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11100007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10400 N TANTAU AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 11100007 OWNER'S NAME: CAMPUS HOLDINGS INC 851 BUCKEYE CT DATE ISSUED: 11/08/2011 OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION r— F G9-7 q 6D BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# `f MECH RESIDENTIAL COMMERCIAL� Contractor 1-4%r v\L�.C a2 Date I` 1 hereby affirm that I am licensed under the provisions o Chapter 9 JOB DESCRIPTION:APPLE-1 ST FLOOR-COMM T.I(3000SQFT);NEW (commencing with Section 7000)of Division 3 of the Business&Professions CONFERENCE ROOMS,INCLUDES STRUCTURAL,ONLY Code and that my license is in full force and effect. MECHANICAL&ELECTRICAL;NO EXTERIOR WORK 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 Sq.Ft Floor Area: Valuation:$380000 permit is issued. APPLICANT CERTIFICATION APN Number:31618027.10400 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. l' N/1 Issued b Date. Signature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Ow or/arthorized agent- forthwith comply with such provisions or this permit shall be deemed revoked. - - =�- Date: APPLICANT CERTIFICATION 1 CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(-kupertino.org ❑NEW CONSTRUCTION ❑ ADDITIONX❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# '\ PROJECT ADDRESS ^ / APN H / (J / O rJ/J+ ' `(/Ov OWNER NAME Apple IncE-MAIL 408 . 996 . 1010 E-MApC / STREETADDRESS 1 Infinite Loop CITY,STATE,ZIP Cup e rt i no, CA 95014 FAX CONTACTNAME Marco Innocenti PHONE 408 .240 . 6000 7F_M1IL minnocenti@xlconst.com STREETADDRESS 8551 Buckeye Court CTTY,STATE, ZIP Milpitas, CA 95035 FAx 408 .240 .6001 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME Marco Innocenti LICENSE NUMBER 647480 7 LICENSE TYPE B BUS.LIC# 21836 COMPANYNAME XL Construction E-MAIL minnocenti@xlconst.com FAx 408 .240 . 6001 STREETADDRESS 851 Buckeye Court CITY,STATE,ZIPMilpitas, CA 95035 PHoNE408 .240 . 6000 ARCHrmcr/ENGINEER NAME e LL,n (J / tl LICENSE NUMBER BUS.LICfH COMPANY NAME/ tEl E-MAIL i�� FAX t'N7 S_&-3I V f-6f 1 1,�v STREET ADDRESS n t I CITY,ST(L'"" D � C / - �' b b 3 PHONJ�0- _b�/ DESCRIPTION OF WORK S 1 r-G'G� S� Orel� v�,(.�p t r-f-- Ctn✓S�S� ►�-� s� l 1 1^' �►�•� > N� o 1 r-�12 1c.�4 w&- Zi -CX r S i FR 6ES Ga►.1(%1i M\JOFF S 1►-/ rKU 6✓►I✓6 V, EXISTING USE PROPOSED USE CONS TR TYPE #STORIES 9- - I USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW DEMO 1 ` TOTAL AREA ARE O�CL AREA NET AREA -� p U✓� V vlI BATHROOM N A KITCHEN OTHER N/A REMODEL AREA REMODEL AREAN/A REMODEL AREA PORCH AREA DECKA TOTAL DECK/PORCH AREA GARA AREA: DETACH N/A N A N/A N/A ❑ATTACH #DWELLING UNITS N I I SECOND U IT [:]YES SECOND STORY [3 YES /A ®NO ADDITION? NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: T VALUATION: PLANNINGAPPL# UNO PLANNING APPROVAL LETTER EICHLER HOME? WNOT7 t3o'OUD By my signature"below,I cecFify toef th-1610 ng:`T am the propewner orionze agen to ac on a grope owner's beha(£ Chave r�thls pplicatio�amd thflinformation -hYidedis mct._Iha 1.eadiheDsscription-oLW-orkand-verifyIt-isaccurate._Lagee to_comply withallapplicable-local ordinances and state laws relating tokb 'Iding co ction. I au o representatives of Cupertino to enter the above-id ntified property for inspection purposes. Signature of Applicant/Agent: Date: 'A1J3� 1 SUPPLEMENTAL ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwe gs: Apply for demolition permit for ID OVER-TIIE-COUNTER CJ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. Z-95RESS &I-POMNING PIAN RFMEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E] STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ U"DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B/dgApp_201 Ldoc revised 06/21/11