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10110188 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 N TANTAU AVE FLR I CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO: 10110188 INC OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED:03/30/2011 OWNER'S PHONE: 4089744876 MILPITAS,CA 95035 PHONE NO:(408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATIONJ_ r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class -9 Lic.# 3991b '� MECH r— RESIDENTIAL r— COMMERCIAL Contractor }24;ilC6Ll C41,t = Date / I hereby affirm that I am licensed under the provisions of Chap er 9 JOB DESCRIPTION:FLOOR I (COFFEE VENDING)COMM'L TI-TENANT (commencing with Section 7000)of Division 3 of the Business&Professions IMPROVEMENTS COFFE VENDING AREA;NON-STRUCTURAL Code and that my license is in full force and effect. IN NATURE(265SQ);NO RE-ROOF&NO STRUCTURE 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:$30000 permit is issued. AS APPLICANT CERTIFICATION APN Number:31618025.FLR I 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 r ulaticns per the Cupertino Municipal Code,Section 9.18. c, / Issued by: Dater �df Signature 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. 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: HAZARDOUS MATERIALS DISCLOSURE [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 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 ,fir become subject to the Worker's Compensation provisions of the Labor Code,l must Owner o, an orized ge G --� ` �// 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 Mork'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. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF / J/Ag -0CITY OF CUPERTINO TENANT IMPROVEMENT CUPERTINO PERMIT APPLICATION FORM APN# / c,2 �/, , rl_�_ ( Date: I f. 2p� Building Address: (D �3 oo /v• Tj`fi7VIW/ llv�" Mailing Address (if different from building address): Tenant (If tenant please provide a letter from the building owner approving the tenant improvement.) Building Owner ❑ Are Hazardous Materials being used as part of this project? Yes ❑ No q14 Tenant/Building Owner's Name: Phone#: 4a8 `7447 —]5� /NC C . N yu Contractor: Phone#: ct�7 Fax#: Cupertino Business License: State Contractor License #: Contac�,�,�,,�..y�t N Y ��UM Phone#: �oe- 'Ll 0. -75-10 �l Fax#: "+,0 23 4 Landscape Ordinance Compliance: Landscape area in sq.ft. (includes all irrigated areas): If 2,500 sq.ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Job Description (be specific): -010 ?V_V^7, - /stn PPS v Iry T fv Vo?vt�)I N G lv4N —_q' 7zc C-f-V/ /tZ, /N A/tlTVrLE . 2�s 12> Tenant Improvement Includes Re-Roof: Yes ❑ No, ; If yes, number of squares Tenant Improvement Includes Structural Yes ❑ NoX -Y Type of Construction (Usage Class): Occupancy Type: J5 1-A, 1-B ❑ HIEEVV-A 2� EVIII B, IV-HT, V-B ❑ Valuation. DO O Project Size: Express Standard ❑ Large ❑ Major❑ Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEER Points Achieved *** For Office Use Only*** Over The Counter ❑ Revised 05/18/10 I Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: iii PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRALTO �p� C-001 BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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: V SUBCONTRACTOR BUSINESS 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 Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10300 N.Tantau Ave. DATE: 11/29/2010 REVIEWED BY: gs APN: BP#: 'VALUATION: 1$30,000 FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building T(JI;1L PENTAMATION 1B TI USE: FLOOR,,IRF +: PERMIT TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-A,III-A,V-A 265 $2,320.00 IBTIPLNCK $650.00 IBTIINSP TOTALS: 265 $2,320.00 $650.00 MECH,HOURLY Q Yes O No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yips -CNo Wr./I. Plan.C'herk !'iruuh. F'lun C ,cc/ E'lec:.Plan C`hcck L1e;h. Permit Fi>e: Phrmh. Permit Fee. h;-lec. Pennit Fee: Other Ak(h. Insp. Li Other Plum]) Li Other Elec.Insp. Alech. Inip. 1,co. Plumb. hle7). l��c�r� L�lcc.fnsp. FLrc�: NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 Ef 7/1/701 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,320.00 Select a Misc Bldg/Structure Suppl. PC Fee: E) Reg. © OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $650.00 Suppl. Insp. Fee-.0 Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C011SIOICtiOn Tc1.a Acoustical Fee: © Yes E) No $0.00 Q Work Without Permit? 0 Yes E) No $0.00 Planning Fee: PLLONGRNGC $0.00 Select a Non-Residential Truvel Docrrinentaiion Fires: Building or Structure Stroniz Motion Fee: IBSEISMICO $6.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $2,978.30 $0.00 TOTAL FEE: $2,978.30 Revised: 11/08/2010