11100071CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19333 VALLCO PKWY
CONTRACTOR: DPR CONSTRUCTION INC PERMIT NO: 11100071
OWNER'S NAME: APPLE INC
1450 VETERANS BLVD DATE ISSUED: 10/1112011
O ER'S PHONE: 4089744876
REDWOOD CITY, CA 94063 PHONE NO: (650)474-1450
LICENSED CONTRACTOR'S DECLARATION
r T—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_.
COMMERCIAL
c
MECH RESIDENTIAL
Contractor i - Date /0 I/
�t>l
I hereby affirm that I am licensed under the provisions o Cha ter 9
JOB DESCRIPTION: APPLE - BLDG C- COMMERCIAL TENANT IMPROVEMENT
FT) CONVERTING 4 SMALL ROOMS INTO I STOREAGE
(commencing with Section 7000) of Division 3 of the Business & Professions
ROOM &NEW OFFICE SPACES
R
ROOM
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 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
Sq. Ft Floor Area:
Valuation: $93000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31620075.00
Occupancy Type:
APPLICANT CERTIFICATION
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
WITHI 0 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 D ROM LAST CALLED INSPECTION.
with all non -point source regulati s per the Cupertino Municipal Code, Section
9.18.
Issued by: Date:
Signature "` Date 0 C
t'
® OWNER- UILDER DECLARATION
RE -ROOFS:
I 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
1, 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:
1, 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:
1 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 die 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 &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
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
Owner authorized age
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereby affirm that ere 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
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.1 &
I understand my plans shall be used as public records,
Signature Date
Licensed Professional
CITY OF CUPERTINO
FFF. FSTTTFAVQ, — V44U111aG DIVISIOV
JimADDRESS: 19333 Vallco Pkwy 10111/2011
APN: --[BP#:
REVIEWED BY: gs
'VALUATION: $93,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 113TI
PERMIT TYPE:
WORK
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (S.0
B (Tenant Improvements) 11-13,111-13,MV-13 538 $1,926.40 IBTIPLNCK $722.96 IBTIINSP
Chu k
NOTE: This estimate does not include fees due to other Departments (1,e. FlannIng, IWOM worts, fire, aantrarymwer vistrict, acnoot
District, eta). These fees are based on the 7relinktar y-inforntation available and are only an estimate. Contact the Dept_ for aaanl info.
FEE ITEMS (Fee Resolution I I-qL.i Eff 7/1/11
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,926.40
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$722.96
Suppl. Insp. Fee-.0 Reg. 0 OT
LEI
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Con,stoulion "I'a"V
0
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure
—1 A
Traved
Strong; Motion Fee: IBSEISMCO
$19.53
Select an Administrative Item
Bldg Stds Commission F�e IBCBSC
$4.00
$2,672.89
$0.00
$2,672.89,