09090140I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10500 N DE ANZA BLVD FLR 2
0` `R'S NAME: APPLE
OW .ER'S PHONE: 8629799
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
I 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 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.
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9.18.
Sig -
Date
� i OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I 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, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
of , above mentioned property for inspection purposes. (We) agree to save
in, ,fy and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of t h permit. Additionally, the
pplicant understands and will comply
with all non o t source r gula ns pe the Cupertino Municipal Code, Section
9.18. 7 G
Signature D e 1/7 d G
CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 09090140
INC
690 GIBRALTAR DR DATE ISSUED: 09/30/2009
MILPITAS, CA 95035
PHONE NO: (408)942-8200
BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB f—
MECH I— RESIDENTIAL f— COMMERCIAL
JOB DESCRIPTION:REVISION-ADD (E,M) HVAC TO (E)LAB
HEATPUMPS NO
CHANGE IN LAYOUT OCCUPANCY OR EGRESS ADD
TRANSFORMER STRUCTURAL PROVIDED FOR SUPPORT AND
Sq. Ft Floor Area: I Valuation: $95000
APN Number: 31622017.F2 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bya Date:
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
I 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 I 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
0% o To i eda t: G
g Date: 0 i
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
am
CUPEkTINO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
APN # J co 2-2 C) 17. FZ
Date: <? 1g4 b`{
Original Permit #: 0 q a k) 0 Z q
Building Address: S� 0 V, 'Drc.&0 zA G Lvp, Z09 rt,o o rL 1-�
Mailing Address (if different from building address):
Owner's Name:P p
Phone #:
Contractor: b*,] Colj
Phone: q y Z -001,v,0
Fax:
Contractor License #: 31Jq [�3
Cupertino Business License #:
Contact: DAA v WtAtT-Pre--1
Phone:
Fax: ?-
Building
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ®`
Residential Commercial 91
Job Description: Apt, JCL*,(TKicAL Alio w%fe4,4, IcAL 6AJpc, -tO (V LAF,
3 APM NFAr P)t T
UW Turif— �biC+iM . �� C Nca� 111 lA."�a��— I OCCJC�Ar1C"l m1'L (°KESS.
FoRIMce— For- S01PPo RT -( '6064oeA(e- of-rbl ;
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No
Type of Construction (Usage Class):
* Occupancy Type:
1-A, 1-B ®, II/III/V-A ❑ II/III B, IV -HT, V -B ❑
-�
Valuation (cost of project): 4 J-4;-1
000
Project Size: Express M Standard Large LJ Major
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
?` Revised 01/07/09
CITY OF CUPERTINO
CITY OF REVISION/DEFERRED
CIJPEI�TINO
PERMIT APPLICATION FORM
FEE SCHEDULE
Quantity
Sq Ft
Fee ID
Fee Description
Fee Group
Permit Type
1BCBSC
Cal Bldg Standards Commission
Fee
B
ALL PERMIT
TYPES
1REVCOMNEW
Revision Commercial New
B
1*
1REVCOMTI
Revision Tenant Improvement
B
1* TI
1REVSFDWL
Revision SFDWL
B
1R3SFDW
1REVRESADD
Revision Addition
B
1R3SFDADD
1REVRESREM
Revision Remodel
B
1R3SFDREM
1DEFINSP
Deferred Submittal not R-3
Inspection
B
1DS
1DEFPLNCK
Deferred Submittal not R-3 Plan
Check
B
1DS
1DEFR3INSP
Deferred Submittal Inspection
B
1DSR3
1DEFR3PLNCK
Deferred Submittal R-3 Plan Chk
B
1DSR3