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11030061CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20705 VALLEY GREEN DR FLR I CONTRACTOR: SOUTH BAY PERMIT NO: 11030061 CONSTRUCTION CO INC OWNER'S NAME: APPLE INC 170 ]KNOWLES DR DATE ISSUED: 04/19/2011 OWNER'S PHONE: 4089744876 LOS GATOS, CA 95032 PHONE NO: (408)379-5500 ❑ LICENSED CONTRACTOR'S DE'C�LARATION r � BUILDING PERMIT BLDG F 3 3 INFO: ELECT PLUMB License Class Lic. # / [_ r � Contractor S°��li isa`r �orvST Date (�( ( MECH RESIDENTIAL COMMERCIAL 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: FLOOR I- ELEVATOR MACHINE ROOM UPGRADE, DEMO (commencing with Section 7000) of Division 3 of the Business & Professions EXISTING FENCE ENCLOSURE, BUILD 1 HR WALL & Code and that my license is in full force and effect. CEILING IN ELEVATOR MACHINE ROOM. PATCH & FIRE 1 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: $15000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 32610046.FLR1 Occupancy Type: 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 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section ��---� � �� Issued Date: C�� 4 ICI ` by Signature Date ❑ OWNER -BUILDER DECLARATION RE -ROOFS: 1 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: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Cade). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the 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. 1 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 & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(x) should I store or handle hazardous material. 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 tie 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 or authcVgcd agent: <)_� f forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there 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 9.18• 1 understand my plans shall be used as public records. Signature Date Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: ;LO -1 O -S PERMIT # 116!7 Ov OWNER'S NAME: P+ Qv�_E PHONE # yei8 - Sg3 - gsz q GENERAL CONTRACTOR: ems,. K T BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 3 -Ny^ \\ Owner / Contractor Signature I Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing W . vp,w-ft ,,,,..Q. j �ctr• o �'g Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 3 -Ny^ \\ Owner / Contractor Signature I Date CITY OF CUPERTINO CITY OF CUPERTINO TENANT IMPROVEMENT PERMIT APPLICATION FORM 32,cp to J (03� �c l APN # Date: Building Address: 2. n 0 v1\e rr as zw (140 - Mailing Address (if different from building address): Tenant H (If tenant pleas _provide a letter from the building owner approving the tenant improvement.) BuildingOwner 0C9L U= Are Hazardous Materials being used as part of this project? Yes No Tenant/Building Owner's Name: Phone APKE Contractor: S6 y1 -W$ P•� Go �S � c. -t � o � Phone #: koa. 3-rq• SSoo Fax #: -i o9 - S Z -B Z'6 Cupertino Business License: State Contractor License #: (5 1 3(. q Contact: Phone #: 4 G f_ -%j -S -3 MNESTO SA44to-xJ Fax /e-mail:405— Z ,6 Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less, compliance with the Landscape Water -Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Job Description (be specific): SL\tvq�rorMwc`.`�v.� 1-456 a.A�'toc�ai, OQ.ww �iR�6��v►� '�'e.�ncR `` QihG�JlVry.� �OV��f? i 1�'P "J%N\` L,Q�►��r►� �a &\l.VOA.Q4- rn4c�r►.v�q voov, C�w�� 1k% -t c.1 Tenant Improvement Includes Re -Roof. Yes ❑ No�& if yes, number of squares Tenant Improvement Includes Structural Yes ❑ No Type of Construction (Usage Class): Occupancy Type: I -A, 1-B ❑ II/III/V-A ❑ 11/III B, IV -HT, V -B Valuation: S OC�o.`� Project Size: Counter U Express JK Standard LJ Large LJ Major LJ Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved *** For Office Use Only*** Revised 12-06-10 r CITY OF CUPERTINO Fm FEE ESTIMATOR - BUILDING DIVISION ocr:h e. Li NOTE: These fees are hated on the nreliminary information availahle and are only an estimates Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 09-051 E '. 7/1/10) ADDRESS: 20705 valley green dr 1st floor DATE: 03/14/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECKTYPE: Tenant Improvement PRIMARY Commercial Building USE: Suppl. PC Fee: G Reg. 0 OT PENTAMATION 1GENCOM PERMIT TYPE: WORK t.i. commercial non structural elevator, machine room addessibility upgrades. SCOPE ocr:h e. Li NOTE: These fees are hated on the nreliminary information availahle and are only an estimates Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 09-051 E '. 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes (D No $0.00 0 hours $378.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: G Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee4D Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 FCnnISIrftvtfo1" 7'elk: Acoustical Fee: Yes E) No $0.00 Q G Work Without Permit? 0 Yes (D No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure Q 0 r r5�1 LJ�rr:rr?nE;nt (tip>�r I"t;'� �: Strong .Motion Fee: 1BSEISMICO $3.15 4.0 hrs $504.00 Inspections 1INSPMIS Standard Inspections Bldg; Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $4.151 $882.00 TOTAL FEE: $886.15 Revised: 01/15/2011