12080102 CITY OF CUPER'TINO BUILDING PERMIT
BUILDING ADDRESS: 20525 MARIANI AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 12080102
OWNER'S NAME: 20525 MARIAN►DRIVE LP 851 BUCKEYE CT DATE ISSUED:08/09/2012
OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ LICENSED CON'CRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
License Class Lic.# tr04 -7 4 &o
MECH F RESIDENTIAL F COMMERCIAL r—
Contractor XL CONSTQ.UCI16P' Date J31911L
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APPLE-INTERIOR DEMO OF CEILINGS AT PORTIONS
(commencing with Section 7000)of Division 3 of the Business&Professions ALONG
Code and that my license is in full force and effect. HALLWAYS ON ALL THREE FLOORS(1-3)OF EX.
OFFICE/LAB SPACE;FLOOR 3 INSTALL NEW CONSTRUCTION
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.
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
permit is issued. Sq.Ft Floor Area: Valuation:$759000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:32656001.20525 Occupancy Type:
correct. I agree to comply with ail 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, PERMIT EXPIRES IF WORK IS NOT S'TAR'TED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WI'T'HIN 180 DAYS OF PERMIT ISSUANCE OR
with all non- 'nt sourc re ulations per the Cupertino Municipal Code,Section 180 DAYS R M[ LASTCALLED INSPEC'T'ION.
9.18. ./�
Signature Date lssu rJ Date:
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,i shall contaminants as defined by the Bay Area Air Quality Management District l will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Heal T& cty A' 1d
e,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this pernnit shall be deemed revoked. O agent:
Date:
1
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of%kork's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City ofCupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCIIITECC'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
F410'. 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINIO (408) 777-3228• FAX (408)777-3333• building(cDcupertino.org
❑NEW CONSTRUCTION ❑ 6g&TION ❑ ALTERATION I TI ❑ REVISION/DEFERRED ORIGINAL PERMIT O
PROJECT ADD11
gESS J ` ( APN H ��E ' j ,
Z$ 1
OWNER NAMEOIV �D0 ` � PHONE 4(p 22`� -MAI .�
794A �b
STREET ADDRESS _ CITY, STATE,ZIP �{ FAX
tJ�1 N`Z c l�QC7� C.�`P�-e-•1► Q
CONTACT L 6 t PHONE J 4� E-MAIL 'CQ
STREET ADDRESS _ qq,�, � CITY,STATE, ZIP FAX
1�1 1ZC CXO "i
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGajEFR ❑ DEVELOPER ❑ TENANT
CONT CTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
-r 604-7 6 9 7 11bo
COMPANY NAME E-MAIL FAX
CANS L rp1J f oN -iC-710ta
STREET ADDRESS CITY STATE,ZIP l PHONE - T
Kip C 10—
ARCHITECTIENGINEER NAME S C T LICENSE NUMBER BUS.LIC k c—
COMPANY NAME , E-MAIL-�VA fes"' FAX
ZZ L� M
STREET ADDRESS CITY,STATE,ZIP PHONE
q65 N� SZDru S r 5Mv 65a_ 7S/
DESCRIPTION OF WORK
LI N6 - MEN CE11ir&q ^l I 5 5 L S -
3�c ES -L
Ptil�vc le i 0 kU Pr Nom] L� 5�f�e t szoto'elE 100 1:7
EXISTING USE PROPOSED USE CONSTR.TYPE N STORIES
USE TYPE r OC SW-) VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL.
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECIUPORCH AREA GARAGE AREA: LJ DETACH
[]ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? C]NO ADDITION' []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES R£CEI ED B.Y: TOTAL VALUATION:
PLANNING ADPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? []NO ,,It� �ny 000
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 ha a provided is co ect. 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 t DO co Vtin. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TY E ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE}COUNTER UIL.DING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. C3 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
submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTALIIEALTH
B1dgApp_2011.doc revised 06/21/11
GI'I'V OF CUPIERTINO
IEEE ]ESTIMATOR - BUILDING DIVISION
tADDRESS: 20525 Mariani Ave DATE: 08/09/2012 REVIEWED BY: Sylvia
N: BP#: 'VALUATION: 1$759,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK Ale- interior demo of ceilings at onions alonghallways on all 3 floors of ex. office/lab space- 3 floor
SCOPE install new construction of non load bearing walls, doors and associated finishes
'h'Ir. Plan Cli,r k Plumb. Plan Check Flee. Plan Check
�h11:11. Permit Fee: Plumh. Permit Fee: L'lec.Permir Fee:
Ofhcr.1fec h. lnvp Other Plumb lnrp. EIF--[- Other Elec. Imp. Li
ilcfb. Insp. 6-o- Plumb. {u,p. Fee' Elec.lnrp. f'ee.
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 lite prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolulion 11-053 U.' 7111111 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ()Yes (E) No $0.00 hours Plan Check,Hourly
Suppl. PC Fee: (D Reg. () OT 0.0 hrs $0.00 $266.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? Q Yes Q No $0.00
Suppl. Insp. Fee:Q Reg. Q OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cmzswuction Tax: T-T
'Idmini.Ntruti4e Fee:
Work Without Permit? Yes E) No $0.00 0
Advanced Plannin Fee: $0.00 12 hours Inspections
1'Vai,el Doctunentutimi Fess: $1,596.00 ISTINSP Inspection, Hourly
Strong Motion Fee: IBSEISMICO $159.39 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $31.00
SUBTOTALS: $190.39 $1,862.00 TOTAL FEE: $2,052.39
Revised: 07/01/2012
uilding Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone:408-777-3228
C O P E RT I M O Fax:408-777-3333 I
CONTRACTOR SUBCONTRACTOR LIST
JOB ADDRESS:20525 Mariani PERMIT#
OWNER'S NAME:Apple PHONE#4082406340
GENERAL CONTRACTOR:XL Construction BUSINESS LICENSE#647480
ADDRESS:1 Infinite Loop CITY/ZIPCODE:95014
*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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical Sprig Electric
Excavation
Fencing
Flooring/Carpeting Welker Brothers 25264
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper Canterbury 25647
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal Daleys Drywall 26451
Sheet Rock
Tile
Owner/Contractor Signature Date