09120060CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20525 MARIAM AVE
OWNER'S NAME: APPLE INC
'R'S PHONE: 4084642245
W LICENSED CONTRACTOR'S DECLARATION
License Class A Lic. # Vr t-Abo
Contractor Y40 ate
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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
permit is issued.
APPLICANT CERTIFICATION
1 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
9.18.
Signaturee"�Date tat 10
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
co: d expenses which may accrue against said City in consequence of the
gra. o of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 09120060
851 BUCKEYE CT
DATE ISSUED: 12/10/2009
MILPITAS, CA 95035
PHONE NO: (408)271-2425
BUILDING PERMIT INFO: BLDG ELECT f— PLUMB
MECH f— RESIDENTIAL I— COMMERCIAL
JOB DESCRIPTION: COMM'L TI; NON-STRUCTURAL INCLUDE ELECTRICAL &
MECHANICAL
Sq. Ft Floor Area:
Valuation: $40000
APN Number: 32656001.001
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date: rZ -/"<
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
rer or uto ! -agent:
Date v
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
ZC-)
CRTY OF cCUP ERTENO
TENANT EMPROVEMENT
ITY
CUPEI�°I.FIINO F ERMRT AFFLI CATRON FORM
APN # Date:
� )- G5 � 0v1, oo I
Building Address:
ZDS %&hKAW
Mailing Address (if different from building address):
Tenant L (If tenant please provide a letter from the building owner approving the tenant improvement.)
Building Owner 19
Are Hazardous Materials being used as part of this project? Yes No
Tenant/Building Owner's Name: Phone#:
9�qq -Zvs
Contractor: Phone#:
Fax #: 455 V40 WOO
Contractor License #: �`
Cupertino Business License#:
Contact: Phone#: 106 7,40 LN31
wo,v UIZml L;Zm Fax #: � Q
Alternate Contac Phone#: 0
' ' Fax #: f) (A&o
Valuation (cost of project):
wg �c�
Job Description(be specific):
�d
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:
1-A, 1-B ❑ lI/III/V-A ❑ II/111 B, IV-HT, V-B
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
LIEIED Points Achieved
***
For Office Use Only*** Over The Counter ❑ Revised 07/06/09
CITY OF CUPERTINO
TENANT IMPROVEMENT
FEESCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
IATINSP Tenant Improvement B 1A TI
Ins ection
1ATIPLNCK Tenant Improvement Plan B
Check
1 1BTIINSP Tenant improvement B 1B TI
I
Inspection
y 1BTIPLNCK Tenant Improvement Plan B
Check
1 ETIINSP Tenant Improvement B 1E TI
Inspection-Preschool
1 ETIPLNCK Tenant Improvement Plan B
Check-Preschool
1FTIINSP Tenant Improvement B 1F TI
Inspection-Factory/Indust
1FTIPLNCK Tenant Improvement Plan B
Check-Factory/Indust
1HTIINSP Tenant Improvement B 1H TI
Inspection-Hazardous
1HTIPLNCK Tenant Improvement Plan B
Check-Hazardous
I ITIINSP Tenant Improvement B II TI
Inspection-Institutional
I ITIPLNCK Tenant Improvement Plan B
Check-Institutional
1MTIINSP Tenant Improvement B 1M TI
Ins ection-Merchandise
1 MTIPLNCK Tenant Improvement Plan B
Check-Merchandise
1STIINSP Tenant Improvement B 1S TI
Inspection-Parking Garag
1 STIPLNCK Tenant Improvement Plan B
Check-Parking Garage
1REROOFCOM Re-Roof Commercial B
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
r 113SEISMICO Seismic Commercial B
1 BUS LIC Business License B
2 of 2
Green L LIAlldling Man Check
Mem ®f Green BuHdO ng Founts/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
PlansSee below
�. WI . a3
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points
11. Permeable Paving, Note L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, detail S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal. Tank, (Note/Spec L-1 10 oints
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
'?
TOTAL POINTS 40 points
Plan Review Process Work Book Page-12-Revised 3/25/08