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09090005 DEF1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 N TANTAU AVE FLR 1 CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO:09090005 INC OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED:09/23/2009 C .4ER'S PHONE: 4088629799 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB r License Class Lic.# MECH F RESIDENTIAL r COMMERCIAL r Contractor 7>`l�� l Date 4 v JOB DESCRIPTION:COMM'L TI TO PORTION ON THE 1ST FLOOR OF I hereby affirm that I am licensed under the provisions o Chap er 9 EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions BUILDING;NEW INTERIOR WALLS,CEILING Code and that my license is in full force and effect. MODIFICATIONS,NEW ELECTRICAL/DATA CC, a��—r — Dei DL'c� `4.5. ffiC� f/ 5� I hereby arm under penalty of perjury one of the following two declarations: � Jo r, ���f ^ �fj0� _ 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 v-^��1 �✓' 60"_ performance of the work for which this permit is issued. J' 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 Valuation:$85000 permit is issued. Sq.Ft Floor Area: APPLICANT CERTIFICATION Occupancy Type: I certify that I have read this application and state that the above information is APN Number:31618025.FLRI P Y YP 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the a licant understands and will comply with all non-point source regulations per e Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Date Issued by:Signatur .�� �—�'� ��� Dater"—,(r ❑ OWNER-B ILDER DECLARATI N I hereby affirm that I am exem t from the C091r or's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. 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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Own authori ed a 3 forthwith comply with such provisions or this permit shall be deemed revoked. Date: �d APPLICANT CERTIFICATION C N LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's ued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter for which this permit is iss u­the above mentioned property for inspection purposes.(We)agree to save Lender's Name nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address cu—,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 t e Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMITeS_q BUILDING ADDRESS: 10300 N TANTAU AVE FLR I CONTRACTOR:DEVCON CONSTRUCTION PERMIT NO:09090005 INC 0- R'S NAME: APPLE 690 GIBRALTAR DR DATE ISSUED:09/23/2009 OWNER'S PHONE: 4088629799 MILPITAS,CA 95035 PHONE NO:(408)942-8200 J"' LICENSED CONTRACTOR'S DEC/LARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# y7 �llJ MECH r RESIDENTIAL COMMERCIAL Contractor Date Date JOB DESCRIPTION:COMM'L TI TO PORTION ON THE 1ST FLOOR OF I hereby affirm that I am licensed under the provisions of Chapter 9 EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions BUILDING;NEW INTERIOR WALLS,CEILING Code and that my license is in full force and effect. MODIFICATIONS,NEW ELECTRICAL/DATA .a'r-y.��. (Lea:�2-��aQ�-^�`(�-� 1(e V }� ,Q�✓-�� 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 Valuation:$85000 permit is issued. Sq.Ft Floor Area: APPLICANT CERTIFICATION anc Occu Type: I certify that I have read this application and state that the above information is APN Number:31618025.FLR1 occupancy yP 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.1Q IN v � _ure ✓ Date � i d Issued by: Date:-3y ❑ OWNER-BUILD DEC TION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. 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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety CodeESTRU ' 533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Oµ or autho ze /� forthwith comply with such provisions or this permit shall be deemed revoked. te: APPLICANT CERTIFICATION LENDING AGENCY I certify that I have read this application and state that the above information is cc, -t.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's ling construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) up. the above mentioned property for inspection purposes.(We)agree to save Lender's Name 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 with all non-point source regulations er the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. __ I understand my plans shall be used as public records. ' Date �Q Signature` V" Licensed Professional