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10090223CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20330 STEVENS CREEK BLVD CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 10090223 INC I OWNER'S NAME: APPLE INC 1 690 GIBRALTAR DR I DATE ISSUED: 09/23/2010 1 I OWNER'S PHONE: 4089745951 1 MILPITAS, CA 95035 1 PHONE NO: (408)941-8100 1 LICENSED CONTRACTOR'S DECLARATION /License Class Lic. # Contractor V�)EiU cox"t- Date V1� C 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 wh' is permit is issued. 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 appli derstands and will comply with all non - . ❑ 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. 1 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. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: SOFT DEMO OF EXISTING CAFETERIA AND SEATING AREA, 4500 SF Sq. Ft Floor Area: I Valuation: $35000 APN Number: 36901020.00 1 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: 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 I will maintain compliance with the C unicipal Code, Chapter 9.12 and the Health & Safe ty Code, Sectiotyr25505,25533, and 25534. te: ( ZZ 1 C v 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. Signature Date I Licensed iCM Of CU;PER,T1N0 CITY OF CUPERTINO DEMO PERMIT APPLICATION FORM L pogoZ23 APN# Date: Z Building Address: �O r CAAS 6celc� V Mailing Address (if different from building address): Owner's Name: Phone: Contractor: �eV C�� � 1 �-� � . Phone :,q ` c6 Z_ g 2 pC Fax: Contractor License #: S 9 c(1 3 Cupertino Business License #: Contact: C O �eJ,JC�1n GzGJ Phone:,�/d g Fax: Residential ❑ Sq Footage CommercialP< Sq Footage V Job Descr�ti'op:��C'Q,�t� V`o� 4,f �C►?�, '� Valuation4%A,,,,,.0 �)5J ©�� Project Size: Express Standard ❑ Large ❑ Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee Description Fee Group Permit Type 1DEMORES Demo -Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM_ 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09 Building Department CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ZO3]�,o PERMIT # Dd O , OWNER'S NAME: C PHONE # GENERAL CONTRACTOR: C-o1n, Crews BUSINESS LICENSE # 2,:-[ 63 ADDRESS: v CITY/ZIPCODE: qS a3 *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. -PE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB TRACTORS HAV T ED A CITY OF CUPERTINO BUSINESS LICENSE. z2 �� 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