B-2017-0629 CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO �408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq
❑NEW CQhSI-RL'C'fI[]N ❑ ADDITION ALTERATION/TI ❑ RL:VIS30N 1�EF£RR[D ORIGINAL PERMIT#
PROJECT ADDRESS 1 9333 V8IIC0 PBfICWa�/ ^P"# 316-20-075
OWNERNAME Apple Inc. c/o Eileen Molloy PHONE 408-974-5951 E-MAIL emOIIO a le.com
Y@ PP
STREETADDRESS,� IC1fIflltE LOOp, mailstop 18-DDC C[TY, STATE,ZIP FAX
corrrncT NnME Bryan Carrera, Nterra Group PxoNE408.610.9958 E-MAI`bryan@nterragroup.com
STREET ADDRESS CITY,STA"CE, ZIP FAX
1155 N. First Street, Suite 214 San Jose, CA 95112
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENC ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITEC'C �ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Christine Minert LICENSENUMBER 916366 L[CENSETYPE B BUS LIC#
COMPANYNAME Barron Builders E-MAIL cminert@barronbuilders.com F�
STREET ADDRESS C1TY,STATE,ZIP PHONE
415 Clyde Ave, Suite 105 Mountain View, CA 94043 650.964.4493
ARCHITECT/ENGINEER NAME L[CENSE NUMBER BUS L1C#
Matt Benas
coMrar,vNnME Mobile Modular Rents E-MAIL Matt.Benas@mobilemodular.com FAx
STREE"C ADDRESS 5700 L8S POSItBS ROaCj c�TY,s-rnre,ziP Livermore, CA 94551 PHONE 925.453.3122
oescxirrroN oF woxK Installation and operation of temporary modular building and necessary sitework, including flatwork
upgrades for accessibility, underground utility connections and site lighting attached to modular building. The project will
require (1) parking lot light pole and (2)trees to be removed for the period of time the modular building is in use.
tX151 lNG USE PROPOSED USE CONSTR TYPE #STORIES
USE rYPE OCC SQ.FT VALUATION(�)
EXISTG NPW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITC[-�N U I tltl(
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA CiA1tAGr.4ktt.A: U Ut I ACH
�ATTACH
#DWELLINGUNITS: ISASECONDUNIT QYES SECONDSTORY �YES
BEINGADDED? QNO ADDITIONY '�]NO
PRf-APPLICAT[ON �YES �'YES,PROVIDE COPY OF IS THE BLDG AN �YES RECEIVED BY: TOTAL VALUATION�
PLANNINGAPPL# �NO PLANNINGAPPROVALLETI'ER EICHLERHOME? �NO 300,000
By my signature below,I certify to each ' ' I lo�ti ing: m the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information 1 ro�•i is COrrec I have read the Description of Work and verify it is accurate I agree to comply with all applicable local
ordinances and state laws re1� � g to b ild �� �onstruct n I au orrr.e represerttatives of Cupertino to enter the above-identified property for inspection purposes.
SignatureofApplicanUAgent: � Date: 4/18/17
SUPPLEMENT11}._ .���ORMATION REQUIRED pLANCHECKTYPE ROUTINCSLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TH�COUNTER ❑ BO[LDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ Exv�ss ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sT.vwaxn ❑ eusL�c wox[cs
form if any Hazardous Materials are being used as part of this project. O Lutce ❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ �ox ❑ SAIVITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIItONMENTALHEALTH
BldgApp_2011.doc revised 06/21/11
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 • building ancuDertino.org __10 11— 0OZ9
❑ NEW CONSTRUCTION ElADDITION 0 ALTERA. 7 REVISION J DEFEUCUPERTINO I D
PROJECT ADDRESS 19333 Vallco Parkway APN 0 316-20-075
OWNERNAME Apple Inc. c/o Eileen Molloy PH°NE 408-974-5951
E-MA,L emolloy@apple.com
STREET ADDRESS 1 Infinite Loop, mailstop 18 -DDC
CITY, STATE, ZIP
FAX
CONTACT NAME Bryan Carrera, Nterra Group
PHONE 408.610.9958
F-MAILbryan@nterragroup.com
STREET ADDRESS 1155 N. First Street, Suite 214
CITY, STATE- ZIP San Jose, CA 95112
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT • ENG MI ER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
Christine Minert
LICENSE NUMBER 916366
LICENSE TYPE,
B
BU C
COMPANYNAME Barron Builders
E-MAIL cminert@barronbuilders.com
FAX
STREET ADDRESS
415 Clyde Ave, Suite 105
CITY, STATE, ZIP
Mountain View, CA 94043
PHONE
650.964.4493
ARCHITECTJENGINEER NAME Matt Benas
LICENSE NUMBER
BUS LIC #
COMPANYNAME Mobile Modular Rents
EMAIL Matt.Benas@mobilemodular.com
FAX
STREET ADDRESS 5700 Las Positas Road
CITY, STATE, ZIP Livermore, CA 94551
PHONE 925.453.3122
DESCRIPTION OF WORT: Installation and operation of temporary modular building and necessary sitework, including flatwork
upgrades for accessibility, underground utility connections and site lighting attached to modular building. The project will
require (1) parking lot light pole and (2) trees to be removed for the period of time the modular building is in use.
EXISTING USE
PROPOSED USE
CONSTR TYPE
it STORIES
I
USE
TYPE
OCC
SQ FT_
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
.AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN OTHER
REMODEL AREA
REMODELAREA REMODELAREA
PORCH AREA
DECK AREA TOTAL DECKTORCH AREA
GARAGE AREA: DETACH
ATTACH
#DWELLING UNITS:ISASECOND
UNrr ❑YES
SECOND STORY YES
BEING ADDED! ❑NO
ADDrrION! ❑NO
PRE -APPLICATION YES IF YES, PROVIDE COPY OF
IS THE BLDG AN 0 YES
R BY TOTAL VALUATION'
PLANNING APPL u NO PLANNING APPROVAL LETTER
EICHLER HOME! 13NO
300,000
By my signature below, I certify to each Ilowlng: m the property owner or authorized agentTo act on the property owner's behalf: I have read this
application and the information 1 ovi is coffee I have read the Description of Work and verify it is accurate I agree to comply with all applicable local
ordinances and state laws reh g to b dd nstfurt n [a rize representatives of Cupertino to enter the above -identified property for inspection purposes
oe
-�� 4/18/17
Signature of ApplicanUAgent: Date:
SUPPLEMENTA . FORMATION RF,QU[RFD
PLAN CKEXX TYPE
ROG'rINGSLIP
11OVE&THE•COUNTER
11BOU,DMG 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
❑ PLANNMI PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11STANDARD
❑ PUBLIC WORICS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
Cl FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ INAMR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_1011.doc revised 06/21'11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0629
19333 VALLCO PKWY CUPERTINO, CA 95014-2506 (316 20 075) BARRON BUILDERS
OWNER'S NAME: Mrs Ellen Molloy ( APPLE INC)
OWNER'S PHONE: 408-974-5951
License Class @ Lic. #916366
Contractor BARRON BUILDERS INC Date 07/31/2017
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:
t. 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.
2. 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.
Additionally, the applicant understands and will comply with all non -point
source regulations
per the Cupertino Municipal Code, Section 9.18.
io/�
Signature �,L�f" Date 06-14-2017
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:
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.
2. 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.
3. 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 06-14-2017
SANTA CLARA, CA
95054
DATE ISSUED: 06/14/2017
PHONE NO: (650) 964-4493
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
INSTALLATION OF MODULAR BUILDING (5680 sq ft) -APPLE
Sq. Ft Floor Area: Valuation: $300000.00
APN Number: Occupancy Type:
316 20 075 A (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 06/14/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 06-14-2017
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 CodeSec�5505, 25533, 5534
Owner or authorized agent:
Date: 06-14-2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional