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15060055
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1 INFINITE LOOP CONTRACTOR: PLANT CONSTRUCTION PERMIT NO: 15060055 OWNER'S NAME: APPLE COMPUTER INC 300 NEWHALL ST DATE ISSUED: 07/09/2015 OWNER'S PHONE: 4088627979 SAN FRANCISCO, CA 94124 PHONE NO: (415) 285-0500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ License Class �� �! APPLE - T.I. TO RECONFIGURE & UPDATE (E) M Lic. # OCCUPANY (RETAIL STORE) (5,695 S.F.) Contractor Kat^ t i�ega'r�ti0`4kasn -Date �` �'( (� DEFERRED SUBMITTAL #1: SECONDARY STRUCTURAL STEEL. ISSUED I hereby affirm that I am licensed under the provisions of Chapter 9 7-9-15. (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 Sq. Ft Floor Area: Valuation: $2500000 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. APN Number: 31602105.00 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS' OF PERMIT ISSUANCE OR 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 this Additionally, Issued by: ��A/ �,� 1 - >'�i"7 0 ,1 Date: granting of permit. the applicant understands and will comply /7 d with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatur Date % (' Ir RE -ROOFS: 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 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, Sections 2 05, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent-(,--TDate: 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 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 CONSTRUCTION PERMIT AR �C j COMMUNITY DEVELOPMENT DEPARTMENT-BUILDIG D VISIOt�� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTIN0 I (408) 777-3228 . FAX (408) 777-3333 • building(LDcupertino.org I b S. -r ❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTFRATTOW /TT r7r, FVTSTnV IT)FFFRRFTI nTaTnrnTAT D=DtX PT PROTECT ADDRESS (1 a / API 4 OV NERNAME PHONE p �o E-MAIL b STREET ADDRESS I bdi�4"�ee��n a�®((�� CITY, STATE, ZIP FAX C4, q `c of q CONTACT NAME I PHONE qo ® 842L- -74C7 E-MAIL �jcfffiw a Gw�I o/ aF��t• G®�s° 1 STREET ADDRESS I 1�q °w 1��� CITY, STATE, ZIP / p FAX C(A - lT® I E3 OWNFR ❑. OWNER -BUILDER ❑ OFVNERAGENr Lr CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT El ENGINEER. ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICEI'SENUMBER I LICENSETYPE'S BUS. LIC 9 3T -7®y 5 COI,APANYNAME , `sw 2.`it �vn .� . �M`�� E-MAIL @ aa� Gva G-Qa�1: 1 6 � FAX STREET ADDRESS I CITY, STATE, ZIP PHONE 3®® cw S�. Sw �� CA 'I 6I l ARCHITECT/ENGINEER NAME � LICENSE NUMBER BUS. LIC � � COMPANY NAME j 11 a E-MAIL( 6 '3.- nis- STREET ADD SS CTIYSTATE, P PHONE DESCRIPTION OF WORK 1 l ss �1 g ��� G,� vc l �. 3b`�6A' .3a/�vpni'i9 e �.GL�ba�®• p EXISTING USE PROPOSED CONSTR. TYPE t s 9 STORIES USE TYPE I OCC.VSQ.FT.F ATION A I (S)EXISTG 56q�� NEW FLOORa� AREA It� L �,' DEMO �q P g�TOTAL2 AREA -9y �tl� y� NEI AREA ' 9� �' �yAREA (-A � �5 °i� 1" ° BATHROOM KITCHEN OTHER P.EMODEL AREA �/ REMODEL AREA �A REMODEL AREA 1� /A PORCHAREA DECK AREA TOTAL DECK/PORCHAREA GARAGEAREA: DETACH Y'SIA-ys,� lv IL ❑ ATTACH I R DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES NA DED? ❑ NO BEING AD ADDItf ONO 'lwlQ PRE -APPLICATION ❑YES IF YES, PRYOVIDE COPY OF PLANNINGAPPLR ❑NO PLANNING APPROVALLETrER IS THE BLDG AN ❑'YESC£IVED EICHLERHOME? ❑ NO " .�, " - - f': s TOTAL V ATION: ' riTE� -{•L F'N9 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state Iaws relating to Id' construction. I authorize representatives of Qupertino to enter the above- identifie� property for inspection purposes. -7/6/ 11 Signature of Applicant/Agent: 9 ,� Date: SUPPLEMENTAL INTFORMATION REQUIRED :,rLan c> cxT E . ?� y .0T3TII�GSI IP r,,} New SFD or Multifamily dwellings: Apply for demolition permit for existingpermit is required prior to issuance of buiI ing -ji-0 04ER T1�GOUNTER � � BUIID�GPLT�NREVSECT �� fr neav rmit for buildingDemolition P o• EXPRESS t �❑ �PLAATII°�PLArNREVIEW�� . _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 sTKIM� tA011 oy= form if any Hazardous Materials are being used as part of this project.G _ Copy of Planning Approval Letter or Meeting with Planningprior to submittal ofBuildina.g Permit application. BldgAlpp_�011.doc revised 06/21/11 W1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1 INFINITE LOOP CONTRACTOR: PLANT CONSTRUCTION PERMIT NO: 15060055 OWNER'S NAME: APPLE COMPUTER INC 300 NEWHALL ST DATE ISSUED: 07/09/2015 OWNER'S PHONE: 4088627979 SAN FRANCISCO, CA 94124 PHONE NO: (415) 285-0500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Clq GI � 3 APPLE - T.I. TO RECONFIGURE & UPDATE (E) M Lie. # OCCUPANY (RETAIL STORE) (5,695 S.F.) Contractorass 0 0 C 0& `�1, P_v afe0"7 - 6 -1 5' I 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. 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 C9pappsation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $2500000 erf (mance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31602105.00 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180POSFROM LAST CALLED INSP CTI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, L� (�� r�' costs, and expenses which may accrue against said City in consequence of the l granting of this permit. Additionally, the ap I' ant understands and will comply !,/•/` Issued by: Date: _ with all non -point source r tia pertino Municipal Code, Section 9.18. ��� ''J c,F —� RE -ROOFS: Signa re 1 l Date dd l 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. ElOWNER-BUILDERDECLARATION 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) I, as owner of the property, am exclusively contracting with licensed contractors to 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 gement District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino . I C , Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 5 05, , a 534. Section 3700 of the Labor Code, for the performance of the work for which this Owner Date: �� l permit is issued. or authorized agen 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408 (c ) 777-3228 • FAX (408) 777-3333 • buildingDcupertino.org / y e2-5-5— cS 8) AT)r)TTTCIN V V. AT TFR ATICWT /TT � DT:l7TQTnAT /n=MT)DL'Tl nDU'-TTTAT DL'DAAT14 PROJECT ADDRESS "N # # STORIES ❑ BUIL RINGFLAN .REVIEW ' ❑ EXPRESS OWNER NAME USE TYPE OCC. p®E � C7 E-MAIL STREET ADDRESS DEMO CITY, STATE, ZIP ,� / �//I1O &Ll FAX CONTACT NAME SA � �v �� E �IAI PHO - E-MAIL a ST T DD SS - OTHER [V STREET ADDRESS AtI_ b2- r ®/ CJ �✓ C Y, STATE, ZIPR12 I /� FAX 1, OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT NAME � ` LICEN LICENSE T E BUS. LIC # CONTRACTOR PROPOSED USE CON TR TYPE # STORIES ❑ BUIL RINGFLAN .REVIEW ' ❑ EXPRESS i USE TYPE OCC. tl C7 EXISTG A NEW FLOOR DEMO TOTAL NET COMPANY NAME ❑ SANITARY SEWER DISTRICT ® �'� E �IAI F-❑ P..NVIRONMF,NTAL HEALTH FA a ST T DD SS KTTCHEN OTHER [V CJ �✓ REMODEL AREA REMODEL AREA �4� ARCD T(ENGINE�g (/ AM� PORCH AREA LICEN NUMBS TOTAL DECK/PORCH AREA GARAGE AREA: DETACH / / US. LIC # (y COMPANY NAME / o , EMAIL n /n , FAX IS ASECOND UNIT OYES =Y"TADI CITY, S ATE, Z BEING ADD D? ONO G PHONE PRE -ADPL CATION OYES IF YES, P OVIDCOPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN L] YES _. . TION- EICHLER HOME? OF EXISTING USE PROPOSED USE CON TR TYPE # STORIES ❑ BUIL RINGFLAN .REVIEW ' ❑ EXPRESS ❑ PLANNING PLAN REVIEW USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG A NEW FLOOR DEMO TOTAL NET ' ❑ SANITARY SEWER DISTRICT - - F-❑ P..NVIRONMF,NTAL HEALTH BA 0 M KTTCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA �4� PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATFACH #DWEL ING UNITS: IS ASECOND UNIT OYES SECONDSTORY ❑YES BEING ADD D? ONO ADDITIO ? ONO PRE -ADPL CATION OYES IF YES, P OVIDCOPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN L] YES _. . TION- EICHLER HOME? By my signature below, I certify to each of the folio I the propel weer or authorid agent to a e property owner's behalf. I have read this application and the information I have provided is rr ver d -the Description of Work and It is accurate. I agree to comply with all applicable local ordinances and state laws relating to building co o j dTL vize representatives of Cupertino to enter the above_idgntiBedproperty for inspection purposes. Signature of Applicant/Agent: (. SUPPLEMENTAL INF ON REQUIRED _ New SFD or Multifamily dwell' gs: ply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECK TYPE . '' I ROUTING SLIP - ❑ OVER-THE-COUNTER ❑ BUIL RINGFLAN .REVIEW ' ❑ EXPRESS ❑ PLANNING PLAN REVIEW ❑ STANDARD ❑ PUBLIC WORKS ❑ LARGE ❑ .`FIRE 6EPT ❑ MAJOR ❑ SANITARY SEWER DISTRICT - - F-❑ P..NVIRONMF,NTAL HEALTH BldgApp_2011.doc revised 06121111 /1 CITY OF CUPERTINO FM -7 FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: 1 INFINITE LOOP DATE: 06/08/2015 REVIEWED BY: MELISSA IlaADDRESS: APN: 316 02 105 BP#: *VALUATION: 1$2,500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building $7,074.05 PENTAMATION PERMIT TYPE: IMTA WORK APPLE - T.I. TO RECONFIGURE & UPDATE E M OCCUPANY RETAIL STORE (5,695 S.F. SCOPE 0,0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID M (Tenant Improvements) I-A,I-B 5,695 $5,094.42 1MTIPLNCK $7,074.05 IMTHNSP Elec. Insfr. Fee: $7,074.05 Suppl. Insp. Fee -(E) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �.Uti:i7r tutit�rt TUX: Administrative Fee: 0 E) Work Without Permit? 0 Yes E) No $0.00 TOTALS: 5,695 1 $5,094.42 Travel Doeumentation lees: $7,074.05 - ME CH, HOURLY.. .•Yes, .. •. No" PLUIlIH, HOURLY Yes ;. • No' EIEC, HOURLY Yes No: Afech. T'lan C''eck Phtwb. Plata CheckF-T f_'lec,.Tan C"{uck Mesh. Petrraril Fire: Plumb. I61 -mit Fee: I"le.c•. Perrrrit I'ee: (),her• ,o'r`es h. Tnsrr. Other Plumb Trtsp. Chher Liles. MS, . i4ech. lnal3. Fisc: Pttuub. TnsTz Fee: Elec. Insfr. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, rare, SanitaryFewer Ulstricl, 6cn001 rl:cir:nr nfn 1 a hn n f n n Ano—I n., Aa C antaet the DeDt for addn �l info. FEE ITEMS (Fee Resolution 11-053 Efj.' 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,094.42 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (E)Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $7,074.05 Suppl. Insp. Fee -(E) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �.Uti:i7r tutit�rt TUX: Administrative Fee: 0 E) Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 Travel Doeumentation lees: Strong Motion. Fee: IBSEISMICO $700.00 Select an Administrative Item, Bldg Stds Commission Fee: 1BCBSC $100.00 SUBTOTALS: ` 12,968.47 $0.00 TOTAL FEE ` $12,968.47 Revised: 05/07/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1 INFINITE LOOP CONTRACTOR: PLANT CONSTRUCTION PERMIT NO: 15060055 OWNER'S NAME: APPLE COMPUTER INC 300 NEWHALL ST DATE ISSUED: 07/09/2015 OWNER'S PHONE: 4088627979 SAN FRANCISCO, CA 94124 PHONE NO: (415) 285-0500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ -C — � APPLE - T.I. TO RECONFIGURE & UPDATE (E) M License Class 73 Lic. OCCUPANY (RETAIL STORE) (5,695 S.F.) /# � �o�rS �ruc Al'-� Date f -31 "'(S Contracto> DEFERRED SUBMITTAL #2: INSTALLATION OF I hereby affirm that I am licensed under the provisions of Chapter 9 STORAGE RACK. ISSUED 8-31-15. (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 Sq. Ft Floor Area: Valuation: $2500000 erformance of the work for which this permit is issued. ve 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 APN Number: 31602105.00 Occupancy Type: permit is issued. 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 Issued by: Date: � L �� i ��/1 granting of this permit. Additionally, the applicant understands and will comply with all non -point source re la ' to Cupertino Municipal Code, Section 9.18. Q^ / (� RE -ROOFS: Signatur Date TJ ! 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 to 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 Cuperttg6lMulftipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code�2, nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized age/ Date: 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 MN� t)4'd"`CorreJ, CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildinq(a)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS .z g4 �L t4. -L 1 v e APN # —31t —/9-5 /9- " OWNERNAME / P(,e l.� PHONE V© ,^ L�G.y Q E-MAIL ` \ ` b G1 �/, 7 STREET ADDRESS I F���-f �� CITY, STATEZIP ���Pt. - 9 s -10i FAX CONTACT NAME PHONE E-MAIL STREET ADDRESSCITY, STATE, ZIP FAX 1:1OWNER 1:1 OWNER -BUILDER 1:1OWNER AGENT 01f0NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR AMEN � LICENSE NUMBER ( LICENSE TYPE BUSS. LAIC # r; Y3 a✓ � J i°1�1 COINA O �, Ul 4.( FAZ `, _ C "CJ / STREET ADDRESS 4w al� C ', STATE,HONE avt ✓•n"rccS y/ 5=0T H ARCHITFCT,'ENG E NAME � � 0-1Jv- G.t�� � LICENSE NUMBER C.-143700 BUS. LIC # u/ �c2- 1.zL--� COMPANY I4AME E-MAIL FAX STREET ADDRESS C TA�I P eN _ DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TVPF.. # STORIES —� 1 USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DFCKIPORCH AREA GARAGE AREA: LJ DETACH ❑ ATTACH # DWELLING UMTS: IS A SECOND UNIT []YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES --'RECEIVED BY:TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HONIE? [] NO By my signature below, I certify to each of the followi I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided ' hav ad the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin t t authorize representatives of Cupertino to enter thebove-identified property for inspection purposes. /7 Signature of Applicant/Agent: GT/e� ' Date: ✓ 1 SUPPLEMENTAL INFORMATION REQUIRED ILAN CHECK TYPE ROUTING SLIP ❑ "ovER-rHE coulvTEx ❑ 'BUHDuvc _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building PLAN REVIEW permit for new building. ❑ EXPRESS ❑ : PLANNING FLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDkRD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ -' ENVIRONMENTAL HEALTH BIdgApp_2011.doc revised 06/21/11 CUPERTINO PURPOSE: CALGREEN NON-RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E.. C.B.O.. BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO. CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(cDcupertino.org The non-residential provisions of the 2013 CalGreen Code outline planning, design and development methods that include environmentally responsible site selection, building design, building siting and development to protect, restore and enhance the environmental quality of the site and respect the integrity of adjacent properties; establishes the means of conserving water used indoors, outdoors and in wastewater conveyance; outlines means of achieving material conservation and resource efficiency; and outlines means of reducing the quantity of air contaminants. Project Name: Apple - Infinite Loop, Cupertino, CA Project Address: 1 Infinite Loop, Cupertino, CA 95014 Project Description: Tenant Improvement for retail store Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013 California Green Building Standards Codes to verify and assure that all required wgp�de;scribed herein is properly planned and implemented in the project. x� 2. The licensed professional, in collaboration with the owner and the design profes,0onal initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the �d o checklist and have the checklist printed on the approved plans for the project. IL 49 3. Prior to final inspection by the Building Department, the licensed professio\thicheckl1ri all te�umn 3 and sign and date Section 2 - Implementation Verification at the end of d s` it the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements APTER 5 — NONRESIDENTIAL MANDATORYMEASURES General Requirements The project meets all the requirements of Divisions 5.101 through 5.508. © ❑ Division Planning and Design - Site Development 5.106.1 Storm water pollution prevention. For projects of one acre or less, develop a Storm Water Pollution Prevention Plan (SWPPP) that has been designed, specific to its site, conforming to the State Storm water NPDES Construction Permit or local ordinance, whichever is stricter, as is required for ❑ ❑ projects over one acre. The plan should cover prevention of soil loss by storm water run-off and/or wind erosion, of sedimentation and/or of dust/particulate matter air pollution. Page 1 of 9 CalGreen Non -Res Checklist. doc revised 01/23/14 5.106.4 Bicycle parking. Comply with Sections 5.106.4.1 and 5.106.4.2; or meet local ordinance, whichever is stricter. ❑X ❑ 5.106.4.1.1 Short -Term bicycle parking. If the qualified project is anticipated to generate visitor traffic, provide permanently anchored bicycle racks within 200 feet of the visitors' entrance, readily visible to passers-by, ❑X ❑ for 5 percent of visitor motorized vehicle parking spaces being added, with a minimum of one two -bike capacity rack. 5.106.4.1.2 Long -Term bicycle parking. For qualified buildings with over ❑ 10 tenant -occupants, provide secure bicycle parking for 5 percent of tenant vehicle parking spaces being added, with a minimum of one space. 5.106.5.2 Designated parking. Provide designated parking for any combination of low -emitting, fuel-efficient and carpool/van pool vehicles as ® ❑ shown in Table 5.106.5.2. 5.106.8 Light pollution reduction. Outdoor lighting systems shall be ❑ ❑ designed and installed to comply with the following: 1. The minimum requirements in the California Energy Code for lighting zones ❑ ❑ 1 — 4 as defined in Chapter 10 of the California Administrative Code; and 2. Backlight, Uplight and Glare (BUG) ratings as defined in IES TM -15-11; and ❑ ❑ 3. Allowable BUG rating not exceeding those shown in Table 5.106.8, or ❑ ❑ Comply with a local ordinance lawfully enacted pursuant to Section 101.7, whichever is more stringent. 5.106.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how ❑ ❑ site grading or a drainage system will manage all surface water flows. Division 5.2 ENERGY EFFICIENCY Performance Requirements 5.201.1 Scope. The California Energy Commission will continue to adopt ❑ ❑ mandatory building standards. Division 5.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 and 503.1.2. 5.303.1.1 New building or additions in excess of 50,000 square feet. ❑ ❑ Separate submeters shall be installed as follows: 1. For each individual leased, rented or other tenant space within the u building projected to consume more than 100 gal/day. 2. Where separate submeters are unfeasible, for water supplied to the following systems: a. Makeup water for cooling towers where flow through is greater ❑ ❑ than 500 gpm. b. Makeup water for evaporative coolers greater than 6 gpm. c. Steam and hot-water boilers with energy input > 500,000 Btu/h. Page 2 of 9 CalGreen Non -Res Checklist.doc revised 01/23/14 5.303.1.2 Excess consumption. A separate submeter shall be provided for any tenant within a new building or within an addition that is projected ❑ ❑ to consume > 1,000 gal/day. 5.303.2 Water reduction. Plumbing fixtures shall meet the maximum flow rate values shown in Table 5.303.2.3. 0 ❑ Exception: Building that demonstrate 20 -percent overall water use reduction. 5.303.2.1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission, as specified in Section 103, the provisions of Section 5.303.2 and Section 5.303.3 shall ® ❑ apply to new fixtures in additions or areas of alterations to the buildings. 5.303.4 Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: 1. The installation of water -conserving fixtures or ® ❑ 2. Utilizing non -potable water systems. ❑ ❑ 5.303.6 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code © ❑ (CPC), and shall meet the applicable standards referenced in CPC Table 1401.1 and CalGreen Chapter 6. Outdoor Water Use 5.304.1 Water budget. A water budget shall be developed for landscape ❑ ❑ irrigation use. 5.304.2 Outdoor potable water use. For new water service or for addition or alteration requiring upgraded water service for landscaped areas of at least ❑ ❑ 1,000 sq.ft. but not more than 5,000 sq.ft., separate submeters or metering devices shall be installed for outdoor potable water use. 5.304.3 Irrigation design. In new nonresidential construction or building addition or alteration with at least 1,000 but not more than 2,500 sq.ft. of cumulative landscaped area, install irrigation controllers and sensors which following El 1:1include the criteria, and meet manufacturer's recommendations. 5.304.3.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as ❑ ❑ weather conditions change. 2. Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicates ❑ ❑ with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. Weather Resistance and Moisture Management 5.407.1 Weather protection. Provide a weather -resistant exterior wall and foundation envelope as required by California Building Code Section 1403.2 ❑X ❑ and California Energy Code Section 150, manufacturer's installation instructions or local ordinance, whichever is more stringent.' Page 3 of 9 CalGreen Non -Res Checklist.doc revised 01/23/14 5.407.2 Moisture control. Employ moisture control measures by the following methods; 5.407.2.1 Sprinklers. Prevent irrigation spray on structures. ❑ ❑ 5.407.2.2 Entries and openings. Design exterior entries and/or openings M ❑ to prevent water intrusion into buildings. 5.407.2.2.1 Exterior door protection. Primary exterior entries shall be covered to prevent water intrusion by using nonabsorbent floor and ® ❑ wall finishes within at least 2 ft around and perpendicular to such openings plus at least one of the following: 1. An installed awning at least 4 ft in depth. 2. The door is protected by a roof overhang at least 4 ft in depth. 3. The door is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5.407.2.2.2 Flashing. Install flashings integrated with a drainage © ❑ plane. Construction Waste Reduction, Disposal and Recycling 5.408.1 Construction waste management. Recycle and/or salvage for reuse a minimum of 50 percent of the nonhazardous construction and demolition waste in accordance with Section 5.408.1.1, 5.408.1.2, or 5.408.1.3; or meet a ❑X ❑ local construction and demolition waste management ordinance, whichever is more stringent. 5.408.1.1 Construction waste management plan. Submit plan per this ® ❑ section to enforcement authority. 5.408.1.2 Waste management company. Utilize a waste management company that can provide verifiable documentation that the percentage of © ❑ construction and demolition waste material diverted from the landfill complies with CalGreen Section 5.408. 5.408.1.3 Waste stream reduction alternative. The combined weight of new construction disposal that does not exceed two pounds per square ❑ foot of building area may be deemed to meet the 50 percent minimum requirement as approved by the enforcing agency. 5.408.1.4 Documentation. Provide documentation of the waste ❑ ❑ management plan that meets the requirements listed in Section 5.408.1.1 through 5.408.1.3. 5.408.3 Excavated soil and land clearing debris. 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land ❑ ❑ clearing shall be reused or recycled. Building Maintenance and Operation 5.410.1 Recycling by occupants. Provide readily accessible areas that serve the entire building and are identified for the depositing, storage and collection ❑X ❑ of nonhazardous materials for recycling. 5.410.2 Commissioning. For new buildings 10,000 square feet and over, building commissioning for all building systems covered by T24, Part 6, process systems and renewable energy systems shall be included in the ❑ ❑ design and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. Page 4 of 9 CalGreen Non -Res Checklist.doc revised 01/23/14 5.410.2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the OPR shall include items listed in ❑ ❑ Section 5.410.4. 5.410.2.2 Basis of Design (BOD). A written explanation of how the design of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems ❑ listed in Section 5.410.2.2. 5.410.2.3 Commissioning plan. A commissioning plan describing how the project will be commissioned shall be started during the design phase of © ❑ the building project and shall include items listed in Section 5.410.2.3. 5.410.2.4 Functional performance testing. Functional performance testing shall demonstrate the correct installation and operation of each component, system and system -to -system interface in accordance with the ❑X ❑ approved plans and specifications. 5.410.2.5 Documentation and training. A Systems manual and systems operations training are required. ❑X ❑ 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall ❑X ❑ include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training. The training of the appropriate maintenance staff for each equipment type and/or system a ❑ shall include items listed in Section 5.410.2.5.2. 5.410.2.6 Commissioning report. A complete report of commissioning process activities undertaken through the design, construction and ❑X ❑ reporting recommendations for post -construction phases of the building project shall be completed and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for buildings less than 10,000 square feet or new systems to serve an addition or alteration subject to Section 303.1. 5.410.4.2 Systems. Develop a written plan of procedures for testing and adjusting systems. Systems to be included for testing and adjusting shall include, as applicable to the project, the systems listed in Section 0 ❑ 5.410.3.2. 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards on each system. 0 E3 5.410.4.3.1 HVAC balancing. Before a new space -conditioning system serving a building or space is operated for normal use, the system should be balanced in accordance with the procedures defined by 0 ❑ national standards listed in Section 5.410.3.3.1. 5.410.4.4 Reporting. After completion of testing, adjusting and balancing, provide a final report of testing signed by the individual responsible for ❑ 1:1performing these services. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of © ❑ guaranties/warranties for each system prior to final inspection. 5.410.4.5.1 Inspections and reports. Include a copy of all inspection verifications and reports required by the enforcing agency. M\/ ❑ Page 5 of 9 CalGreen Non -Res Checklist. doc revised 01/23/14 Fireplaces 5.503.1 Install only a direct -vent sealed -combustion gas or sealed wood - burning fireplace or a sealed woodstove and refer to residential requirements ❑ ❑ in the California Energy Code, Title 24, Part 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves. Woodstoves shall comply with US EPA Phase II I 1:1 I 1:1emission limits. Pollutant Control 5.504.3 Covering of duct openings and protection of mechanical equipment during construction. At the time of rough installation or during storage on the construction site and until final startup of the heating and cooling equipment, all duct and other related air distribution component ❑X ❑ openings shall be covered with tape, plastic, sheet metal or other methods acceptable to the enforcing agency to reduce the amount of dust or debris which may collect in the system. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.4. 5.504.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the requirements of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or ❑ ❑ SCAQMD Rule 1168 VOC limits, as shown in Tables 5.504.4.1 and 5.504.4.2. 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds (in units of product, less packaging, which do not weigh more than one pound and do not consist of more than 16 fluid ounces) shall comply with statewide VOC standards and other ❑X ❑ requirements, including prohibitions on use of certain toxic compounds, of California Code of Regulations, Title 17, commencing with Section 94507. 5.504.4.3 Paints and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. ❑X ❑ 5.504.4.3.1 Aerosol paints and coatings. Aerosol paints and coatings shall meet the Product -Weighted MIR Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of ❑ ❑ certain toxic compounds and ozone depleting substances (CCR, Title 17, Section 94520 et seq). 5.504.4.3.2 Verification. Verification of compliance with this section shall be provided at the request of the enforcing agency. ❑X ❑ 5.504.4.4 Carpet systems. All carpet installed in the building interior shall meet the testing and product requirements of at least one of the standards ❑ ❑ listed in Section 5.504.4.4. 5.504.4.4.1 Carpet cushion. All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute ❑ ❑ Green Label program. 5.504.4.4.2 Carpet adhesive. All carpet adhesive shall meet the requirements of Table 5.504.4.1. ❑ ❑ Page 6 of 9 CalGreen Non -Res Checklist.doc revised 01123114 5.504.4.5 Composite wood products. Hardwood plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for ❑X ❑ formaldehyde as specified in Table 5.504.4.5. 5.504.4.5.3 Documentation. Verification of compliance with this section ❑ ❑ shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following standards listed in Section 5.504.5.3. 5.504.4.6 Resilient flooring systems. For 80 percent of floor area receiving resilient flooring, installed resilient flooring shall meet at least one ❑ ❑ of the following standards listed in Section 5.504.4.6. 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and ❑ ❑ return air prior to occupancy that provides at least a MERV of 8. 5.504.7 Environmental tobacco smoke (ETS) control. Prohibit smoking within 25 feet of building entries, outdoor air intakes and operable windows where outdoor areas are provided for smoking and in buildings; or as enforced ❑ ❑ by ordinances, regulations or policies of any city, county, city and county, California Community College, campus of the California State University or campus of the University of California, whichever are more stringent. Indoor Moisture and Radon Control 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of California Building Code, CCR, Title 24, Part 2, Sections 1203 ❑X ❑ and Chapter 14.1. Air Quality and Exhaust 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the California ❑ ❑ Energy Code, CCR, Title 24, Part 6 and Chapter 4 of CCR, Title 8 or the applicable local code, whichever is more stringent.' 5.506.2 Carbon dioxide (CO2) monitoring. For buildings equipped with demand control ventilation, CO2 sensors and ventilation controls shall be ❑ ❑ specified and installed in accordance with the requirements of the latest edition of the Califomia Energy Code, CCR, Title 24, Part 6, Section 121(c).' Environmental Comfort 5.507.4 Acoustical control. Employ building assemblies and components ❑ with STC values determined in accordance with ASTM E 90 and ASTM E 413. L21J 5.507.4.1 Exterior noise transmission. Wall and floor -ceiling assemblies making up the building envelope shall have an STC of at least 50 and exterior windows shall have a minimum STC of 30 for any of the building ❑X ❑ locations listed in Items 1 through 3 in Section 5.507.5.1. 5.507.4.2 Interior sound. Wall and floor -ceiling assemblies separating tenant spaces and tenant spaces and public places shall have an STC of ❑ ❑ at least 40. Page 7 of 9 CalGreen Non -Res Checklist. doc revised 01/23/14 Outdoor Air Quality 5.508.1 Ozone depletion and greenhouse gas reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. 5.508.1.1 Chlorofluorocarbons (CFCs). Install HVAC and refrigeration equipment that does not contain CFCs. 5.508.1.2 Halons. Install fire suppression equipment that does not contain Halons. ❑ Page 8 of 9 CalGreen Non -Res Checklisl.doc revised 01/23/14 Project Name Project Address: CALGREEN SIGNATURE DECLARATIONS Apple - Infinite Loop, Cupertino, CA 1 Infinite Loop, Cupertino, CA 95014 Project Description: Tenant Improvement for retail store SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 – "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. YVW-- U, 0 Owner's Name (Please Print) Design Professional's Signature Design Profession I's Name (Please Print) Signature of License Professional —responsible for CalGreen compliance �'•-- }s.� `7�l�- _—tip.,. j-�o •._ Name of License Professional responsible for Cal reen compliance (Please Print) Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Date Date Date Phone Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 9 of 9 CalGreen Non -Res Checklisi.doc revised 01/23/14