B-2016-2880CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2880
4 INFINITE LOOP CUPERTINO, CA 95014-2087 (316 02 108)
NOVO
CONSTRUCTION INC
MENLO PARK, CA
94025
OWNER'S NAME: APPLE COMPUTER INC
DATE ISSUED: 10/13/2016
OWNER'S PHONE: 408-828-5770
PHONE NO: (650) 701-1500
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class la Lie. #791_022
Contractor NOVO CONSTRUCTION INC Date 02/28/2017
X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECHRESIDENTLAL X COMMERCIAL
— _
with Section 7000) of Division 3 of the Business & Professions Code and that my `
license is in full force and effect.
JOB DESCRIPTION:
TEMPORARY ASSEMBLY SPACE IN (E) A-2 OCCUPANCY (APPLE)
I hereby affirm under penalty of perjury one of the following two declarations:
(INCLUDING WALL/FLOOR/CEILING ASSEMBLIES AND
1. i have and will maintain a certificate of consent to self -insure for Worker's
ADDITIONAL FIRE PROTECTION)
Compensation, as provided for by Section 3700 of the Labor Code, for the
of the work for which this permit is issued..
I. tperformance
i 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: $150000.00
permit is issued.
APPLICANT CERTIFICATION
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
316 02 108
A (Tenant Improvements)
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 regulations per the Cupertino Municipal Code, Section 9.18.
,_
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 10_/13/2016
Issued by: MEL
OWNER -BUILDER DECLARATION
Date: 10/13/2016
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:
1. 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: 10/13/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS °A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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 & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:",
APPLICANT CERTIFICATION
Date: 10/13/2016
certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county, ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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
ARC'HITECT'S DECLARATION
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 10/13/2016
Professional
CUPERTINO
❑ NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT.• BUILDING DIVISION
10800`TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • building o—kuperfino.org
—?I�C
❑ ADDITION 19 ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
. 1N 1�1CTE hoZr _, ,_-
APN #
S16-02"-1_98- `.
.OWNER NAME
A iPPLLe INC,.. CmARY CiAAo
PHONE --MAIL
1108. 828.5?70
E 9o -h o C ctj�ple , corvl
STREET ADDRESS
�; INF►h11TE L-00�f''
CITY, STATE,
T-rliao CA gS01
FAX
CONTACT NAME GIA"grY C1916101 YX��T I -E IHC�
-PHONE 'I
�. 8 v5p7G-MAIL 4 Cia,ppple-• C O(".
STREETADDRESS
11`tF11�1 tT1= L
CITY, STATE, ZIP
it4 o 6150 114
FAX
❑ OWNER ❑ OWNER -BUILDER . OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 0 DEVELOPER ❑ TENANT
CONTRACTOR NAME t� K `, - LICENSE NUMBER t� 1 ® Z LICENSE TYPE BUS. LIC #
COMPANY NAME E-MAIL FAX
NOVO CoNS`ilZu eTtc�N, ISC• kt'�ves-riovocohstruciia c 415v.3Z 119 1
STREET ADDRESS- I
4�i 6O �R.ti✓.1� �TztvE
CITY STATE, ZIP PHONE
N1�.N1.0 rATzK, CA 9yo 5 65a.7o1, � o0
ARCHITECT/ENGINEER NAME AC 1 1
LICENSE NUMBER C iJ 8
BUS. LIC #
COMPANY NAME
A*5 6176 P A CH IREINC.
E-MAIL
J W le 6 & f he ha cs ro . cowl
FAX
650.384.6670
STREET ADDRESS
Z6 ' S SIOA 61 oop a
CITY, STATE, ZIP
T<abvJOOD rT C' 6)� o65
PHONE
i0o, 365.0600
DESCRIPTION OF WORK
__,.. T� _ -P-O _ � _ _ :- -S ,1�G_� 6.v . 1 N- �X �T ►l�l��-�'-Z.-=OGwp E'�!
-aEHPa -R. EMtSIrIC-7 WALL, 'F1.00tz WAL(. AH.> C�ll�tr�C�,�I�IsHES
A,5 vctA70> Ai - b MEC H&H IOAL WOVK. ,k>b1-00VJAL 'F(RE 'PR Orad o !
EXISTING USE -
A%eM$ L.y
PROPOSED USE CONSTR.
A55EMU -YUSE
TYPjESTORIES
TYPE OCC.
SQ:FT.
VALUATIONEXISTG
L'�I p
NEW FLOOR
AREA C)AREA
DEMO
O57
TAREA
tbp. ut+y a J� oQ
1 16J. _ /,'�.
?500
J V_
4ISoI tj0(7.(
BATHROOM KITCHEN - -
OTHER -
..
REMODEL AREA I ( x REMODEL AREA NA
' qr
REMODEL AREA q 5 0 O
PORCH AREA
DECK AREA
TOTAL DECKIPOORfCA AREA
GARAGE AREA: DETACH
A
1-1 Q
A
III A E]ATTACH
# DWELLING UNITS:
IS ASECOND UNIT []YES
SECONDSTORY []YES
BEING ADDED? UNO
ADDITION? RNO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
PLANNINGAPPL# SNO PLANNING APPROVAL LETTER
IS. THE BLDG AN []'YES VALUATION:
EICHLER HOME? RSN
By my signature below, I certify to each of the following: I am the property owner or authorize nt to act on operty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and ve ' accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I u Orfze representatives of Cuperti o enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENIAt INFORMA'T'ION REQUIRED
PLAN CHECHL"t
ROUTING SLIP
❑ OyER-TBE-COUNTER
b BUILDING PLAN REVAW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
0 EXPRESS
0 PLANNINGPLANREVIEw
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
Q LARGE
EI FIRE DEPT '
Copy of Planning Approval Letter or Meeting with Planning prior to
[I IYIAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06/21/11