10100152CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6 INFINITE LOOP FLR I CONTRACTOR: SOUTH BAY PERMIT NO: 10100152
CONSTRUCTION CO INC
OWNER'S NAME: APPLE INC
OWNER'S PHONE: 408996 10 10
❑ LICENSED CONTRACTOR'S DECLARcA,TION
License Class_ Lie. # ��j
Contractor Date t6
1 hereby affirm that 1 am licensed er 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:
1 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. 6JQ' (z_-
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,
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.
Date )b—
"20-t' v
IN
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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).
1 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,
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.
170 KNOWLES DR DATE ISSUED: 10/20/2010
LOS GATOS, CA 95032 PHONE NO: (408)379-5500
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
COMM INTERIOR DEMO 970 SQ FT
Sq. Ft Floor Area: I Valuation: $8000
APN Number: 3160211O.FLRI I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued br . Date:
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
I 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
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code ctio 25505, 25533, and 25534.
Owner or authorized a Date: 16-12-0
CONST CTIO ENDING 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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Date
DEMOLITION
CITY OF CUPERTINO
F-M-W FEE ESTIMATOR - BUILDING DIVISION
ADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
'VALUATION: 1$8,000
PERMIT TYPE: Demolition Permit
Pl- I.V C111, CK TI'F'E.
PRIMARY Commercial Building
USE:
PENTAMATION 1COMMLDEM
PERMIT TYPE:
WORK
SCOPE
FEE ID FLR AREA
s.f.
1DEMOCOM 970
,Arch. Plan Check
Alrru'h. Plau C`Ixrck
E/ec, flan ("heck
F'�fecl'. Acrn'i[Fee-
P,'�.;:�.. pot ;w hoc':
l,:" ". p'v»air Fee
Other Rlech. Il � �
()"h"r P.11i e, l�f:' �
of;;'f ,�Ilcc'. hop,Lj
lkrch. In.�P. Pee
Plumb. I'�.cp. Fee
FI,^(. insp 1, 'c°
NOTE. These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 09-051 Eff. 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check-
Suppl. PC' 1 'ee
Plumb./:'lfech./Flee, Plan Check:
Permit Fee:
$507.00
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
firs
$0.00
P1umbJi'v1ec 1z.;Elee Unit Fee:
P1umb./'1A'c'h./Elec Permit Fee.
Conswaction Tax
Acousllcal Review Fee.
f for/c 4'ithout Pei-miO
Planning Fires:
I
Travel Doi uinentution Fees.
Strong Motion Fee: 1BSEISMICO
$1.68
Select an Administrative Item
Bldg Stds Commission -Fee: 1BCBSC
$1.00
SUBTOTALS:
$509.68
$0.00 TOTAL FEE:
$509.68
Revised: 10/17/2010