11040045 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10670 N TANTAU AVE CONTRACTOR:XL CQNSTRUCTION PERMIT NO: 11040045
OWNER'S NAME: APPLE INC 851 BUCKEYE CT DATE ISSUED:04/07/201 1
OWNER'S PHONE: 4088626229 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ SENSED CONTRACTOR'S DECLARATION r r r
�. ` 4�O BUILDING PERMIT INFO BLDG ELECT PLUMB r
License Class /C Lic.1#
Contractor
C or+$7 M LT, evi Dale I I MECH RESIDENTIAL COMMERCIAL
I hereby affirm that i am licensed under the provisions of Chapter 9 JOB DESCRIPTION: IST FLOOR- INTERIOR DEMO 10,900 SQ FT DEMO OF
NON-STRUTURAL WALL,FLOORING,AND CEILINGS
(commencing with Section 7000)of Division 3 of the Business&Professions 2-PHASES
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. Sq.Ft Floor Area: Valuation:$30000
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 APN Number:31609019.00 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 LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the G,
granting of this permit. Additionally,the applicant understands and will comply Issued b Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that i am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 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
I 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(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I 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 I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. �y
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: L Date: 4
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 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 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I 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
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• building(c cupertino.org
-7-
PROJECT ADDRESS V APN b 09 61q.0()
OWNER NAME IQ PHO E zy G-te `0M
STREET ADDRESS V CITY,STATE ZIP -1 FAX
L.,00 -�;no ��} RSL
CONTACT NAMEI 0"i Yer ho n da- P D 6 E�i e,.r Q n a w /e-•Z-d'+"9
STREET ADDRESS Cil Y„STATEa ZIP O l FAX
10 a S �f
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrFCT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAWF PNS LICENSE ER O LICENSE TYPE BUS.LIC#
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COMPANY NAME E-MAIL FA
X L S to e,, I cahJ ,Cowl OD I
STREET ADDRESS CirY,�yA ZIP PHO
C. G� /"�r f0�3L1(O-6D
DESCRIPTION OF WORK
o work on r 0 iil C-(CAJe-- ole4'40
O V1Oh-S ru G'I"ul�(I �3 1a0I to w�•c� cer��n S /41
i
RESIDENTIAL N DWELLING - OFFICE" SE ONLY
FLOOR AREA UNITS USE TYPE FT. V AL UATION
COMMERCIAL / 0 QLD r �1
FLOOR AREA C�1YA�I�1,d \(( 101 q6 3
TYPE OF CONSTRU N q STORIES eL
AQMD JOB NUMBER f eyy • h� q RECsIvED BY. IWAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I autho2'zEepresentatives of Cupertino to enter the above-i entifiep property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL TNFOYMA N REQUIItE PRIOR TO ISSUANCE OF DEMOLITION P RMIT OMCE USE ONLY
_Provide Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-749-4762. ` PLAN.01MCrc TYPE
Provide three copies of a site plan showing protection for any trees 10"in diameter or more at Y 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) —j IARGF
certified in asbestos,mercury and/or hazardous material examination. NIA-IOR
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.
Demo.4pp_2011.doc revised 03/16/11