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11040083 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10700 N TANTAU AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 11040083 OWNER'S NAME: APPLE INC 851 BUCKEYE CT DATE ISSUED:05/20/2011 OWNER'S PHONE: 4089745951 MILPITAS,CA 95035 PHONE NO:(408)240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION r r &>If -7 � 6 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. �r MECH F RESIDENTIAL F COMMERCIAL r v Contractor �L S h^tn G��o h Date S 2� I hereby affirm that I am licensed under the provisions of Chapter JOB DESCRIPTION:COMM'L TENANT IMPROVEMENT(14,720SQFT)INTERIOR (commencing with Section 7000)of Division 3 of the Business&Professions MODIFICATIONS TO EXISTING OFFICE SPACE INCLUDING Code and that my license is in full force and effect. PREP,NEW PARTITIONS,CEILING&NW FINISHES, I hereby affirm under penalty of perjury one of the following two declara�S. I have and will maintain a certificate of consent to self-insure for Worker's {�L 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:$750000 permit is issued. APPLICANT CERTIFICATION APN Number:31609028.10700 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 S Issued by 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,1 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 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 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,I must Ow o thori'zed agent- forthwith comply with such provisions or this permit shall be deemed revoked. L-L� Date: Sza 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 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• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 •building(@cupertino.org CUPERTINO ❑NEW CONSTRUCTION -� ADDITION ALTERATION R.EbV I2SION/DEFERRED S MTTTAL PROJECT ADDRESS AN H 4 n f17 � E OWNER NAME PHONE E art le. STREET ADDRESS /'N T G / CITY S r~ ��• 6 g501 y FAX APPLICANT N B4lJ (b`OyyO� PHO Z • / 13 D CIS . STREET ADDRESS ZD n i 1 I� �• CITYAIE. ZIP ,ne �J MCIFAX FAX (� ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT >0 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR)T , 0 I� -I e� 77sEe E Bus-'21-m, COMPANY N L's..9�7 t,t C.��0 Tee�+f 1�{ G� E-MAIL41`I O MtA1�� /` ' h5-�.GO/Yl FAX G` STREET ADDS W CITY,STATE !ZII' "Vio !35-01 P g.Z y0• y3 ARCHITEMENS� / #o\ LICENSE NUMBER I BUSS.(LIIC N COMPANY NAME�Pp Grob MA E-MA /' JSO ere FAX STREET ADDRESS `1. �. CITY.S ATEA-OZIP J it ,/ Q�I f PHONE "7� 89.•t� ::ESCRC-....r.+.i:7:-'+VORK N !� .F - - - I -I. 1 .-7 J fit/ a: ;_ IN EXISTING US$ PROPOSED U CONMR E I STO -- _ USI y- r L' EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE ARFA ❑ DETACH ❑ ATTACH '•1§ M DWELLING UNrrS IS A SECOND UNIT ❑YES SECOND STORY ❑YES - --. r `�• ^�� " ?� - - BEING ADDED? ❑NO ADDrrIOM C]NO PRE-AFFLICATION ❑ YES IF YES.PROVIDE COPY OF PLANNER'S NAME' CELL ,A (/ TO'i�A!.VALI:•i::�]ti - - - PLANNING ADPL I C] NO PLANNING APPROVAL LETTER [• •�.+�' - :.» - C) _ 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 ha 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 buiidin stru 'on. t��resentatives of Cupertino to enter the abov�e-id tiffproperty for inspection purposes. Signature of Applicant/Agent L Date: SUPPLEMENTAL INFO TION REQUMED _New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building - permit for new building. � ! - _Commercial Bldgs: Provide a completed Hazardous Materials Disclostue -- ;�: sx. 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. _ - s' - B/dgApp_2011.doc revised 03/03/11 cow " y INSPECTION LARRY S. DATE: 4'2'� , t PERMIT NUMBER: / 4 4 a � ADDRESS: D700 �`� "7''�� INSPECTION TYPE: 30' COMMENTS: RESULTS. C Iry 1 . 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