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15070134I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20525 MARIANI AVE OWNER'S NAME: 20525 MARIANI DRIVE LP OWNER'S PHONE: 4084721275 Lv LICENSED CONTRACTOR'S DECLARATION License Clas s o'�z_ Lic. N ��7(t ( n, � Contractor '1�- Date_716::-�'/J 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 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. 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 -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. �� �X Signat�e - Yr - Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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. 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 Califomia. 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. Date CONTRACTOR: DEVCON PERMIT NO: 15070134 CONSTRUCTION INC 690 GIBRALTAR DR DATE ISSUED: 07/20/2015 MILPITAS, CA 95035 PHONE NO: (408)942 -8200 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ APPLE TI PREP ON FIRST FLOOR FOR FUTURE TENANT IMPROVEMENT (8672 SQ FT). Sq. Ft Floor Area: I Valuation: $0 APN Number: 32656001.20525 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS IT ISSUANCE OR 180 DAYS FRO -LA ALLED INSPECTION. Issued Date: RE- ROOFS: 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. Signature of Applicant: Date: 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 Code, Sections 25.505, 25533, and 25534. GCS Owner or authorized age t:` 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 • building @cupertino.org � 5c 7O ` 3 ❑ NEW CONSTRUCTION ❑ ADDITION D4 ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # _�V6 OWNER NAME PHONE /,t- za a.1ai� E-MAIL S "IREL''F ADDRESS CI'LY, ' "I'�r�V`��� CONTACT NAME PHONE E -MAIL fC t�' �G rc S "fREE "I'AD DRESS » \' 1C�J CITY, STATE, ZIP C'p, PAX F� "�. Vv w, 941105 tA`I -k G ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME G µl -� LICENSE NUMBER39� 1 LICENSE TYPE BUS LIC k COMPANY NAME E -MAIL FAX yob STREET ADDRESS CITY, STATE, ZIP 9ro-SS PHONE -S13 vpy�N_% Ck y6t -OS,4 ARCHITECT /EN GINEERsNAME C ("F-A LICENSE NUMBER /^ -�\ a j jC\ l� BUS LIC # COMPANYNAME �vCC:C1�1 AR(� \�liZ -\J E -MAIL � IIt ['CSC,- QL�1Q'�C1S•C.�/'' FAX �+ �'S"1 STREET ADDRESS '3(.\ 'j� vA Stit�x CITY, STATE. P p 1-r FiLA�clSto C� l41ol PHONE DESCRIPTION OF WORK -� -�- EXISTING USE dff) c e, L.D. PROPOSED USE CONSTR. OF�-) CF5 I LAS TYPE # STORIES USE TYPE OCC. SQ FT VALUATION I$) EXISI '(', AREA AREA NEW FLOOR AREA DEMO � AREA TOTAL NET AREA -71� y , I��� BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNTI S 1S A SECOND UNIT [] YL'S SECOND STORY ❑YIiS BEING ADDED? ❑NO ADDITION? []NO PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REe IIY ; TOTAL VALUATION: "a PLANNING APPI, k []NO PLANNING APPROVAL LETTER EICHLER HOML? NO 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. 1 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 for inspection purposes. Signature of Applicant/Agent, Date: S SUPPLEMENTA FORMATION REQUIRED PLANCAECKTVPE.: ROUTIING$ILIP oviRT COn1 TtR '1Iq B(,T DI[NGYLA14, REVdEW _ 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. CI EXPRESS ❑ PLANNING PLANREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORDS 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 ❑ � DISTRICT submittal of Building Permit application. MAJOR SANITARY SEWER ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doe 1-evised 06/21/11 FM_7 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictri!' /_ Pt!'_ ) _. Tho.vo foov are lia.Ced an tho preliminary infarmatian availahle and are only an estimate. Contart the lent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff: 7 /1,13) ADDRESS: 20525 Mariani Ave DATE: 07/20/2015 REVIEWED BY: Sean APN: BP #: / , V 'VALUATION: 1$25,000 RPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARY USE: Commercial Building Civil / Religious activities in B zone? Yes Q ® � No PENTAMATION PERMIT TYPE: 1TIPREP WORK Apple TI prep on first floor for future tenant improvement (8672 sq ft). SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictri!' /_ Pt!'_ ) _. Tho.vo foov are lia.Ced an tho preliminary infarmatian availahle and are only an estimate. Contart the lent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff: 7 /1,13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 = # $417.00 Tenant Improvement Prep 1TIPREP Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee :Q Reg. Q OT FO.O hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONST,4XC $0.00 Work Without Permit? © Yes O No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure A zil r Strong, Motion Fee: IBSEISMICO $7.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $8.00 $417.00 TOTAL FEE: $425.00 Revised: 07/02/2015 CUPERTINO 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: kb�TQ;b—Z:11 PERMIT # OWNER'S NAME: PHONE # — Cq GENERAL CONTRA R: A BUSINESS LICENSE # p ADDRESS: -„ CITY /ZIPCODE: *Our municipal code requires all businesses working in tfie 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical1.� -- ®c (� 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 Owner / Contractor Signature Date