11020019CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20605 LAZANEO DR CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 11020019
INC
OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED: 03/31/2011
OWNER'S PHONE: 4089743735 MILPITAS, CA 95035 PHONE NO: (408)942-8200
❑ LICENSED CONTRACTOR'S DECLARATION r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. N
��� MECH r RESIDENTIAL COMMERCIAL
ConVactor N (�iJ� Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADDITION OF LN-2 PIPING FROM LN-2 TANK TO LASER
(commencing with Section 7000) of Division 3 of the Business & Professions TOOL
Code and that my license is in full force and effect.
1 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: $10985
permit is issued.
APPLICANT CERTIFICATION APN Number: 32633096.00 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 DAYS-FROM1,AST CALLED INSPECTION.
with all non- oint sour regulat
Issued by: Date: 3 3/ �/
❑ OWN R-BUILDER DECLARATION
RE -ROOFS:
1 hereby affirm that 1 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
1 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 1 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 1 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 1 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 ;;ner
h &
:
APPLICANT CERTIFICATION CONSTRUC ION 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 no - oint s urceLs per the Cupertino Municipal Code, Section
9.18. d I understand my plans shall be used as public records.
Signatur ` Licensed Professional
FM-7
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20605 lazaneo dr.
DATE: 02/04/2011
REVIEWED BY: bobs.
APN: 3�{n a3ogcA
BP#: 9
'VALUATION: 1$10,985
*PERMIT TYPE: Mechanical Permit
-
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 RMAP1
PERMIT TYPE:
WORK
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Other Appliance/Equip
113APPLOT
1
#
$63
TOTALS:
$63.00
Mech. Plan Check 1 2.0 1 hrs $252.00
Phunh. Plan Ckwe/
E'le ..f'Iarr (:{i ck
IMECPLNC Mech. Permit Fee: IMPERMIT
P —J). P';: >;r F c
Flec. Permit Fee,
Other Mech. Insp. 1.0 hrsL$42.00
017wr plumb 1„ ,).
Of1w.- Fit,( Insl).Mech.
Insp. Fee: IMECHINS126.00
hho„ t,. lisp. Fe'.
Elec. Insp, 1,C
NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resohition 09-051 Eff. 711110)
FEE
QTY/FEE
MISC ITEMS
Plun Check Fire:
suppl. PC Fete
PME Plan Check:
$252.00
Penni.t Fee:
Sulapl. Insp F''ce
PME Unit Fee:
$63.00
PME Permit Fee:
$168.00
Construction Tux
11cousticul Review Fee:
Work Without Permit? Q Yes E) No
$0.00
Plunning Fees:
Travel Documentation Fee: ITRAVDOC
$42.00
Strong; Motion Fee: IBSEISMICR
$1.10
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
17:,';<;TOTALS:
$527.10
$0.00 TOTAL FEF,
F$527.10
Revised: 01 /15/2011