12050157 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20625 ALVES DR CONTRACTOR:REDWOOD CITY ELEC PERMIT NO: 12050157
OWNER'S NAME: APPLE INC 2775 NORTHWESTERN PKWY DATE ISSUED:05/21/2012
OWNER'S PI IONF.: 4085904180 SANTA CLARA,CA 95051 PHONE NO:6503695555
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El CObIMERCIAL
IJ
License chis (It 0
Lie�'#--�'- IS� —� TEMPPOWER
Contractor P4Ct � �PLl7er.`b Date—`S- - �� .�� J
1 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 certificale of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of work for whichthis permit is issued. Sq.Ft Floor Area: Valuation:$2000
1 have and will maintain Workers Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32634069.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM 71CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 9
costs,and expenses whidh may accrue against said City in consequence of theL/
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/72
RE-ROOFS:
Signature-6 ---Date—5— I All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without fust obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
:
1 hereby affirm that 1 em exempt from the Contractor's License Lew for one of Signature of ApplicantDale:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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)
I,as owner of the property,am exclusvely contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE:
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District
performance of the work for which this permit is issued. will maintain compliance with the Cup rlino M icipaI Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dale:
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person inany manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code;I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C-)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 stale 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32634069.00
DATE ISSUED. . . . . . . : 05/21/2012
RECEIPT #. . . . . . . . . : BS000016869
REFERENCE ID # . . . : 12050157
SITE ADDRESS . . . . . :. 20625 ALVES DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : APPLE INC
ADDRESS . . . . . . . . . . : 1 INFINITE LOOP MS 38 3TX
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : FERNANDO ROSERO
CONTRACTOR . . . . . . . : HARKER, DENNIS LIC # 21108
COMPANY . . . . . . . . . . : REDWOOD CITY ELEC
ADDRESS . . . . . . . . . . : 2775 NORTHWESTERN PKWY
CITY/STATE/-ZIP . . . : SANTA CLARA, CA 95051
TELEPHONE . . . . . . . . : 6503695555
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -------
-ADMIN HOURS 1 . 00 41. 00 0. 00 41 . 00 0.00
1BCBSC VALUATION 2, 000 . 00 1 . 00 0.00 1 . 00 0 ..00
1BSEISMICO VALUATION 2, 000 . 00 0.. 50 0.00 0 .50 0 . 00
IECT<200 UNITS 1. 00 44 . 00 0.00 44 . 00 0 . 00
1EPERMITFE FLAT RATE 1.00 44 . 00 0.00 44 .00 0 .00
1TRAVDOC FLAT RATE 1.00 44 . 00 0. 00 44 .00 0. 00
TOTAL PERMIT 174 .50 0.00 174 .50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ----
CREDIT CARD 174.50 MC
---------------
TOTAL RECEIPT 174.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------------
304 ROUGH ELECTRICAL 402 TEMPORARY POWER
505 FINAL ELECTRICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20625 Alves Dr DATE: 05/21/2012 REVIEWED BY: Sylvia
APN: BP#: 'VALUATION: $2,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 10EAP14
USE: PERMIT TYPE:
WORK Temp power
SCOPE
L=
1;'':h' l h"y l.lo,1, /Yrr nh P2,1n is Gac k Elec. Plan Check 0.0 hrs $0.00
.I l.a:lr. l'.vnrn fi.•_ l'lurnh, I'cr-rnii I„u Elec. Permit Fee: 1EPERMIT
Odn” l'h.ndr/nsla Other Elec. Insp. E hrs $44.00
,I/rrlr_ /ri•p. P?r' /'boob, bop_Frr: /C/rr,
NOTE: This estimate does not includejees due to other Departments(i.e. Planning,Public Works, Fire,Sanilary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'I info.
FEE ITEMS (hee Rcsohuion 11-053 bYL 71111 1) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00200 amps Electrical
Suppl. PC Fee: Q Reg. O OT FO.01 hrs $0.00 $44.00 IECT<200 I Temporary Power
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q MEEThrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $44.00
(;onsri m tion l'n.
Administrative Fee: IADMIN $41.00 Q
Work Without Permit? O Yes E) No $0.00 E)
Advanced Planttntfl Fee. $0.00 Select a Non-Residential E)
Building or Structure O
Travel Documentation Fee: ITRA VDOC $44.00 A
Strong Motion Pee: IBSEISMICO $0.50 Select an Administrative Item
131de Skis Commission Fee: IBCBSC $1.00 11
SUBTOTALS: $130.50 $44.00 TOTAL FEE: $174.50
Revised: 04/01/2012
GENERAL PERMIT APPLICATION P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 I
CUPERTINO (408)777-3228•FAX(408)777-3333• building(d)cupertino.org
126s'ols�-
PLUMBIN�GPr IOc MECHANICAL ELECTRICALSC
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OWNER:SAME p)e L `1 V�J PHONE i/65 / „)1E-MAIL pasefa �+
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STREETADORESS CITYSTATE.ZfIP H FAX
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CONTACT NAME Fe(-nc�i�C. V"�C�Se QC> PHO76: S'900 L f2x) EMAIL
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❑OwNER ❑ OWNER-BURDER ❑ OWNER AGENT 9 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENAN'T
CONTRACTOR NAMEC�Cc1 woLc( f`I t,L` LICCNSO-U OE�20( LICENSE TYPE BUS.LICA
COMPANY NAME cc�� 11 II LL/--aa..CC''rr N. E-MAIL FAX
STREETADDRESS.nq-/ W��1^ I , \ CITY,STG�,& I 729 -z;-76/6 LHOO
ARCHITECTIENGINEEERR NAME ` �GLiU LICENSE NUMBER C�-I" BUS.LIC!
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COMPANY NAMED / E-MAIL FAX
STREET ADDRESS �JC CITY,STATE,ZIP nom, -r PHONE
USE OF ❑SFDm DUPLE% ❑ MULTYFAMILY PROJECTm WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN L1 YES;
BUJLDLNG. ❑COMMERCIAL URBANI TERFACEAREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK --�11''
- I 5tc4N 1
TOTAL VALUATION: 7006 RECEIVEDB .
By my signature below,I certify to each of the following: I am the property owmer or authorized agent to act on the property oW is behalf. I have read this
application and the information I have vided is correct. I have read the Description of Work and verify,it is accurate. 1 agrc o comply With all applicable local
ordinances and state laws relating to b Idhg eo cuon 1 authorize representatives of Cupenino to embi the abocc 'derni�ed property for inspection pu(poses.
Signature of Applicant/ genes— [ ti— D1 Date.S y
SlIVILEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
❑ O\'F.R-TIIE-COUNTER
❑ EXPRESS
1
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'� ❑ STANDARD
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❑ URGE
c ❑ MAJOR
MEPA4iscApp_2011.doc revised 06/21/11