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11090142CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1 RESULTS WAY OWNER'S NAME: EMBARCADERO CAPITAL PARTNERS 'ER'S PHONE: 4089961010 pf, LICENSED CONTRACTOR'S DECLARATION License Class p Lie.# Contractor XL Date a /Zo i 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. hereby affirm under penalty of perjury one of the following two declarations: 1 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. APPLICANT CERTIFICATION I certify that 1 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 whicyimay accrue against said City in consequence of the granting of this p it dditionally he appl' ant understands and will comply with all non-po' t o e regulation per the pertino Municipal Code, Se tion 9.18. /, e IA9 �� r6 • lfAFA OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: I, 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 exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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 California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that 1 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, coy and expenses which may accrue against said City in consequence of the of this permit. Additionally, the applicant understands and will comply wu..... I non -point source regulatiom per the Cupertino Municipal Code, Section 9.18. CONTRACTOR: XL CONSTRUCTION PERMIT NO: 11090142 851 BUCKEYE CT DATE ISSUED: 09/20/2011 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 BUILDING PERMIT INFO: BLDG f— ELECT I— PLUMB MECH F- RESIDENTIAL f— COMMERCIAL i JOB DESCRIPTION: APPLE -BLDG 14 - DEMO/PREP- COMMERICAL OFFICE SPACE INTERIOR ONLY Sq. Ft Floor Area: I Valuation: $50000 APN Number: 35720041.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued byl. J.r'� cDate: 2,%, - 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 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 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 co pliance with the Cupertino Municipal Code, Chapter 9.12 and the Healtlu& ety C" ) t'( CONSTRUCTION LENDING AGENCY I Ifereby affirm that there is a construction lending agency for the performance of "ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date f Licensed Professional FM -7, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Depts (L e- Public Works, Sanitary Sewer District, School District, etc.). These fees are based on the prelindnary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/UII) ADDRESS: esults way bldg 14 DATE: 09/20/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $50;000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building USE: :•.j, t PENTAMATION 1TIPREP PERMIT TYPE: 19 WORK demo/prep commercial offices ace interior only. SCOPE NOTE: This estimate does not include fees due to other Depts (L e- Public Works, Sanitary Sewer District, School District, etc.). These fees are based on the prelindnary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/UII) FEE ,.Piwi r.,., Plan Check Fee: .'.ori.. .rff.5�l. ?`ler"3' fi�llP•'.; f°�:.0,,h(,:u Elti;,., t.? _.. fN•�J.Ll :•.j, t I 0.0 NOTE: This estimate does not include fees due to other Depts (L e- Public Works, Sanitary Sewer District, School District, etc.). These fees are based on the prelindnary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/UII) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $380.00 Tenant Improvement Prep mpREp Suppl. PC Fee: 0 Reg. () OT I 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT FO.07 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 .1,1minivrnai re fee. 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i T -al l [ecs, Strong Motion Fee: IBSEISMICO $10.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $12.50 $380.00 TOTAL FEE: $392.50 Revised: 09/02/2011 f 109 C � DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(&cuoertino.org CUPERTINO PROJECT ADDRESS 11 Results Way Building 14 APNN 5 q '?0 o OWNER NAME Apple Inc PHONE 408.996.1010 E-MAIL STREET ADDRESS 1 Infinite Loop CITY, STATE, ZIP Cupertino CA 95104 FAX CONTACT NAME John Rickard PHONE 408 .996.1010 E-MAIL STREET ADDRESS 1 Infinite Loop CITY, STATE, ZIP Cupertino CA 95104 FA" ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT FI CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Marco Innocenti LICENSE NUMBER 21836 LICENSE TYPE B BUS. LIC N 647480 COMPANY NAME XL Construction E-MAIL minnocenti@xlconst.CoM FA" 408.240.6001 STREETADDRESS 851 Buckeye Court CITY, STATE, ZIP Milpitas CA 95035 PHGNE408.240.6406 DESCRIPTION OF WORK Interior demolition of non-structural elements. Demo of restroom cores, miscellaneous lighting, electrical and HVAC. No exterior demo or change of use is included. RESIDENTIAL O S f FLOOR AREA N DWELLING 0 UNITS OFFICE USE ONLY USE OCC. TYPE so. FT. VALUATION COMMERCIAL 16 , 6 81 s f FLOOR AREA TYPE OF CONSTRUCTION Type V FR #STORIES 2 stories AQMD JOB NUM 3ER T RECEIVED BY: TOT6LYALU 0 N-� By my signature below, I certify to each of the)folowing: I am aproperty owner or authorized agent to act on the property owner's behalf I have read this application and the information I have pro ecorrect. I ha readthe Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil g truction. I horiee representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicam/Agent: Date: 9/14/11 SUPPLEMENTAL INFO AIVN RE D PRIOR TO ISSUANCE OF DEMOLITION PERMIT Provide Job Number from B Area Air Quality Management District www.baagmd.ore @ 415-749-4762. Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. _ Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) certified in asbestos, mercury and/or hazardous material examination. Planning Dept clearance to verify building is not considered an historical landmark Allow 10 business days. Provide letter of clearance of all vermin from a licensed pest control contractor. Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection. Provide signed Debris Bin and Recyclable Materials form. Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. OFFICE USE ONLY PLAN cRECIc TYPE i ❑ STANDARD ❑ LARGE ❑ MAJOR DemoApp_2011.doc revised 03/16/11