11010109 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20605 VALLEY GREEN DR CONTRACTOR:SOUTH BAY PERMIT NO: 11010109
CONSTRUCTION CO INC
" VNER'S NAME: APPLE INC. 170 KNOWLES DR DATE ISSUED:01/19/2011
�.VNER'S PHONE: 4088620902 LOS GATOS,CA 95032 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# 3-�(op1 14
MECN T_ RESIDENTIAL r— COMMERCIAL�
Contractor SNT)( QA14 GoNS-r Date 1 ) Il
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL 24 EXIT SIGNS FOR PATH OF TRAVEL
(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:
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. Sq.Ft Floor Area: Valuation:$7000
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. APN Number:32610046.20605 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by l� Date �r
9.18.
Signature �-I -� Date I (1
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,1 shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner or au razed agent:
Compensation laws of California. If,after making this certificate of exemption,17 Date:
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. CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
1 certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
'emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
.s,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20605 VALLEY GREEN DR CONTRACTOR:SOUTH BAY PERMIT NO:11010109
CONSTRUCTION CO INC
OWNER'S NAME: APPLE INC. 170 KNOWLES DR DATE ISSUED:01/19/2011
OWNER'S PHONE: 4088620902 LOS GATOS,CA 95032 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class � Lic.# .S3(C l I4
MECH RESIDENTIAL COMMERCIAL
Contractor QJ`(V {37�i{ Go n1 SJr- Date 1'1 l l
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL 24 EXIT SIGNS FOR PATH OF TRAVEL
(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. Sq.Ft Floor Area: Valuation:$7000
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. 1% APN Number:32610046.20605 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by Date' ( �^��
9.18. �—
Signature � r" Date t i l e, 14 i
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury: one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
p Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I7�iF Date: t lit
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
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
.granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF
`CITY OF CUPERTINO
GENERAL BUILDING 1
CUPERTINO PERMIT APPLICATION FORM
APN# O Il r ,o Date:
Building Address:
-o(aDS V A taef G RM&j
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA
If Residentiall,is house an Eichler? Yes ❑ No If es, needs planning approval.
Owner's N e• Phone#: p oLI
07
Contractor: Y �jJn1 S Te-v C�a Phone:
4494Fax:
Contractor License#: 'J
Cupertino Business License#:
Contact: Phone: zkZ S R 3 �9
tAieST-0 CAfIif w Fax/e-mail:
Residential ❑ Commercial ❑
Job Description: ..M L l (24) rax I T si 6 A S FbK Pvq dF
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type: flZ
1-A, 1-B ❑ IUIII/V-A ❑ II/III B, IV-HT,V-B (�
Valuation: .)iQDID
Square Footage:
Project Size: Counter x ress ❑ Standard ❑ Lar e ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable,include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 12/06/10
CITY OF CUPERTINO
F9FEE ESTIMATOR—BUILDING DIVISION
JADDRESS: 20605 valley green dr. DATE: 01/19/2011 REVIEWED BY: bobs.
APN: 3a�Q. BP#: *VALUATION: $7,000
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1 CEAPB
USE: Commercial Building PERMIT TYPE:
WORK r�
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Other Power Devices 1BREMPOWER 1 # $158
TOTALS: $158.00 ya:
.0 k ..
;111ech.Plan Check Plumb.Plan "p" ',
Elec.Plan Check 0.0 hrs $0.00
iL1ech. Permit Fee' Elec.Permit Fee: IEPERMIT
t)Ilrer,�Ic ch.Irts[3. Other Plumb Insp. Other Elec.Insp. 0.0 hrs $42.00
dfe�ch. Insp-Foe. Plumb. Insp.Fee: Elem.Insp. Fee:
NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E . 7/1/10JFEE QTY/FEE MISC ITEMS
Plan Check.Fee.
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suppl. Insp lee
PME Unit Fee: $158.00
PME Permit Fee: $42.00
Construction Tax
Acoustical Review Fee:
Work Without Permit? O Yes G No $0.00
Planning Fees:
Travel Documentation Fee: 1TRAVDOC $42.00
Strong Motion Fee: IBSEISMICO $1.47 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00 .
$244.47 $0.00 OS` L E $244.47
Revised: 01/03/2011