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11040084 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10670 N TANTAU AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 11040084 OWNER'S NAME: APPLE INC 851 BUCKEYE CT DATE ISSUED:05/05/2011 OWNER'S PHONE: 4089744876 MILPITAS,CA 95035 PHONE NO:(408)240-6000 Cl LICENSED CONTRACTOR'S DECLARATIONr r � [J BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.q 7 r Y MECH RESIDENTIAL COMMERCIAL Contractor /1L �r+3�r4c.f•pvr Date lI I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 1 ST FLOOR&2ND FLOOR-COMM'L TENANT (commencing with Section 7000)of Division 3 of the Business&Professions IMPROVEMENT(21,200SQFT)-2ND PHASE PROJECT TO Code and that my license is in full force and effect. INCLUDE TENANT i7vIPROVEMENTS OF 1ST FLLOR&2ND 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. 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:$1200000 permit is issued. APPLICANT CERTIFICATION APN Number:31609019.00 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 D S FROM L ST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. SignatureK Date /( Issued by: ' .a Date: ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that l 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 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 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 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(a)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 Arca 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,I must Own ar ized gent:,,,,, ' forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that 1 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 C I c>C-1 vc�:> CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINQ (408)777-3228• FAX(408)777-3333•buildin�cugertino.org NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGI PERMIT b d PROJECT ADD& � I ahT v APNN OWNER NAME STREET ADDRESS 1 � 1 n. G CrrY,�'I'ATE,ZIP , (f /A ,I FAX CONTACT NAME Tem I P NE . 2 E-MAIL (22 l �hP(h ITVi� v �`�y� STREET ADDRESS O © I/ Il Gnu Dr. C `r�1.O ZIP I'1 D fit! 4 FAX eV ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT A CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRA N C LICENSE B O LICENSE TAPE BUS. COMPA E E- AI FAX G.•,► �r t d✓1 �s �k� � con �, 6 STREET ADDRESS CITY,�TE,ZIP PHO Gr� l/% elro Gy _/0-6q 3 ARCFUTECT/ENGINEU.NAVEW01 I LICENSE NUMBER BUS.LIC N 7 ✓Z Q COMPANY NAME L LK d 1.0 1 f� E MAIL L4 Q 1 a .� FAX STREET ADDRESS ( CITY,STA7Ti, �' t S PH S. .7575 DESCRIPTION OF WORK s ` /-'G 6 �s a n K d d ��� r"f�E �' ��t!i �or>� Gv" P•rw►t't ,,,/CI s pu 116d EXISTING UIQI PROPOSED E CONS/T& E k STO OFFICE. HI. VB • SJ2FT VA1,13ATION(S) EXISTG NEW FLOOR DEMO TOTAL -(J, AREA AREA AREA NET AREA 112eO BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH ❑ ATTACH Y DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEINGADDEDT ❑NO ADDITION! ❑NO PRG-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: RECEIVED BY: TOTAL VA VA7T0 V. �l PLANNING APPL M ❑ NO PLANNING APPROVAL LETTER r 1 �V �6 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'fhave 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 bu . g co structi n. I au ze representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ( `�Z- SUPPLEMENTAL INFORMATION REQUIRED PLANCRECKTYPF, ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for C1 OVER-TH&C^OUNTERt Q 13MLEING PLAN RXVIF`.W existing building(s). Demolition permit is required prior to issuance of building rrII permit for new building. ❑ EXPRESS �I'' PI.ANNENG PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Z STANDARD [�_VUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE IRE DEPT —Copy of Planning Approval Letter or Meeting with Planning prior to 2" Submittal of Building Permit application, C1 MAJOR Ja SANITARI'SEWER DISTRICT ENVIRONMENTAL HEALTH BldgApp 201 Ldoc revised 03/16/11 Chusyr INSPECTION LARRY S. DATE: 011 - � - �i PERMIT NUMBER: ! 0 G ADDRESS: /Ob 70 ny• T�,�T/�'�► /�-(/!S' INSPECTION TYPE: I' l COMMENTS: .moi z - ? o Z � J 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 r . ` COu ► A- J INSPECTION LARRY S. DATE: ' L'� �� 1 PERMIT NUMBER: J cos ADDRESS: )0 00 ^/'�-�j�''''y a, c6�-r✓I - INSPECTION TYPE: COMMENTS: 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 May 5, 2011 City of Cupertino 10300 Torre Avenue Cupertino,CA 95014 Attn:Aki Honda, Senior Planner Ms. Honda: This letter serves as a response to.your comments regarding permit# 11040084.As previously discussed with yourself and Larry,we would like to keep the site work on it's own permit(110040009) and remove it from our permit 11040084 so that we can move forward with our building work. I would like to confirm the following: 1) We will not perform any site work in conjunction with permit 11040084. 2) No trees will be impacted or removed with permit 11040084. 3) All site work will be conducted under permit 110040009. Please let me know if you need any further clarifications.You can reach me at (408)240-6438 or tkloppenburg@xlconstruction.com. el Sincerely, l-' ` 'vV R.Trent Kloppenburg Project Engineer, LEED GA 'OPMpN. EFMN0 all t' tt QRQ�� to kePt at the ` }ons MUS l make any and sP°0 un,aor t �l orx the Bull d Pte° on• to dev c1a1. dur,n9 on Ofd W1t trorn dons SHpu-NOT and sPeclfk of the violation ?Ita he1d to Pitt x to City Ordinance or State haw. b, �(anY ' y MAS 0 5 oA� -�, arr No.