11030006 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10501 N TANTAU FLR l CONTRACTOR:SOUTH BAY PERMIT NO: 11030006
CONSTRUCTION CO INC
OWNER'S NAME: APPLE INC 170 KNOWLES DR DATE ISSUED:03/01/2011
OWNER'S PHONE: 4089745951 LOS GATOS,CA 95032 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class f2 Lic.# ;%1&97+ r r r
`,�/ e- MECH RESIDENTIAL COMMERCIAL
Contractor ��y,11 ppY �p'1V Date 7 - 1 —t
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FLOOR I-COMM'L DEMO-DEMO 8,000 SQFT T-BAR DUCT
(commencing with Section 7000)of Division 3 of the Business&Professions WORK RAISED FLOOR OF AN UNOCCUPIED BUILDING
Code and that my license is in full force and effect.
I 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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$20000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:31606052.00 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 B'':! Date:
Signature ? Dates — I,
❑ 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 HAZARDOUS MATERIALS DISCLOSURE
declarations:
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&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(x)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I 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,I Owner or aut zed age
become subject to the Worker's Compensation provisions of the Labor Code,I must -- Date: _
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.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
DEMOLITION
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10501 n tantau ave. DATE: 03/01/2011 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: 1$20,000
PERMIT TYPE: Demolition Permit 11L,4,N CHECK TYPE
PRIMARY Commercial Building PENTAMATION 1COMMLDEM
USE: PERMIT TYPE:
WORK demo non-occupied comm. bldq interior only non-structural
SCOPE
FEE ID FLR AREA
s.f.
1 DEMOCOM 8,000
.Lfech. Plan('hack Plumb. Plan Chrrk DeL.Plan Chr'c:k
kc:h. Permi!Fee: Phrrnh. Pcl reit Fec. k( Permit l c
00-ler Alech. Imp. Other plumb lrnp. U/h r Elec_Insp.
Blech. Insp. h'crc' Numb. lnq). Fcc Elec. Imp. Pee.
NOTE: These ees are based on the prelitninary in ormation available and are only an estimate. Contact the D t or addn'1 info,
FEE ITEMS (Fee Resolution 09-051 Eff. 7/1/101 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC'Fee
Plumb./Mech./Flee Plan Cheek:
Permit Fee: $1,013.00
Suppl. Insp. Fee'O Reg. 0 OT 0.0 hrs $0.00
Plumb.%:blech.;Elcc Unit.Fee:
Plumb./Mech./Flee Pernlit Fee:
Construction Tax
Acoustical Review Fee:
lGork lf'ithout.PerniiO
Planning Fees:
Travel Docznnentution Fees: �
Strong Motion Fee: IBSEISMICO $4.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS- $1,018.20 $0.00 TOTAILFEE: $1,018.20
Revised: 01/15/2011