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090802339OC rep V 'n<a i �Z uorLLF 7UC tr, F �0i y41m Z> 0 z W �r ►'7 U Is, O H U CITY OF CUPERTINO PERMIT fi� 1��.G I� 11V1� BUILDING DIVISION .0R BUILDING ADDRESS: PERMIT NO. 10201 N DE ANZA BLVD FLR 1 XL CONSTRUCTION 09050151 PERMIT ISSUE DATE `tER'S NAME: S XmyAgtt CONTROL NO. PHONE: (408)271-2425 BUILDING PERMIT INFO ARCHITEGTIENGINEER: BLDG ELECT PLUMB MF -CH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divi on 3 of the Business and Pr o my license is in full force and effect COM ' L TI ELCTRC L C ONNTN OF FURNITURE FRAME ON License�ys Date � CoLlentra--ctor BELOW GRID PARTITION WALL w ARCHITECT'S DEC I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct alter, improve, demolish, or repair any structure ! prior to its issuance, also requires the applicant for such permit to file a signed statement 1 that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $40000 I that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars ($5W). 3 2 6 3 4 0 7 0. E LR 1 ❑ 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 forsalc (Sec. 7044, Business Required Inspections and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). Q 1, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li. cense law does not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a contractor(s) licensed pursuant to the contractor's License Law. Q I am exempt under Sec. B & P C for this reason .nerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of Ute following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the rk for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section of the Labor Code, for the performance of the work for which this permit is issued. y Wor s Compensilbon Insurance carrier and Policy nor Carrier. Policy No.: 4MEAA V CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 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 Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must 7 forthwith comply with such provisions or this permit shall be deemed revoked. j CONSTRUCTION LENDING AGENCY el I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued (Sec. 3097, Civ. C.) 1 Lender's Name Lendees 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 authorim representatives of this city to enter upon the above-mentioned property for inspection purposes ]r (We) agree to save, indemnify and keep harmless the City of Cupertino against y) liabilities, judgments, costs and expenses which may in any way accrue against said City 7_ in consequence of the granting of this permit. -Z Issued b): Date G APP CANT UNDEMPANDS AND WILL COMPLY WITH ALL NON -POINT SOMQX REG S. 5 Re -roofs Signature o App t/Con tori °oto T Of Roof Type MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12• and the Health and Safety ,de, Section 25532(x)? All shall be inspected prior to any roofing material being installed. �� ❑Yes Imo roofs a roof s installed without first obtaining an inspection, I agree to remove ill the applicant or future building occupant use equipment or devices which Will emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ��' ❑Yes QNu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Secuorts 25505, 25533 and 75534. l understand that if the building does not currently It ve tenant that it is my responsibility to notify the occupant of the w ' h be met prior to issuance of a Certificate upancy. Signaturt of Applicant Date ants All roof coverings to be Class''`' or better Owner or authorized agent Date CITY OF CUPERTINO BUILDING PERMIT ________[CONTRACTOR:DEVCON BUILDING ADDRESS: 10201 N DE ANZA BLVD FLR 1 CONSTRUCTION PERMIT NO:09080233 INC 690 GIBRALTAR DR DATE ISSUED:08/27/2009 ( "R'S NAME: APPLE PHONE NO:(408)942-8200 MILPITAS,CA 95035 OWNER'S PHONE: 4086666614 [s(. LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 3 9 C1 MECH r— RESIDENTIAL COMMERCIAL Contractor I/eN&m / A(. 6r Date 3'I JOB DESCRIPTION:COWL TI DEMOLITION(104,OOOSQFT)PHASE 1 I hereby affirm that I am licensed under the provisions of Chapter 9 AND 2; (commencing with Section 7000)of Division 3 of the Business&Professions I ST,2ND&3 RD FLOORS&LOBBIES 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. Valuation:$150000 1 have and will maintain Worker's Compensation Insurance,as provided for by S q. loor Area: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. mber:32634070.FLR1 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 PENT 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. � .!� Date 2 Ile S re -- RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, I Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Business&Professions Code) 1,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: nt to I have read the hazardous 5 of the I have and will maintain a Certificate of Conse 3700 of theLabor Code, the Worker'sf-insure for California Health&Safety Code,aSections 25505,requirements25533,and 25534.Chapter 91 will maintain Compensation,as provided for by Chapter 9.12 and the Health& compliance with the Cupertino Municipal Code, 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,I 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 aking this certificate of exemption,1 O or authorize agent: _D 4 Compensation laws of California. If,after in 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 APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.1 agree to comply with all city and county ordinances and state laws relating Lender's Name to I— Iding construction,and hereby authorize representatives of this city to enter e above mentioned property for inspection purposes.(We)agree to save Lender's Address int.- ..iify 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 with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date -' CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10201 N DE ANZA BLVD FLR 1 CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 09080233 INC OWNER'S NAME: APPLE 690 GIBRALTAR DR DATE ISSUED: 08/27/2009 OWNER'S PHONE: 4086666614 MILPITAS, CA 95035 PHONE NO; (408)942-8200 C LICENSED CONTRACTOR'S DECLARATION f— F_ F 'BUILDING License ClassLic. # 3 -I I (a '�5 PERMIT INFO: BLDG ELECT PLUMB r— F r r Contractor lJ �/iT iii �( J S1L A V Date 3 i✓ 7 D ct MECH RESIDENTIAL COMMERCIAL 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COMM'L TI DEMOLITION(] 04,OOOSQFT) PHASE I (commencing with Section 7000) of Division 3 of the Business & Professions AND 2> Code and that my license is in full force and effect. I ST,2ND &3RD FLOORS & LOBBIES 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: $150000 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: 32634070.FLR1 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 to building construction, and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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• Issued by: z Date: Signature ❑ OWNER -BUILDER DECLARATION RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. if a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business & Professions Code) 1, 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: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self -insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & 1 have and will maintain Worker's Compensation Insurance, as provided for by Safety Code, Section 25532(a) should I store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this Additionally, should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will 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, I 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 Compensation laws of California. If, after making this certificate of exemption, 1 Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION l hereby affirm that there is a construction lending agency for the performance of work's I certify that l have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address 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 ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date