15090082I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 4 INFINITE LOOP I MECHANICALCONTRACTOR: SILICON VALLEY I PERMIT NO: 15090082 I
OWNER'S NAME: APPLE COMPUTER INC 12087 RINGWOOD AVE STE 50 1 DATE ISSUED: 09/14/2015 1
OWNER'S PHONE: 4088622341 1 SAN JOSE, CA 95131 1 PHONE NO: (408) 943-0380 1
an LICENSED CONTRACTOR'S DECLARATION
License Class dom Lic. # " gy VrWA 3 I
s
Contractor -!!� 1/ PIA 4 -Date4,1figt
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:
1. 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
permit is issued.
APPLICANT CERTIFICATION
1 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 t
indemnify and keep harmless the City of Cupertino against lia ' ' �,�ecosts, and expenses which may accrue against said City in consequence o
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cue 'uo Municipal Code, Section 9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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.
a. 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
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.
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
upon the above mentioned property for inspection purposes. (We) agree to save
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 with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Date
JOB DESCRIPTION: RESIDENTIAL ❑. COMMERCIAL ❑
APPLE - CHANGE OUT 2 AIR HANDLING UNITS, LIKE FOR
LIKE, ON THE 2ND FLR
Sq. Ft Floor Area: I Valuation: $600000
APN Number: 31602108.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
`E:1I"I "I�W_Iutl&1M31371
,IMF
Date: /// 1//0
All roofs shall be inspect&-Vf1—or 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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
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
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
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
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner zeync'— ( I Z O 1 ��
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 • buildinc(cDcupetno.org
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USE OF ❑ SFD or DUPLEX ❑ MULTI-F.4A'[ILY PROJECT IN WIIDLAND ❑YES
PROJECT R4 ❑ YES
LS THE BLDG AN ❑ YES
BTAIDLNG: ❑ COMMERCIAL URBAN WrERFACE AREA ❑ NO
FLOOD TANS ❑ NO
EICMMHOME7 ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION:
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on e property owner's f. I have read
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agr omply wi p Icable local
ordinances and state laws relating to build' a iructi a esentatives of Cupertino to enter the above- dentor inspection purposes.
SiSnatureofApplicant/Agent. �'� -�ia
Date: r Z
SUPPLEMENTAL D\TFORMATION REQUIRED
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A11'EPMiscrlpp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
19
ADDRESS: 4 INFINITE LOOP
DATE: 0911412015
REVIEWED BY: MELISSA
Mech. Permit Fee: IMPERMIT
APN: 316 02 108
BP#:
*VALUATION: 1$600,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
Plumb. (nsp. Fite:
PENTAMATION
PERMIT TYPE: FURN/A
WORK
APPLE - CHANGE OUT 2 AIR HANDLING UNITS LIKE FOR LIKE ON THE 2ND FLR
SCOPE
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 1./-053 E. 7/I/13�
Mech. Plan Check 0.0 hrs $0.00
Plun:b. Plan Check
Flee. Plan Check
Mech. Permit Fee: IMPERMIT
Plumb, Perrnit Fee:
Elec. Perrnitlee:
Other Mech. Insp. 0.0 hrs $48.00
Other Plurnb .lnsp.
Other Elee. hasp.
Alech. Insp. Fee:
Plumb. (nsp. Fite:
Elec. frisp. Fee:
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 1./-053 E. 7/I/13�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$286.00
Mechanical
IMCAI)WAN Air -Handling (>10K cfm)
Suppl. PC Fee: Q Reg. OT
--
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:(D Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction 71m
Administrative Fee: IADMIN
$45.00
Q
G
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee: IBSEISMICO
$168.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$24.00
SUBTOTALS:
1 $333.00
$286.00
TOTAL FEE:
1 $619.00
Revised: 07/02/2015