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B-2016-3107 it al CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3107 19333 VALLCO PKWY CUPERTINO,CA 95014(316 20 076) S C BUILDERS INC SUNNYVALE,CA 94085 OWNER'S NAME: APPLE INC DATE ISSUED:11/21/2016 OWNER'S PHONE:408-396-8968 PHONE NO:(408)328-0688 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic.#767196 Contractor S C BUILDERS INC Date 08/31/2017 X BLDG 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: 2ND FLOOR;T.I.-OFFICE/WORK ROOMS/PHONE I hereby affirm under penalty of perjury one of the following two declarations: ROOMS/CONFERENCE ROOMS(200 SF)APPLE 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. Sq.Ft Floor Area: Valuation:$98250.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 316 20 076 A(Tenant Improvements),B(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 conseqstands and the hg this WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applic.nt u derstands and will comply with all non-point source regulations p• he/ .ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. t, itr, G,Signature ' Date 11/21/2016 Issued by:AbbyAyende Date:11/21/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an insnspection.pection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for i 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(Sec.7044,Business&Professions Code). Date:11/21/2016 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 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 Bay equipment or de ices which emit hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use air contaminants as defined bythe Area Air o Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cu+•rtino i le' Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co: ,Sec+ nfl"V 533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. G-Owner or authorized agent: APPLICANT CERTIFICATION Date:11/21/2016 I certify that I have read this application and state that the above information is I .TR + LE t h = 54 correct.I agree to comply with all city and county ordinances and state laws I hereby affirm 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 ARCHITECTS D and will comply with all non-point source regulations per the Cupertino Municipal ECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 11/21/2016 Professional 1 1 \re\1/4/ 1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-32551 B CUPERTINO (408)777-3228•FAX(408)777-3333•buildlncp cupertino.orq r 20/62 El NEW CONSTRUCTION f❑ ADDITIONAL ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS XXXXX ( 1 .7j 3 3 VA C L.C�3 P APN N r. /57( 3A) -^ 20•— ) 6 Apple99 / �,rl�t,��.�� cc��r�R � rp,�c� OWNERNAME .Inc. . .. PHONE408-396-8968 E-MAIL lorrlopez@apple.com t n t STREET ADDRESS 1 Infinite Loop Cupertino, 95014 IX CITY,STATE, FA CONTACT NAME Lorraine LopezPHONE 408-396-8968 E-MAIL P lorrlopez@apple.com STREET ADDRESS 1 Infinite Loop CITY,STATE,ZIP Cupertino, 95014 FAX D OWNER 0 OWNER-BUILDER ElOWNER AGENT 0 CONTRACTOR El CONTRACTOR AGENT in ARCHITECT 0 ENGINEER I 0 DEVELOPER D TENANT CONTRACTOR NAME John Stieber..,.. .. LICENSE NUMBER 767196 1, LICENSE TYPE 13 BUS.LIC N. 24074 COMPANY NAME SC Builders Inc. E-MAIL jstieber@scbuildersinc.com FAX STREET ADDRESS 910 Thompson Place CITY,STATE,ZIP Sunnyvale, 94085 PHONE 148/326-Q688 ARCIuTECT/ENGINEERNAME Sophia Tyra LICENSE.NUMBER BUS.LICE COMPANY NAMEy @ g AI'+I EMAIL st rap'a tdesin.com FAX STREET ADDRESS 117 Easy Street CITY,STATE,ZIP Mt. View, CA 94043 PHONE 650-254-1444 I fBRCRIPTION OF WORK -Z.. '-D .. _ .Tenant Improvement in approx, 2,200sf of existing office space. Space is office, work rooms, phone _ rooms, and conference rooms. No hazardous work or materials in the space. I EXISTING USE PROPOSED USE - - - CONSTR.TYPE SSTORIES- USE TYPE OCC. S Q,FT . VALUATION(S) EXISTG NEW FLOOR DEMO _ -- TOTAL ,- n AREA AREA AREA NET AREA. I1-Bp D... 2;200 $98,2.-7y 0.1,1�{ 6 BATHROOM KITCHEN OTT[ER:. .. _ _. . i. REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA. GARAGE AREA: 0 DETACH 1 0 ATTACH If DWELLING UNITS: IS A-SECOND UNIT DYES SECOND STORY OYES ,,. BEING ADDED? DNO. ADDITION? ONO , PRO-APPLICATION DYES IF YES,PROVIDE COPY OF IS THE BLDG AN D YES RECEIVED BY: JJ TOT" VAT T I ITIOM• PLANNING APPLE 0 NO PLANNING APPROVAL LETTER EICHLERHOME? 0 NO - , $98,250.00 application and the information I hav . I* .-d c, rect /':vc read the Description of Work and verify it is accurate. I agree to comply I allhave ad this By my signature below,I certify to each of the foil I' ng: i: the property owner or authorized agent to act on the property owner's beh with all applicable local ordinances and state laws relating t MI din:•I n •nett• authorize represe.tatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent: •'-, -+=4/ /Date: I t"--/1-1 _ l(aj SUPPLEMENT`s INFORMAT •N REQUIRED ; .. PLAft CHECK TYPE ' • ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑::OVER rite COUNTER 0 BUILDING Ar1REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. 0 EXi RESS '• 0 PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 "STANDARD. 0 PUe is WORKS form if any Hazardous Materials are being used as part of this project. p•LARGE © FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application, I n1Aro. 0 SANITARY SEWER DISTRICT .. - :. © ENYIRONI4IENTAL.HEALTH .. ' Bldg/1pp 2011.doc revised 06/21/11 i