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04070080CITY OF CUPE, `. .. - ' -- 711,171,11,1711177971 BUILDING DIVISIONSION PERMIT,. _-.. ECONTRACTd�2'[ CUa-DINGADDRESS: SOUTH BAY CONSTRUCTION CO W!TNo04070080 20740 VALLEY GREEN DIR OWNER'S NAME: PERMIT ISSUE DAM APPLE COMPUTER S11 nTVTqTON STREET E:. SANITARY NO. - CONTROL NO. (408)379-0400 ARCHITEC (ENGINEER: BUILDING PERMITINFO BLDG ELECTPLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description p I Wrchy affirm the, I am licensed under provisions of Chapter 9 (cammeneing s Codondm ties. is with Section71H10)of Division 3 of use Business and Pmfmainn,a I. full force and dr C_ 3�q _ _ N - REVISION --IN HOUSE USE ONLY Llcenx ms Lim. DaR ctntnctor NO NEW PERMIT ISSUED/ORIG. #04010076 ARCHMCrSDECLARATIUN 1 u dcntand my plans Shall W used a! puhlic rccoNs Licensed Professional OWNER -BUILDER DECLARATION P hereby affirm Nat 1 am exempt from On Contractor's License Law for the - following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit m construct, alter, improve, demolish, or mpair any atmcture prior us its issuance, also mquires the applicant for such permit to rile a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant o the provisiorR of the Common's License Law (Chapter 9 (commencing with Section 71100) of Division 3 of the Business and Professions Code) or $35 Nat he is exempt Nemfram and the baste for the alleged exemption. Any violadon of APN Number Occupancy Type Sectlon 7031,5 by any applicant for a permit subjtcm Ne eppl¢muo 0 civil pcmity of not more Nen five handled dollars (55001 L owner of the pmpeny, or my a cW. Required Inspections oiN11and F (Sec.Busmen, intended WIIIdO NC WOIk.Ond Ne3WC1aR IS n011nlended O(aQtRd rMlale ($Cc. ]Db. BYSIIVSS do and limitations Code: The Conuacmr! License Law doe! WE apply W an owner or property who builds or improves thereon, and who does such work himsel f or through his own employees, provided Nat such improvements; are not intanded aroffmad for sale. If, however, the building or improvement is Kid within one year of completion, the owner builder will have the burden of proving Nat he did not build or improve for purpose of A xIC `• 1, ownerof convecting withlicensedommaiddorato ❑ I, ct Sm.7 ,B sinesandely d. construct theproject(Sm. 7W, Code:)]Ileves tVKWr9LId andProfessionswho Wilds cede law docs notapplym an owner of property who Wilda nr improves Norton. and, eLa an owner for such projects with a conuacKr(q licensed pursuer m Ne Contractor's whence License Law. Law, \ ❑ I am ezempl under Sec. . B 8: P C for Nis moon Owner Data WORKER'S COMPENSATION DECLARATION I hereby M. under penalty or perjuryro oof the following deelantlon3: ve and will mvntain a CenifiaaR of Console, self-in3uR for Workers Coati setion ass provided for by Section 3700 of the Labor Code, for the performance of Ne work for which this permit is issued. 1 have and will mainion Worker's Compensation Insurance, as required by Section 3700 of Ne laborCode, for the performance of Ne work for which this permit is issued. My Wnr r' rope//pSation lmumn certicr an number am: Carrier., ��a eUEt CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This action need not he camplemd if the permit is franc hundred dollen ($100) or lest.) 1 certify Out in the periummu ce of the work for which this permit is issued. I shell nut employ any person In any mannerm as in became subject to the Workerd L'ampenlation I. of California. Data Applicant NOTICE TO APPLICANT: IL after making this Cenificam of Exemption, you should become subject in the Worker a Compensation provisions of fee Labor Code, you must forthwith comply with such provisions or this permit shall W deemed revoker. CON LENDING AGENCY em is a construction agency for the perfurmence of 1 herby afOrm Net NCR is s d(So.,lending Ne work for which Nis permit u issued (See J09], Civ. C.) Lender's Name � Lender's Address 1 certify that 1 have mad thisapplieation and state that the above information is covet. 1 agree to comply with all city and county ominmmes and suite laws relating to building construction, and herby authorise representatives of this city to crime upon the above-mentioned property for inspection purposes, and keepCupertinoagainst (Wc) agme ro save, indemnify and kith harmless the City theyinanyweytyof mCupcnst id City j liabiliues,judgmenla.colla and miasmas City e�F APPLin ICANTcof the UNDEgrOnANDf this P'WILL COM Y WITH ALL NON INT �tQ Issued by: Dat (/�'�J WA/ SOURCE AE r L&54 a -roofs Type of Roof Signelure o Ap ten n for ate HAZARDOUS MATERIALS DISCLOSURE Willy h applicant or future building occupant st9.1 m..it O Health anmaterial as definadStu by the Cupertino Municipal Code. Chapter 9.12, and tW Health and Safety t Code, Student All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future vilding occupant ..,equipment or ucvices which hattommus air conteminanm defined by Ne Bay Arca Air Quality Management all new materials for inspection. trio? ❑ Yes I have mad the hasarNms materials requirements under Chapter6.95 of the Calif., , vie Health A Safety Cgde, Seeuons 8505,25533 and 25536.1 understand thatifmhe building Jars not cu 0 o L Out it te y responsibility to nobly the u:cup t of the Rquimmm m part suanetofacemma or upon . Signature of Applicant Date G All roof coverings [o be Class "B" or better ownm eau once agent D e CITY OF CUPERTINO QR INF,U�I N BUILDING DIVISION PE10#4`C�NTi2AC BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO ffl!!"N004070080 2074 W NER'S NAME: PERMIT ISSUE DATE APPLE COMPUTER 9 NE: SAN"ARY CONTROL N0. (408)379-0400 ARCHITECT/ENGINEER: - BUILDING PERM" INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description hereby afllrm that I un limraed under previsions of Chapter 9 (commencing with Section 701k1)ofDivisionJof Ibe Business seri Pro(culons Code.aodm liccttse is is full to..md.ff tiC_ (P� _ umnw as, e.» vote caatrI REVISION--IN HOUSE USE ONLY NO NEW PERMIT ISSUED/ORIG. #04010076 ARCH OECLARA 1 1 v dereand my pons shall be used u public records Licensed Professional OWNER-BUILDER DECLARATION I hereby .!firm Nal 1 a.1. exempt from Ne Contractor's License law for the followingreason.(Section ]onstr Business and Code: Any tiny or county ve doiuns which requires Permit construct, aluy improv, demolish. m repair aweum re permit m file sia od suumcnl pith us its i n arse requites the forsucthan Sq. Ft. Floor Area Valuation Contractor's License w that heir llansed pursusal 70th) of Division! the Comuotor'enPoIlsio (Chapter9 licensed p previsions (commencing with Section7000)of Division? of Coca) or exe anion. 35 esemplion. Any violation of that r exempt therefrom and the bur alleged Any the cts ApN Number Occupancy Type subjects dm applicant toadvil pamlly of Section airy it the reddamfor•permit ret mom Nen Rve hundrtd intro (I500). son than five ❑ I.uo uof Nepmpmy,mmyemployaawiNmr-suftirmiemmpewdm, ' Required Inspections will do the .,L..d the swclute isnotinunded or Offered forule (Sec. 7044, Busima and Pmfesalons Cade: The Co metora u«me Law docs ret apply to an owmr of property wha builds or imprewa deman, and who does such work himself or through his own employes. provided alatsmh impresxmenls arc notinmrtdell maffernd formle. If. however, Ne building an improvement I. mid within one year OI mmpktian, Ne mvmF builder will have the bunion of proving that he did oat Wild or Improve for purpose of ale.). ❑ 1, as owner of the property. am exclusively contracting with licensed contractors to conslNcl the project (Sec. 7044, Business and Professions Cade:) The Couraouses Lt. ...a Law dons041 apply w an Owner Of property who bull" or improves Olsson. and, , who concocts for such projects with a eontracwr(q licensed pursuant to the COnV6tora License Law. ❑ l are exempt under See , B A, P C for this reason caner Data WORKER'S COMPENSATION DECLARATION 1 thereby aRren under penalty of perjury one of the fallowing declarmau: ❑ 1 have and will maintain aCenificme of Consent to self-Insure for Worker's Compere align, u provided fm by Section 37M of the labor Code. for the performance of the weak for which this permit is issued ❑ 1 haw and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the perfar umca of the work for which Ibis permit is issued. My Work a ompe sadm Inauun cauicrtn I numberam: Gartner. %1 �' i o.: CERTIFICATE OF EXEMPTION FltOM WORKERS' COMPENSATION INSURANCE (Dtrsecto. reed not W eampleud if nW pemlt is for omhundred dollars (Sim) or Mas.) 1 unify that In the performance of du work for which Ibis Permit Is issued. I shit not employ any person in my mumru as to beconue.bjuella dxworkeri Compenalion Laws of Cahbomia. Dau Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption. you should become subject no the Wmker', COmpcessdan provisions of the lobar Cods, you more forthwith comply with such provisions at Ibis permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affum Nn there is sc agency for the Performance of d (See. 30 7. Clx. ' the work fur which Nb permit r issued (Sec. 709], Civ. C.) Lenders Name Lender's Address 1 cmify than I have mad this application and stat, that the show information is correct. I agree to comply With all city and county ordinances and slate laws misting he building conswaion, and hereby aunhods mpresenmlws of this city no enurupnn the show-mentioned property for inspection Purposes / " 3 (We) sag. in saw. Indemnify ad keep harmleas the City Of Cupertino against ` A j liabilities judgments, costs and expenses which may in any way cc= agumt said City / \\Jl I. consequence or the ganting of this permit. ' APPLICANT UNDE AND A 'WILL COM Y WITH ALL NON- INT Issued by:9 Dat SOUBCERE r ' lL aC T J e-roofs , Type of Roof Signature 0rApotmilemliucherau HAZARDOUS MATERIALS DISCLOSURE Wit the applicant or fuwm building mcupam sum or haodlc he'rsrdous materiel as dai by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Coda, Seaton 25532(a)7 All roofs shall be inspectedn to any roofing material being Installed.❑Yea N prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or fuwu vilding occupant tau equipment or devices which ma M.,mus alt conuuinanu defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes tXN. 1 haw mad the hnudomanderialso quiremema under Chepterh.95 of the Califon nice Hc4lth & SafenyCpde. Sections 25505.25533 and 75534.1 understood Nati!do Wilding dao not cu hit ow It, Nat in r y hollyrtspomto notify the ottu n of the mquimmc t m nprior vancoafaCcrtihcauof span . Signature ofApplicant Date L All roof coverings to be Class "B" or better 0wner Tau mn'a agent Da •CUPEI�TINO a IBM,, CITY OF CUPERTINO 67 o Ur 0� PERMIT APPLICATION FORM o-e� 0 APN # O Fee Description Date: 5 D Building Address: 11�t�� Mailing Address (if different from building address): zoo D �re2 i✓� BBOILER2 Owner's ame (e_ C� �t MECHANICAL Phone #: % � —88( Boiler> 500K to IM Btu « BBOILER4 Boiler>.IM.to 1.75 M Btu Contractor ]o,,A CtanS�rw� �-c�.-39f License #: 1SS I Contact: Q Phone: 1 3 Cupertino Business License#: C'CAFax: Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Buildine Permit Info: BUILDING BCONSTAXH Hotel and Motel Bldg Elect ❑ Plumb ❑ Mech ❑ Job escription: Elec 600V <= 1000A ELECTRICAL BELEC1001 Residential ❑ ELECTRICAL BELEC200 Elec Svcs 600V <= 200A Sq.Ft. Floor Area: BENERGY Energy $/S .Ft.: Cost of Project: Energy Add Multi BUILDING Occupancy Group: Type of Constru tion:Please LOY t'5 BUILDING check this box if the project is a ❑ AY- +-Q--C i 6,. a-*. 4 1 second -story addition: Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BB0I1,ER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler>.IM.to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu - MECHANICAL BCONSTAX Construction Tax BUILDING. BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING C. 1 of 3 OITY OF CUPERTINO* CUPEt�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCONEAE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMYOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CUPEI,TINO OCITY OF CUPERTINA PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERNUTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING �e 3 of 3 •CUPEI�TINO a IBM,, CITY OF CUPERTINO 67 o Ur 0� PERMIT APPLICATION FORM o-e� 0 APN # O Fee Description Date: 5 D Building Address: 11�t�� Mailing Address (if different from building address): zoo D �re2 i✓� BBOILER2 Owner's ame (e_ C� �t MECHANICAL Phone #: % � —88( Boiler> 500K to IM Btu « BBOILER4 Boiler>.IM.to 1.75 M Btu Contractor ]o,,A CtanS�rw� �-c�.-39f License #: 1SS I Contact: Q Phone: 1 3 Cupertino Business License#: C'CAFax: Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Buildine Permit Info: BUILDING BCONSTAXH Hotel and Motel Bldg Elect ❑ Plumb ❑ Mech ❑ Job escription: Elec 600V <= 1000A ELECTRICAL BELEC1001 Residential ❑ ELECTRICAL BELEC200 Elec Svcs 600V <= 200A Sq.Ft. Floor Area: BENERGY Energy $/S .Ft.: Cost of Project: Energy Add Multi BUILDING Occupancy Group: Type of Constru tion:Please LOY t'5 BUILDING check this box if the project is a ❑ AY- +-Q--C i 6,. a-*. 4 1 second -story addition: Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BB0I1,ER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler>.IM.to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu - MECHANICAL BCONSTAX Construction Tax BUILDING. BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING C. 1 of 3 OITY OF CUPERTINO* CUPEt�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCONEAE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMYOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CUPEI,TINO OCITY OF CUPERTINA PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERNUTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING �e 3 of 3