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10080194I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20650 VALLEY GREEN DR OWNER'S NAME: APPLE INC VNER'S PHONE: 4088624397 13' LICENSED CONTRACTOR'S DECLARATION License Class__�ryyLiic. # ContractorDate 1 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. 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. q ,,�/ 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. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. 1 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 relations per the Cupertino Municipal Code, Section 9.18. C 1 1 T _ , ._J OWNER -BUILDER DECLARATION I hereby affirm that 1 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 1 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 'ndemnify and keep harmless the City of Cupertino against liabilities, judgments, ts, and expenses which may accrue against said City in consequence of the ..anting 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: DEVCON PERMIT NO: 10080194 CONSTRUCTION INC 690 GIBRALTAR DR DATE ISSUED: 08/26/2010 MILPITAS, CA 95035 PHONE NO: (408)942-8200 r r r BUILDING PERMIT INTO: BLDG ELECT PLUMB MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: COMM DEMO WALL AND CEILING 708 SQ FT Sq. F Floor Area: I Valuation: $12000 I APN Number: 32610053.00 I Occupancy Type: I PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180;DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issutd by: Date: RE -ROOFS: All rc ofs shall be inspected prior to any roofing material being installed. If a roof is instal ed without first obtaining an inspection, 1 agree to remove all new materials for inspe,:tion. Signature of Applicant:_ Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I have read the hazardous materials requirements under Chapter 6.95 of the Calif rrnia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Heal h & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air aontaminants as defined by the Bay Area Air Quality Management District I will Maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the F ealth & Safety Code, S ns 2 505 2 533, and 25534. Own -r or authorized agent: Date CONSTRUCTION LENDING AGENCY I herby affirm that there is a construction lending agency for the performance of work s for which this permit is issued (Sec. 3097, Civ C.) Lenc er's Name Lenc er's Add ARCHITECT'S DECLARATION I uneerstand my plans shall be used as public records. Licensed Profess CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR: DEVCON PERMIT NO: 10080194 CONSTRUCTION INC OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED: 08/26/2010 OWNER'S PHONE: 4088624397 MILPITAS, CA 95035 PHONE NO: (408)942-8200 UK LICENSED CONTRACTOR'S DECLARATION r r r 1�� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # r- r" ` ,� AZ,(O� Contractor 1�J( (1 �y` N Date MECH RESIDENTIAL COMMERCIAL I hereby affirm thatI am licensed under the provisions of Chapter 9 JOB DESCRIPTION: COMM DEMO WALL AND CEILING 708 SQ FT (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 thq___ Sq. Ft Floor Area: Valuation: $12000 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 die performance of the work for which this permit is issued. APN Number: 32610053.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: with all non -point source re lations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature' Date / 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 td HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sns 2 505 2 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Datea� 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date TY OF CUPERTINO -. . CI 2� it c� w4tL . Qk4- 2 DEMO 4no Fp dc-Oax , 3bb tUPE TINO PERMIT APPLICATION FORM APN# _ Date: ,ka �- t () — — Z(o-) � Buildin Address: LO� 09i" Demo -Residential Mailing Address (if different froba building address): 1SFDWL-DEM Owner's Name: Phone: INC., B Contractor: Phone: C49 ,C 1 Z U J-77Fax: Contractor License #:. Z`Y:X' Cel ALL PERMIT TYPES Cupertino Business License #: 1BSEISMICRE Contact: ,`N�Q2��?<XV` � „ _ ��Z Phone: Gook _:B3rl Z, Fax: --7-7(3 Residential ❑ Sq Footage Commercial's Sq Footage Job Description: � �� A Valuation:1(AOa0 mez Y (lam, 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 Fm, -7, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISICnEMOLITION p� FEE DATE: REVIEWED BY: lialADDRESS: APN: BP#: *VALUATION: 1$12,000 *PERMIT TYPE: Demolition Permit PIAN CHECK 7')'PE: PRIMARY Commercial Building USE. Other Elec. Insp. Li PENTAMATION 1COMMLDEM PERMIT TYPE: WORK lElee.Insp. fee: SCOPE p� FEE �a rbtech. Plan Check Plumb. Mart Check Elect. flan Check Lfech. Permit Feet: Plumb. Permit Fee: Flec, Permit Fee: Other rlfech. Insp. (hher Plumb Insp. E Other Elec. Insp. Li Ilech. lnsp.I,ee: Plumb. hisp. Fee: lElee.Insp. fee: NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 E . 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check fee: Supe/. PC i,'ee PlumbAllfech./f lec Plan Cheek: Permit Fee: $507.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PluinhJtllech.. Flee Unit Fee: t'lurnb.:':t1et'lz.ils'lc>C Permit Fee., Construction Tax Acoustical Review Fee: Work Without Permit? Planning l=ees: i 7'1,Uvel Doetunentatt.on feces: Strong Motion Fee: IBSEISMICO. 2 Select an Administrative Item Bldi: Stds Commission Fee: IBCBSC $1.00 g $510.52 $0.00 O L FBF $510.52 Revised: 8/17/2010 CUPERTINO Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR: LIST, JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # .. GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE:: A IIL I U *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: Signature 'fiate 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 Signature 'fiate