11050004CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 3 INFINITE LOOP I CONTRACTOR: XL CONSTRUCTION I PERMIT NO: 11050004 I
O" 4ER'S NAME: APPLE INC
0...,ERIS PHONE: 4089744876
❑ LICENSED CONTRACTOR'S DECLARATION
License Class L Lic. # 2 19 �L
Contractor r 4U Date l
I hereby affirm that I am licens d under 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.
851 BUCKEYE CT
MILPITAS, CA 95035
DATE ISSUED:06/01/2011
PHONE NO: (408) 240-6000
BUILDING PERMIT INFO: BLDG J_ ELECT r PLUMB r
MECH i RESIDENTIAL f— COMMERCIAL r—
JOB DESCRIPTION: COMM'L TENANT IMPROVEMENT (1,204SQFT) LAB
SPACE
MINOR STRUCTURAL, RELOCATE EQUIPMENT, DOORS,
PARTITIONS, INCLUDE MECH/ELECT
I hereby affirm under penalty of perjury one of the following two declaratiousL
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 Sq. Ft Floor Area:
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. /
4-
Signature Date /
❑ 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
the above mentioned property for inspection purposes. (We) agree to save
nnify 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.
APN Number: 31602107.00
Valuation: $100000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued byf` ate:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material berg 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. I 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.
Owapg a 6ri ed a ent:
Date
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of pork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
Signature Date
I understand my plans shall be used as public records.
Licensed Professional
4
WIN
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
691
ADDRESS: 3 infinite loop
DATE: 05/02/2011
REVIEWED BY: bobs.
APN:
BP#:
VALUATION: j$100,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
comm. labs ace minor structural relocate equipment, doorspartitions, include M E.
�t.i.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
I-A,I-B
1,204
$2,854.00
IBTIPLNCK
$1,688.60
IBTIINSP
TOTALS:
1,204
$2,854.00
1
1 $1,638.60
MECH, HOURLY 0 Yes (j) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No
Ll F-1
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Deot for addn'l info,
FEE ITEMS (lee Resolution 09-051 Ljf '__L10).
FEE
QTY/FEE
MISC ITT'MS
Plan Check Fee:
$2,854.00
Select a Misc Bldg Structure
or Element of a Building
Suppl. PC Fee: G Reg. O OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,688.60
Suppl. Insp. Fee42) Reg.
0 OT
0.0
hrs
$0.00
PM E Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
O Yes O No
$0.00
Q
E)
Work Without Permit? ® Yes E) No
$0.00
Planning Fee:
$0.00
Select a, Non -Residential
Building or Structure
Q
II
„f„nt=,r
Strout Motion Fee:
IBSEISMICO
$21.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4,0Q
SUBTOTALS:
$4,567.60
$0.00
TOTAL FEE:
$4,567.60
Revised: 04/29/2011