B-2016-2926CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2926
10441 BANDLEY DR CUPERTINO, CA 95014-1912 (326 33 079)
S C BUILDERS INC
SUNNYVALE, CA
94085
OWNER'S NAME:: LV CUPERTINO LLC
DATE ISSUED: 10/17/2016
OWNER'S PHONE: 510491-8424
PHONE NO: (408) 328-0688
LICENSED CONTRACTOR'S AR TION
BUILDING PERMIT INFO:
License Class B Lic, #767196
Contractor S C BUILDERS INC Date 08/31/2017
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH _ RESIDENTIAL 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:
i ST FLOOR; T.I. - WORK ROOMISTORAGE ROOM (293 S.F.) - APPLE
I hereby affirm under penalty of perjury one of the following two declarations;
i. 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
/-f -'performance of the work for which this permit is issued.
- 2: I have and will maintain Worker's Compensation Insurance, as provided for by
C f Section 3700 of the Labor Code, for the performance of the work for which this
ermit is issued.
�JP
Sq. Ft Floor Area:
Valuation: $18550.00
APPLICANT RTIFI ATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
326 33 079
A (Tenant Improvements),A (Tenant Improvements),A
representatives of this city to enter upon the above mentioned property for
(Tenant Improvements),A (Tenant Improvements),A
inspection purposes. (We) agree to save indemnify and keep harmless the
(Tenant dmprovements),A (Tenant Improvements);A
City of Cupertino against liabilities, judgments, costs, and expenses which
(Tenant Improvements),A (Tenant Improvements),A
may accrue against said Cid cginsequence of the granting of this permit.
Additionally, th pplicant�(in er f'ands and will comply with all non-point
(Tenant Improvements),A (Tenant Improvements),A
(Tenant Improvements)
source regul #ion per the u rtino Municipal Code, Section 9.18.
PERMIT EXPIRES IF WORK IS NOT STARTED
Signature Cate 10/17/2016
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OVVNER-B III ERDECLARATION
180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:.
Issued by: AAbbyAvendg
1. I, as owner of the property, or my employees with wages as their sole
Date: 10/17/2016
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
RE-ROOFS:
2. I, as owner of the property, am exclusively contracting with licensed
All roofs shall be inspected prior to any roofing material being installed. If a roof is
contractors to construct the project (Sec.7044, Business & Professions Code).
installed without first obtaining an inspection, I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations:
inspection.
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
Signature ofApplicant:
performance of the work for which this permit is issued.
Date: 10/17/2016
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
_
permit is issued.
3. 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
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95of the
Worker's Compensation laws of California. If, after making this certificate of
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
exemption, I become subject to the Worker's Compensation provisions of the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Labor Code, I must forthwith comply with such provisions or this permit shall
Health & Safety Code, Section 25532(a) should I store or handle hazardous
be deemed revoked,
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area ality Management District I
APPLICANT CERTIFICATION
will maintain compliance with t upertino icip ode, Chapter 9.12 and
I certify that I have read this application and state that the above information is
the Health & Safety de Section 505, 33; aml25534.
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--
Owner or authorized agent:
to save indemnify and keep harmless the City of Cupertino against liabilities,
Date: 10/17/2016
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
CONSTRUCt ON LENDING AGENCY
I hereby affirm that there is a o°onstruction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal
of work's for which this permits issued (Sec. 3097, Civ C.)
Code, Section 9.18..
Lender's Name
f
Lender's Address
Signature Date 10/17/2016
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
13- Zola- 2612&
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •'BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 building(cDcupertino.org
',,,. L—I INnw l.V1N 6 I KU t I IUN LJ ADDITION JAI ALTERATION / TI " REVISION/ DEFERRED ORIGINAL PERMIT #
g� �i
A
PROJECT ADDRESS 10441 Bandley Drive APN# (� p�
OWNER NAME Apple Inc. PHoNE510/491-8424 barbara_niedzielski@apple.com
STREET ADDRESS 1 Infinite Loop .CITY, STATE, ZIP Cupertino 9501.4 FAX
CONTACT NAME Barbara Niedzielski PHONE 5101491-8424 barbara_niedzielski@apple.com
STREET ADDRESS 1 Infinite Loop CITY,STATE, zIP Cupertino, 95014 FAX
OWNER ❑ OWNER-BUOWNER-BUILDER®-OWNER AGENT ❑ CONTRACTOR 11CONTRACTOR AGENT 11ARCHITECT 1:1ENGINEER 11DEVELOPER ❑ TENANT
CONTRACTOR NAMEMichael Soik LICENSE NUMBER 767196 LICENSE TYPE B BUS. LIC# 240744
COMPANY NAME SC Builders Inc. E-MAIL 1Tlsoik@a scbuildersinc.com FAX
.
STREET ADDRESS910 Thompson Place CITY, STATE, ZIPSunnyvale,UCrVale94085 . PHONE nV/32Vtp
8
ARCHITECT/ENGINEER NAMESophia Tyra LICENSE NUMBER
BUS. LIC #
COMPANY NAMEAY +l Design EMAIL Styra@apidesign.C•C}rl'1 FAX
STREETADDRESS,11.7 EasyStreet CITY, STATE,. ZIP Mt. View, CA 94043 PHONE650/623'1807,.
D - TION: F WOI
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o f SOS M _ e� J
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'I" el MAe 9-05A, too 10?-Irkbbo, S ,µ 47-C n -L N 03`� Sra rti
EXISTING USE - PROPOSED USE CONSTR. TYPE # STORIES
USE TYPE OCC. SQ.FT, VALUATION (S)
EXISTG NEW FLOOR DEMO TOTAL
AREA - AREA AREA NET AREA y� v 1 P'y G3. (� �f o . '0 _
BATHROOM - KITCHEN OTHER _. t //!!
REMODEL AREA REMODEL AREA REMODEL AREA
[j ATTACH
-- -
# DWELLING UNITS; 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 REC 1VED$Y , '''L. y TOTAL VALUATION:
PLANNING ADPL# []NO PLANNING APPROVAL LETTER EICHLERROME? [3NO '
By my signature below, I certify to each of the following: I am the property owner or authorized agent to fact on thk property owner's behalf. I have read this
application and the information I have pro ided is correct. I have read the Description of Work and verify it is accurate. Iagree to comply with all applicable local
ordinances and state laws relating to binIng cons on. I orizeJ"resentativeS of Cupertino to enter the above id tiferd�property for inspection purposes.
Signature of Applicant/Agent: Date: 772-t> 7/ Zt> / l>
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.
_ 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.
BldgApp_2011.doc revised 06/21/11