSO l-T.I.(100,084 SF)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1 -ACCESSIBILITY ROUTE SIDEWALKS;CATCH BASIN;
1. I have and will maintain a certificate of consent to self-insure for Worker's REMOVE HVAC LOCATED ON ROOF-ISSUED 5-7-2019
Compensation,as provided for by Section 3700 of the Labor Code,for the DEF#I-ELECTRICAL EQUIPMENT ANCHORAGE-ISSUED
performance of the work for which this permit is issued. 06/19/2019
2. I have and will maintain Worker's Compensation Insurance,as provided for by DEF#2-UPS SPECIFICATIONS AND VOLUME(GALLONS)OF
Section 3700 of the Labor Code,for the performance of the work for which this CORROSIVE ELECTROLYTES-
, permit is issued.
Sq.Ft Floor Area: Valuation:$20332579.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 09 037 A(Tenant Improvements),B(Tenant Improvements)
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source
Signature . = 'Date 06/19/2019 Y
Issued b :Jasmine Archbold
-�
Date:02/19/2019
OWNER-BUILDER DECLARATI N
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:06/19/2019
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure far Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Code,for the
perforinance of the work for which this permit is issued. I HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25505,X2553 Va d 534.
be deemed revoked. -
APPLICANT CERTIFICATION gate:06/19/2019
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 06/19/2019 Licensed
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
10300 TORRE AVENUE e CUPERTINO, CA 95014-3255
(408) 777-322 buildln Ccu erino.or PERMIT#B- �-
_ ,
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION'ZT.I. El MEP ❑RE-ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS APN#
OWNER NAME PHONE E-MAIL
STREET ADDRESS pb CITY,`JSTATE,ZIP
CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
STREET ADDRESS C7iITY,STATE, ZIP
E-MAIL LPHONE BUS.LIC#
Q 4 1 C)Q-A
A cov,% -<_,,c.:zA;,`).�A q
❑ARCHITEC'T OOWNER ❑OWNER AGENT ❑CONTRACTOR AGENT[]ENGINEER❑DEVELOPER❑TENANT
CONTACT NAME E-MAIL
G-,
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTON
•,.• .., -;,.fs+...... w�`-, i,,.....•.. 'A ,.F""..`" .w. "...4,rd',. ,^ � ,� "....,.. "'•�,....e. -•P f'..F.. .. ".,®+...� `kb,,`�r(A''`a.,,., �"" ""'�..... ti ;'�.T"tw^:, ` t�
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL COMMERCIAL.
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO 5, S TORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR. GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISING r.%q YES ® YES SECOND STORY ADDITION C�YES
FIRE SPRINKLERS[] NO EICHLEII ® NO ®NO
DWELLING SECOND DWELLING ®YES ❑ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON; ❑NO S F
POOLS ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑ PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED❑YES ❑ NO TOTAL-,9F
RECEV,PD BY: TOTAL VALUATION:
Commercial or Multi-Farmly Buildings with Public Swimming Pools requires Dgartment of Environmental Heath approval �J
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES[]WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO I IF NO PLYWOOD ❑1/2i, ®3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER •12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
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 provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinarjces and state laws relating to building construction. I authorize representatives of Cupertino to
i
enter the above-identified property fcw s �ection purpose's. I acknowledge and authorize all informati `n contained q , is application form
to be made available for public record. ',� fir,,
Signature of Apphcant/Agent: Date:c.. 1
SUPPLEMENTAL INFORMATION REQUIRED/
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials'are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
WHOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08101117
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-2041
18880 HOMESTEAD RD CUPERTINO,CA 95014-0721(316 09 037) DEVCON
CONSTRUCTION
INCORPORATED
690 GIBRALTAR DR
MILPITAS,CA 95035
OWNER'S NAME: DATE ISSUED:02/19/2019
OWNER'S PHONE: PHONE NO:408.942.8200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#399163
Contractor DEVCON CONSTRUCTION INCORPORATED Date 02/28/2021 x BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
APPLE HS01 -T.I.(1005084 SF)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1 -ACCESSIBILITY ROUTE SIDEWALKS;CATCH BASIN;
I have and will maintain Worker's Compensation Insurance,as provided for by DEF#2-UPS SPECIFICATIONS AND VO UME,(GA LONS)OF
Section 3700 of the Labor Code,for the performance of the work for which this CORROSIVE ELECTROLYTES- IQMCI 0i
permit is issued.
APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$20332579.00
1 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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 09 037 B(Tenant Improvements)
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations jaer the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Si n/
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/26/19
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Labor Code,I must forthwith comply with such provisions or this permit shall the Health&;
be deemed revoked.
Owner or authorized �..�
APPLICANT CERTIFICATION Date:6/26/19
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code, Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 6/26/19 Licensed
CONSTRUCTION PERMIT APPLICATIONNt
w
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
' 10300 TORR E AVENUE • CUPERTINO, CA 95014-3255 1,1 00"
(408) 777-3228 buildl.ngL@cupertina.arg PEMIT#B
CUPERTINOREV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION E]T.I. EIMEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN#
18880 Homestead Rd, Cu-nertino,CA 95014-0712 316-09-037
OWNER NAME PHONE E-MAIL
Apple, Inc 4159870682 t eyang3@apple.com
STREET ADDRESS CITY, STATE,ZIP
One Apple Park Way Cupertino,CA 95014
21 CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
Daniel Alfaro Devcon Construction, Inc. 399163 B
STREET ADDRESS CITY,STATE, ZIP
690 Gibraltar Dr. Milpitas,CA 95035
E-MAIL PHONE BUS.LIC#
dalfaro@devcon-const.com (408)964-5602 400045
❑ARCHITECT Q OWNER ❑OWNER AGENT ❑CONTRACTOR AGENT[I ENGINEER❑DEVELOPER ❑TENANT
CONTACT NAME E-MAIL
Ellen Yang eyang3@apple.com
STREET ADDRESS CITY,STATE,ZIP PHONE
One A le Park Way Cupertino, CA 95014 4159870682
DESCRIP'FON
Deferred Submittal for UPS SPECIFICATIONS AND VOLUME GALLONS OF CORROSIVE ELECTROLYTES.
[]SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL El COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(�)
B-business 100,084 100,084 2
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BA'I':H:ROOM SF SF SF SF ❑DETACIIED
EXISING El YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRESPRINKLERS ERS❑ NO ❑ NO ❑NO
DWELLING SECOND DWELLING []YES ❑ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO S F
POOLS1 FIBERGLASS []VINYL-LINED ❑GUNITE ❑ PREFABRICATED
PMOL-SF __--_.__�. SPA-SF SPA ATTACHED❑YES ❑ NO TOTAL-SF
RECEI1I3 TOTAL VALUATION:
Cojrtnrercla or Multi-Fnnnity Buildings with Public Szvintrrtin Pvols re wires L��int t�rtcr7l n Enz�ironnierrtrrl Ncnfh r7�rYoTyC�I � � �� q� �'
=-RE-R,00EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPI-IALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
�JF
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'�� ❑3/8" PLYWOOD'TYPE: PITCH:CH: ROOF CLASS
YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SI-iINGLES ❑WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
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 provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property �or inspectio p iirposes. I acknowledge and authorize all information c tai 4ed on�t is application fon
to be made available for public record
Signature of Applicant/Agent: 3 Date:
r
EMENTAL INFORMATION REQUIR L3
FD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
ercial buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
Provide a letter of approval frons the Home Owner's Association
Bld,gAPp_2017.doe revised 08101117
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-2041
18880 HOMESTEAD RD CUPERTINO,CA 95014-0721(316 09 037) DEVCON
CONSTRUCTION
INCORPORATED
690 GIBRALTAR DR
MILPITAS,CA 95035
OWNER'S NAME: DATE ISSUED:02/19/2019
OWNER'S PHONE: PHONE NO:408.942.8200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#399163
Contractor DEVCON CONSTRUCTION INCORPORATED Date 02/28/2021 x BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
APPLE HSO 1 -T.I. (100,084 SF)
I hereby affirm under penalty of perjury one of the following two declarations: REV#1 -ACCESSIBILITY ROUTE SIDEWALKS;CATCH BASIN;
1. I have and will maintain a certificate of consent to self-insure for Worker's REMOVE HVAC LOCATED ON ROOF-ISSUED 5-7-2019
Compensation,as provided for by Section 3700 of the Labor Code,for the DEF#1-ELECTRICAL EQUIPMENT ANCHORAGE-
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfonnance of the work for which this
permit is Issued. Sq.Ft Floor Area: Valuation:$20332579.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31609037 A(Tenant Improvements),B(Tenant Improvements)
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
g Date 5-7-2019 Issued by:Jasmine Archbold
Si nature
Date: 02/19/2019
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sce.7044,Business&Professions Code). Date:5-7-2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the perfonnance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.1.2 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505 25533, nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date: 5-7-2019
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENC
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed �
Signature Date 5-7-2019
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-2041
18880 HOMESTEAD RD CUPERTINO,CA 95014-0721(316 09 037) DEVCON
CONSTRUCTION
INCORPORATED
690 GIBRALTAR DR
MILPITAS,CA 95035
OWNER'S NAME: DATE ISSUED:02/19/2019
OWNER'S PHONE: PHONE NO:408.942.8200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#399163
Contractor DEVCON CONSTRUCTION INCORPORATED Date 02/28/2021 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
APPLE HSO 1 -T.1.(100,084 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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. Sq.Ft Floor Area: Valuation:$20332579.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31609037 A(Tenant Improvements),B(Tenant Improvements)
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
F �
Signature Date 02/19/2019 Issued by:Jasmine Archbold
Date:02/19/2019
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:02/19/2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. ®caner or authorized agent:
APPLICANT CERTIFICATION Date:02/19/2019
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY .
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agencyf-r the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 02/19/2019 Licensed