11040219 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10501 N TANTAU FLR I CONTRACTOR:SOUTH BAY PERMIT NO: 11040219
CONSTRUCTION,INC
OWNER'S NAME: APPLE INC 1711 DELL AVE DATE ISSUED:06/02/2011
OWNER'S PHONE: 4089745951 CAMPBELL,CA 95008 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F_ PLUMB
License Class_ Lic.4 !atej
MECH r RESIDENTIAL F_ COMMERCIAL r
Contractor SftJT]A 5AY 601ST_ Z
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COMM'L TENANT IMPROVEMENT(13,090SQFT)
(commencing with Section 7000)of Division 3 of the Business&Professions WAREHOUSE/OFFICE SPACE CONVERT PORTION TO SHREDDER
Code and that my license is in full force and effect. FACILITY,INCLUDE STRUCTURAL,ELECT,LIGHT,
I hereby affirm under penalty of perjury one of the following two declaration
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 Sq.Ft Floor Area: Valuation:$250000
permit is issued.
APPLICANT CERTIFICATION APN Number:31606052.00 Occupancy Type:
I certify that l have read this application and state that the above information is
correct. 1 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
9.18.
Signature / Date"?— Issued by: ham' 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:
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:
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. 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&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
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,l must Owner orthoa��ent: )I
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
CC
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10501 N TANTAU AVE CONTRACTOR:SOUTH BAY40219
CONSTRUCTION,INC
OWNER'S NAME: APPLE INC 1711 DELL AVE DATE ISSUED:06/02/2011
OWNER'S PHONE: 4089745951 CAMPBELL,CA 95008 PHONE NO:(408)379-5500
LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Ar IZ2 G-1 O Lic.# (4.2-"p C) I r r r
MECH RESIDENTIAL COMMERCIAL
Contractor 2QhCV- Q E� - Date 6*IZp ) 1 I
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: COMM'L TENANT IMPROVEMENT(13,090SQFT)
(commencing with Section 7000)of Division 3 of the Business&Professions FACILITY,
INCLUDE
SPACE CONVERT PORTION, SHREDDER
FACILITY,INCLUDE STRUCTURAL,ELECT,LiGHT,
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: 6/2/2011 -DEFERRED#I -DEFERRED ELECTRICAL FOR NEWSHREDDER FACILITY-ISSD 6/20/11
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:$250000
1 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:31606052.00 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 0 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 1801 AY F OM LAST CALLED INSPEC ION
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. AdditionallyOe applicant understands and will comply Issued by: Date:
with all non-point source regula s per the Cupertino Municipal Code,Section 01
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
1 hereby affirm that 1 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). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I 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(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 Cupsomv, nicTal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this /
Owner or authorized agent Date:
pen-nit is issued. G
I certify that in the perfonnance of the work for which this pen-nit 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 afrn that there is a construction lending agency for the performance of
forthwith comply with such provisions or this pen-nit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
1 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, ARCHITECT'S DECLARATION
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
CITY OF CUPERTINO BUILDING PERMIT DATE
BUILDING ADDRESS: 10501 N TANTAU AVE CONTRACTOR:SOUTH BAY PERMIT NO: 11040219
CONSTRUCTION,INC
OWNER'S NAME: APPLE INC 1711 DELL AVE DATE ISSUED:06/02/2011
OWNER'S PHONE: 4089745951 CAMPBELL,CA 95008 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r
License Class Lic.# 3 3 69 7
soul-* �� 20 �� MECH r RESIDENTIAL r` COMMERCIAL r
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COMM'L TENANT IMPROVEMENT(I3,090SQFT)
(commencing with Section 7000)of Division 3 of the Business&Professions WAREHOUSE/OFFICE SPACE CONVERT PORTION TO SHREDDER
Code and that my license is in full force and effect. p FACILITY,INCLUDE STRUCTURAL,ELECT,LIGHT,
`/��(�"j 6/20/2011-REV#2-REVISE EXIT PATH OR TRAVEL ELIMINATE RAMP-6/20/2011
I hereby affirm under penalty of perjury one of the following two declarations: REV#2 ISS'D
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. Sq.Ft Floor Area: Valuation:$250000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:31606052.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature �� Date (' w I Issued � Po- e,
�� Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material berg installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(x)should 1 store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
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. Owner o agent:
Dater
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CONSTRUCTION PERMIT APPLICATION -
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDINGftIa-
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255ION #
(408) 777-3228• FAX(408) 77 333• buildingacupertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION O<VISI N DEFER-RED ORIGINAL PERMIT# U
PROJECT ADDRF15 1050 1 -rA011\U Ave APN#
OWNER NAME A P P L E PHONE s—/ E-MAIL.
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME S PHONE `fib 8—S` - E
STREET ADDRESS CITY,STATE, ZIP y FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME - SENSE NUMBER LICENSE TYPE Q BUS.LIC N
COMPANY NAME FRt3V �J e5TE-MAM �J FAX
STREET ADDRESS O t LL AVS
CITY,STATE,ZIP RSooy PHONE
ARCHITECT/ENGINEER NAME lz-G�L ! lZaMAPI LICENSE NUMBER BUS.LIC N
COMPANY NAME �G cot's 0� E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
9h N SV-01,30 S-r SAS oyE c�► gSIr3
DESCRIPTION OF WORK IZEVI 5 E r v 11-
PATH
/I T ^C -r9MLI E L I M I SATE 9►M P .
EXISTING USE PROPOSED USE CONSTR TYPE it STORIES crNty
TYPE ON So Fr. V. ,. ,
EXISTG NEW FLOOR DEMO TOTAL `y
AREA AREA AREA NET AREA CI
BATHROOM KITCHEN OTHER FM W J
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA ❑ DETACH
❑ ATTACH _
/DWELLING UMTS: 3 A SECOND UNIT
El Yo SECOND STORY ❑YES
BEING ADDED? E]NO ADDITION? 1:1 NO
PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: RECEIVED ay: T6rAL VALUATI V
PLANNING APPL B ❑ NO PLANING APPROVAL LETTER
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 nstruction I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Z Date: 10-2�—
Q PLAIN CSECF1 rYpF ROUTING ING SLW
SUPPLEMENTAL INFORMATION REQUIRED
New SFD or Multifamily dwellings: Apply for demolition permit for i.riF_s� z� F�� IgG VLMN ULVUW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ .EM-WS ❑ PLAN-NMC-G-PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q STAM Axn ❑ PLBL.IC WORDS
form if any Hazardous Materials are being used as part of this project ❑ LARGE �rIE T
_Copy of Planning Approval Letter or Meeting with Planning prior to 0 MAJOR ❑ SANITARY SEWER]M7MCT
submittal of Building Permit application.
1 LVVIRO'VN NT-ALLEMAL,TH
Bldg,4pp_2011.doc revised 03/16/11
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPVRT lr4o (408)777-3228•FAX((4408)/777-3333-building Dcuoertino.org
❑NEW CONSTRUCTION ❑ ADDITION LJ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINALPERWT#
PROJECT ADDRESS ��/jl ,1 �v (�J_U APN#
OWNER NAME POLE /V V PW^ -7 f ,5q � E-MAIL �J
STREET ADDRESS IMFiN« (,OZf CITY, STATE,ZIP l� FAX
CONTACT NAME ^� PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑LO'n-11JUXER ❑ OWNERAGENT ❑ CONTRACroR ❑CONTRACrORAGENT ❑ ARCm= ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICEN YPE BUS.LIC#
E,"ESI-0
0MPANYNAME Soym W coN 0tJ Ee:.rroA s12e- 40&A FAX _V11 3zs6
STREET ADDRESS It OEC1 L P\/E CITY. ATF PQ
ARCHTTECT/ENGII�ER N w SCOTT LICENSE NUMBER BUS.LIC H J{.
ZOAkA
COMPANYNAWflEr(� Vn //J ,� 1 E-MAIL FAX
STREET ADDRESS F-CJO/�/J N CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK V 'rM A oe7o 0 r-3 o F -M
� Ura
U N uelev � L I M I 5516 L- 1
�UILpING f 5 SCAT " Pe(uaLt'C"�n� �N A-RP�� 2 YE �-S. �Gr E` Grooms
2
=rxNGt PROPosr CONSI3.TYP 0STORIES
11'Z� I( -
MWTC^F 'OO NEW FLAGR DEMO TOTAL
AREA �. AREA 13 OQ 0 AREA NET AREA _
BATHROOM KTTCEIEN OTM
REMODEL AREA I REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑ DETACH
❑ ATTACH
DWQLNT UNIT& M A SECOM UMI ❑YES SECOND STORY ❑YES
BEMADDIDT []NO ADDMONT ❑NO
PRE-APPLICATION ❑ YES @YMPROVIDECOPYOF FLANMINA&M
PLANNM AMI ❑ NO PfANNINGAPPROVALLUM
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 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 co ction. I authorize representatives of Cupertino to eater the above-i trfied p for inspection purposes.
Signature of Applicant/Agent: —r Date:
SUPPLEMENTAL INFORMATION REQUIRED
_New SFD or Multifamily dwellings: Apply for demolition permit for
exdstmg building(s). Demolition permit is required prior to issuance of building
permit for new building.
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
—Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp 2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10501 n.tantau ave. DATE: 06/20/2011 REVIEWED BY: bobs.
APN: I BP#: 'VALUATION: 1$100
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION
USE: —1 1 PERMIT TYPE:
WORK revise exit path or travel eliminate ramp
SCOPE
Li Li
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptjor addn 7 info.
FEE ITEMS (Fee Resolution 09-051 Eff 7111101 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Mise Bldg/Structure
Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: _T7 $0.00
Acoustical Fee: 0 Yes G No $0.00 0
Work Without Permit? 0 Yes G No $0.00 E)
Plal.min- Fee. $0.00 Select a Non-Residential 0
Building or Structure
Strom Motion Fee: IBSEISAECO $0.50 = # Revision
Bldg Stds Commission Fee: IBCBSC $1.00 $760.00 IPEVCOMTI I Tenant Improvement
SUBTOTALS: $1.50 $760.00 TOTAL FEE: I
Revised: 04/29/2011
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDIN4DEFED
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildin cu erlinoZ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI REVISION/ ORIGINAL ^r"Ie
PROJECTADDRESS1050/ N. Tantau Avenue
OWNER NAME Apple PHONE(4 0 8) 974-3,,56k"'
STREET ADDRESS 1 Infinite Loop CITY, STATE,ZIP Cupertino, CA 95014 FAX
CONTACT NAME Steve Loeffler PHONE E-MAIL
(408) 534-2827 sloeffler@rosendin.com
STREET ADDRESS 8 8 0 Mabury Road CITY,STATE,ZIP FAx
San Jose, CA 95133 (408) 295-6423
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT W CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR N"r'¢ ROSeridln Electric LICENSE NUMBER 142881 LICENSE A,B,C-10 BUS.LIC N 10834
COMPANY NAME &MAI, FAX
STREET ADDRESS 880 Mabury Road CITY,STATE,ZIP PHO
San Jose, CA 95133 x(408) 534-2827
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK Electrical for prototype shredder
EXISTING USE PROPOSED USE CONSTR.TYPE N STORIES OFFICE USE DNLY
OCC TYPE DESC N
NEW FLOOR DEMO TOTAL
AREA J �) �`
AREA AREA AREA NET AREA l
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑ DETACH
❑ ATTACH
K
DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑ YES I+YES,PROVIDE COPY OF PLANNER'SNAIE: RECEIVED BY: TOTAL.VALUATION: r�
PLANNING APDL M ❑ NO PLANNING APPROVAL LL'7TER
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' rrect. I have readlbjp Description of Work and verify it is accurate. I agree to comply with all applicable local
Ordinances and state laws relating to buildi I LaL1 of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: 0 5�31 1 2 01 1
1� Oda SUPPLEMETION QUIRED rLANGTIE�[lcTYPE Ra_tMNGSL1P
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVBR-THF-COUNTER 9UIL01144 PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ ex�` ❑ rLANNrnc PLAN REr1Ew
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials ane being used as part of this project. ❑ LARGE ❑ FIRE DEP'r
_Copy of Planning Approval Letter or Meeting with Planning prior to 11 MAJOR E] SANITARY SEWER DISTRICT
Submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 03/16/11
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: 10501 M • MM-rA\J AvE PERMIT# t-(
OWNER'S NAME: AR LE PHONE # 406 -513-'8571
GENERAL CONTRACTOR: SoulIr1 Rb,`( c 0 3r- BUSINESS LICENSE#
ADDRESS: 11-it QeLt- A Ve GAMftetL 1�* CITY/ZIPCODE: CGAs OrPtV8
*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:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical �,ps
Excavation
Fencing
Flooring/ Carpeting S $0LU710 4S
Linoleum /Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing ( M (CA L
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
-- COW SY
INSPECTION LARRY S.
" � s-bk7W 6
DATE: 24 � '
PERMIT NUMBER: Jl Z" )
ADDRESS:
INSPECTION TYPE: 3or
COMMENTS: GD►"n42LK"TE '
3 0C 3 0 cv� )ws ak
RESULTS:
P-PASS, F-FAIL, C-CANCEL, I-INCOMPLETE, N-NOT REQUIRED, R-TO BE RESCHEDULED
IF FAIL, LIST REASON:
TIME SPENT: NO. OF UNITS: 21
• CLOSE PERMIT? YES NO
cow sy
INSPECTION LARRY S.
DATE: 6 •�I
PERMIT NUMBER: d 1 2�)
ADDRESS: Q �� l �• �/� �'h I'�/IS-
INSPECTION TYPE: 30q ,� �)s 3(3,s-
COMMENTS: 1 N 1 b )d n
RESULTS:
P-PASS, F-FAIL, C-CANCEL, I-INCOMPLETE, N-NOT REQUIRED, R-TO BE RESCHEDULED
IF FAIL, LIST REASON:
TIME SPENT: NO. OF UNITS:
CLOSE.PERMIT? YES NO