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B-2016-1571CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1571 19333 VALLCO PKWY CUPERTINO, CA 95014 (316 20 076) Rick Zgragen 1132 N. Seventh St San Jose, CA 95112 OWNER'S NAME: Apple Inc DATE ISSUED: 05/20/2016 OWNER'S PHONE: PHONE NO: None LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. # 63 Contractor Rick Zgragen Date 08/31/2016 X BLDG X ELECT —PLUMB MECH _ RESIDENTIAL X COMMERCIAL 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. JOB DESCRIPTION: INSTALL TEMPORARY 2000KW GENERATOR FOR POWER I hereby affirm under penalty of perjury one of the following two declarations: SHUTDOWN t. 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 Sq. Ft Floor Area: Valuation: $20000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 316 20 076 3 16 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non-point source regul do s per the Cu ertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 157{P_Zt UO Issued by: Phuong Devries 1� Date: 05/20/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: t• I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. 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. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & SafetyiSections 2P545"25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner o aut orized agent: 0 Date: ��� f APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is f�' COLENDING AGENC correct. I agree to comply with all city and county ordinances and state laws I hereby affir that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date Professional PLUMBING MECHANICAL LXJ ELECTRICAL MISUELLANMUUS PROJECT ADDRESS APN E-MAIL. rick zgrmagen@cel.com 19333 Vallco Parkway 1132 R. Seventh 5t. CITY,STA'CE "P San Jose, CA 95112 PHONE 408-808-8016 ARCHITECTMOINEER NAME LICENSENUMEER EUS. LIC H OWNER NAME E-MAIL PHONE P.-MATL Apple PHONE USE OF Q SPD orDUPLEX D MULTI -FAMILY BUILDING: [XCO111AERMAL PROTECT 1N w7LDLANU EYES LILWANINTERIIACHAR13A p NO R STRE[i ne IMAR. Loop IS 71 -IB BLDG AN d YES HICHLERHOMP? ❑ NO "MUPe i o CA 95014 PAX CONTACT NAMP PHONE E-NIAIL STREET ADDRESS CrfY.STATE, ZIP FFAX� M t-1 n mn or,nnno t -I nimwn AnmmT IN rnnn'nAr:'rnA ❑ (•()N'fRAM-ORAGLNT ❑ ARCHrrECT ❑ PNG1NtuR ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Rick Zgragen LICENSENUMBER 174637 LIC NSOTYPE BUS. LIC It COMPANYNprotE Cupertino Electric E-MAIL. rick zgrmagen@cel.com "408-275-6492 1132 R. Seventh 5t. CITY,STA'CE "P San Jose, CA 95112 PHONE 408-808-8016 ARCHITECTMOINEER NAME LICENSENUMEER EUS. LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF Q SPD orDUPLEX D MULTI -FAMILY BUILDING: [XCO111AERMAL PROTECT 1N w7LDLANU EYES LILWANINTERIIACHAR13A p NO PROJECT IN Q YLS FLOODZONL+ ❑ NO 'w IS 71 -IB BLDG AN d YES HICHLERHOMP? ❑ NO jDESCRIPTION OF WORK Temporary Generator (2 Meg) to support Apple power needs during annual'PM maintenancq, 2 week period. TOTAL VALUATION: 20,000. I RECEIVEDBY: By my signature bel DIV, I certify to each of the fallowing: I ant Ilse property owner or authorized agent to act oil the properly owner's behalf. I have read this application and the Information I hnve provided is corroot. I have read tho Description of Work and verify it Is accurate. '1 agree to comply tvith all applicable local ordfnances nad state laws rotating to bt llding construction. I authorize representatives of Cupertino to enter ilia above -identified properly for iuspeetton purposes, Signature of Applicaw/Agent: _ Date: SUPPLBivI NTALINFORMATIONREQUIRRD CitF1CLUSFONLY 1MMLP11vfisc11p,p_2011.doe. r'evisee106/21/!1 W a w ❑ 011ER-TIM-COUNTER © EXPRESS n STANDARD n 1,At1GR 0 MAJOR 1MMLP11vfisc11p,p_2011.doe. r'evisee106/21/!1