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11030142 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10435 N TANTAU AVE FLR l CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 11030142 INC OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED:05/04/2011 OWNER'S PHONE: 4089744876 MILPITAS,CA 95035 PHONE NO:(408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATIONF_ Q Q�Q' (,, BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class V Lie.# 3 1 ` (`p� Fy,, `�1 MECH F_ RESIDENTIAL r— COMMERCIAL� Contractor 1 Date ✓� ` I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FLOOR I-COMM'L Tl-(2806SQFT)CONVERSION OF (commencing with Section 7000)of Division 3 of the Business&Professions EXISTING OFFICE SPACE TO NEW APPLE COPY CENTER. Verebyde, d that my license is in full force and effect. DEMO WALL,&NEW WALLS,ELECTRIC/MECHANICAL 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 die work for which this Sq.Ft Floor Area: Valuation:$125000 rmrt issued. APPLICANT CERTIFICATION APN Number:31606039.FLRI Occupancy Type: 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 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 7 L� Issued by: _ Date: ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I 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. wil I 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: HAZARDOUS MATERIALS DISCLOSURE l 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 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 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 the work for which this permit is issued,l 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,1 must Ownc�r �or d agept: /� C forthwith comply with such provisions or this permit shall be deemed revoked. Dater[ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of mork's correct.1 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 // CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION /) 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 •building(okupertino.ong ❑NEW CONSTRUCTION ❑ ADDITION/ALTERATION ❑ RE ON/DEFERRED SUBMITTAL PROJECT ADDRESS I 70c) ( _ 0�q`OWNER NAME ` PHONE _ _ ` E-MAIL STREET ADDRESS ` 1 �J — Ft'", S TE.ZIP q tD I FAX 1.3 APPLICANT NAPHO -OEM- O E-MAIL�C-Qom n ft �(Q STREET ADDRESSC , TATE ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR'AGENT ❑ ARCHMCT ❑ENGINEER ❑ DEVELOPER ❑TENANT LICEN E NUR LICTYPE BUS.LIC N COMPANY N (, MAII F P r STREET ADDRES a& i fes/3S PHONE ARC Cr/ENG ERLICE E i BUS.LIC N COMPANY E 1 E-MAIL FAX 41c-42L:q(ge STREF� j� CITY ST TE ZIP ^ IQ P1 DESCERPPT�- ION OF WORK :,a:: Y► W[nJ►..� i EXISTRJG USE PROPOSED USE CO STR TYPE W STORIES OFFI E U r YI.Y Depict, 2 N -qO V'r , EXISTG NEW FLOOR DEMO TOTAL ` AREA AREA AREA NETAREA 7 •.3, BATHROOM KITCHEN OTHER 'i REMODEL AREA REMODEL AREA REMODEL AREA N PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑ DETACH - ❑ ATTACH N DWEUING lfNrrS: IS A SECOND lfNrr ❑YES SECOND STORY ❑YES I BEING ADDED? ❑NO ADDITION? ❑NO c PILE-APPLICATION ❑ Y&9 IFYES,PROVIDE COPY OF PLANNER'S NAME' RECEIV�.DBY' PLANNING APFL N ❑NO PLANNING 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 hav, rovide is c rrec. 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 u! ing ons Ctio . authorizer esentatives of Cupertino to enter the ove-i ntifiled property for inspection purposes. Signature of Applicant/Age..- Date: SUPPLEMENTAL INFO TION REQUMED usE ntiT.Y _New SFD or Multifamily dwellings: Apply for demolition permit for PLAN CFJECKTYPE ROWING SLIT' existing building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. U OVER-THE-COUNTER Lr "Butt 1)M;Pt.ati REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ EYPRRSS ❑ PLANVIYGPr.AYRHVIFW form if any Hazardous Materials are being used as part of this project. sT.►:rnAlm C PUBLIC wnRK5. _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ I ARGE �- RJ DEPT submittal of Building Permit application. MAJOR ❑ E.I IRONMENTAL HEALIJA B1dgApp_201 Ldoc revised 03/03/11 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: PERMIT# Z_ OWNER'S NAME: C— PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: "Our municipal code requires all businesses working h7 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: V SUBCONTRACTOR SINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 3 � O ner Co trac or ignature Date