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11010160 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10435 N TANTAU AVE CONTRACTOR:NOVO CONSTRUCTION PERMIT NO: 11010160 OWNER'S NAME: APPLE INC 4025 BOHANNON DR DATE ISSUED:03/23/2011 OWNER'S PHONE: 4157103063 MENLO PARK,CA 94025 PHONE NO:(650)701-1500 ❑ LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 19 Lic.# ( Oaa MECH r RESIDENTIAL r COMMERCIAL r Contractor j J"Q CO%STa1)COW Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 1ST FLOOR--COMM T.l OF 9,721 TO INCLUDE(E,M) (commencing with Section 7000)of Division 3 of the Business&Professions CONSTRUCTION OF NON-RATED PARTITIONS AND(N) Code and that my license is in full force and effect. FINISHES. 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:$290000 permit is issued. APPLICANT CERTIFICATION APN Number:31606039.00 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. Addit' Wally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source re ations per the Cupertino Municipal Code,Section 9.18. Issued by: S6� Date: 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 I,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 [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. 1 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 become subject to the Worker's Compensation provisions of the Labor Code,I must Ow er uthorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. �� j� 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 wrk'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 CITY OF CUPERTINO TENANT IMPROVEMENT CUPERTINO PERMIT APPLICATION FORM APN#31 l.o Dco o T5ate: J 1131 0 Building Address: �Oy N•7'AN1'A?) AUf , �S'r Mailing Address (if different from building address): 4. =tJlaIVtTE Lzap Tenant ❑ (If tenant please provide a letter from the building owner approving the tenant improvement.) Building Owner R. Are Hazardous Materials being used as part of this project? Yes [:[-NoC] Tenant/Building Owner's Name: Phone#: 615->10 30&3 APPL . Contractor: Phone#: 6S-0 6lo a(036 NW6 Fax#: Cupertino Business License: State Contractor License #: qI Contact: �A,L/ Phone #: !cam 610 &63(p Fax/e-mail:F_-WA8RA1 o U Landscape Ordinance Compliance: .Cori, Landscape area in sq. ft. (includes all irrigated areas): ASF 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): Qe)p -srMuCWA , OPPAOn�_ -T,=: . ,�Nu v�rN� ELEG�c+�lcAti AND N�c �A�J��4L CA��o�l op ,jW- {) PAah-ncM_, MO Guy tN . Tenant Improvement Includes Re-Roof. Yes ❑ No ❑ If yes, number of squares Tenant Improvement Includes Structural Yes ❑ No ❑ Type of Construction(Usage Class): Occupancy Type: j3 1-A, 1-B ❑ UMI/V-A ❑ IMII B, IV-HT, V-B Valuation- *6t70 K Project Size: Counter Express Standard Large 0 Major Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable,include in plans & sheet index LEED Points Achieved *** For Office Use Only*** Revised 12-06-10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: I 0q Aor PERMIT# OWNER'S NAME: AAP PHONE# mv GENERAL CONTRACTOR: 0\10 BUSINESS LICENSE# ADDRESS:c( 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: Qnature 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