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B-2016-3261CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3261 19333 VALLCO PKWY CUPERTINO, CA 95014-2506 (316 20 075) T MARSHALL ASSOCIATES LTD PLEASANTON,CA 94588 OWNER'S NAME: APPLE INC DATE ISSUED: 12/13/2016 OWNER'S PHONE: 408-783-5395 PHONE NO: (925) 734-9999 LICENSED CONTRACTOR'S DFCLARATIQNL BUILDING PERMIT INFO: License Class M Lic. #664428 Contractor T MARSHALL ASSOCIATES LTD Date 02/28/2017 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: 12 (N) EV CHARGING STATION (600 AMP) - PARKING LOT I hereby affirm under penalty of perjury one of the following two declarations: REV#1 - ADD (2) EV STATIONS - ISSUED 6-22-2017 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. 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. !!ff Sq. Ft Floor Area: Valuation: $150000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 316 20 075 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 Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. _per -the Signature! Date 06-22-2017 Issued by: Abby Ayende Date: 12/13/2016 OWNER-BUH DER 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 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 (Sec.7044, Business & Professions Code). Date: 06-22-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. 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 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 & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked.��C Owner or authorized agent: APPLICANT CERTIFICATION Date: 06-22-2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 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 06-22-2017 professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDINRE1®ISION 4jmK=0q& 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 La CUPERTI'NO (408) 777-3228 - FAX (408) 777-3333 - bull. 9ing4cupertino.ord ❑ NEw CONSTRUCTION I ADDITION ❑ ALTERATION I TI t;� REVISION /DEFERRED ORIGINALPERMIT# B-Z6/6-3z(o 1 PROTECT ADDRESS VV,S3 1l LCo ere APN # -> OWNER NAM& PHONE MAIL STREET ADDRESSCITY, l l.4 J W0 STATE, ZIP FAX CONTACT NAME-VicP t4i 5 ) 7 E- STREETADDRESS t� �� C 7Y, STA78 CuK/ C t i �7 S��tS FAX LS-73' 79 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT '♦CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ 'TENANT CONTRACTOR NA] "— LICEt *ca *^ * ^ ^` L--- ""'PE BUS, LIC # FAX COMPANY NAME - E-MAIL:-- STREET ADDRESS CITY, STATE, ZIP '~f PHM ARCHITECTlENGTNEERNAME LICENSENUMBER BUS, LTC# COIAPANY NANM 111 &MAH. FAX STREET ADDRESS CITY, STATE, 7.IP PHONE DESCRiP110N OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ,FT, VALUATION (S) EXISTO NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER - REMODELARFA REMODELAREA P. MODELAREA PORCHAREA DECK AREA TOTAL DECK/PORCH AREA GARAGEAREA: LJDETACH [] ATTACH I # DWELLING UNITS: IS A SECOND -UNIT ❑ YES SECOND STORY YES BEING ADDED? NO ADDITION? [:]NO PR.E-APPLICA7TON []YES IFYES,PROVIDECOPYOF ISTBTiALDGAN ❑YES�x -� TOTAL VALUATION: PLJ.NNINGAPPL# []NO PLANNINGAPPAOYALLETTER EICHLEAHOMET - ❑NO �„ " - _ - = By my signature below, I certify to each of the following: I am the property owner or auth 'zed agent to act oo the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-id�ennttified/property for inspection purposes. ' ���✓�` Signature of Applicant/Agen Date: SUPPLEMENTAL IIn RMATION REQUMED _ New SFD or Multifamily dwellings: Apply for demolition permit for � ������ � �z� `�`i ti � ' �� �- � � �s ❑ 'BULLDH�'GPY:ANYtPsj existing building(s). Demolition permit is required prior to issuance of building z❑ OYE$THR-COVETER - ' iEW 3- c . FNM ar MTS permit for new building, <� `❑>ss# r �T ATsi\IIs s7aRw e Commercial Bldgs: Provide Hazardous Materials Disclosure ❑PUBLteR _ a completed }L7 sxAaDAun GTixs` c form if any Hazardous Materials are being used as part of this proj ret, ,,.❑c.3RD2EDEET-s,_ _ Copy of Planning Approval Letter or Meeting with Planning prior or to 3a ❑'MeLIORr'' '"'`.: H x ❑ SA]�IITARYSE'RDLSTRTC')u f` submittal of Building Permit application.�_ ENSaNAZ;TALHE,AITH�;,:x-�. BIdg,4pp_2011.doe revised 06/21/11 _4%z CITY OF CUPERTINO BUILDING PF RMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3261 19333 VALLCO PKWY CUPERTINO, CA95014-2506 (316 20 075) TMARSHALL ASSOCIATES LTD PLEASANTON,CA 94588 OWNER'S NAME: APPLE INC DATE ISSUED: 12/13/2016 OWNER'S PHONE: 408-974-6870 PHONE NO: (925)734-9999 LICENSED CONTRACTOR'S DECLARATION BUILDING PERNEIT INFO: License Class C10 Lic. #664428 Contractor T MARSHALL ASSOCIATES LTD Date 02/28/2017 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ NIECH _ RESENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTI Ni 12 N EV CHARG NG STATION (600 AMP) - PARKING LOT 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. 2.,,I have and will maintain Worker's Compensation Insurance, as provided for by C1 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $150000.00 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 20 075 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 E3 PIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITffiN 18 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 F OM LAST CALLED INSPECTION. Signature Date 12/13/2016 Issued by: A A nde Date: 12/13/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following All roofs shall be; ins RE-ROOFS: 3ected. prior to any roofing material being installed. If a roof is two reasons: i. I, as owner of the property, or my employees with wages as their sole installed without first Ataining 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 ofApplican : contractors to construct the project (Sec.7044, Business & Professions Code). Date: 12/13/2016 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. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the ha rdous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Healtl & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. - maintain complianq 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(x) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Addition air contaminants as y, should I use equipment or devices which emit hazardous defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain comp ante 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.`-, Owrierorauthorized agent—i APPLICANT ERTIFICATION !bate': 12/13/2016 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 I hereby affirm that I here is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which t iis 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 pla s shall be used as public records. Licensed Signature Date 12/13/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buiidinaCalcupertino.ora MISC ❑ PLUMBrNG [:]MECHANICAL QELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN # _fl� i OWNER NAME WV'V"Ck� �IM.W�F lil� PHONE ;.j,��.���� - g_MAIL STREET/ADDRESS _ CITY, STATE, ZIP/ e1 FAX CONTACT NAME` ,4 ° �r7�X ` nI �fiJL 1- PHONl �zs STREET ADDRESSCITY, 0 ?--Z3 C--Le-�7�E �d6Z. , STATE, ZIP Ia c�ltC ��� qe/_5 _ r FAX gZ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ED AcHITECT ❑ ENGINEER ❑ DEVELOPER ❑. TENANT CONTRACTOR NAME _ W ✓�St f1-cL }SSC r1 ilZ LICL�NSE NUIv1BLE1R> �p L YPE BUS. LIC # �a COMPANY NAME. g ,� �y Z3-0,4C—_,r �AH �Q/j&3 1 Lf s� cL Z - F gz ���r- g� STREET ADDRESS _ TY,ST E,ZI�C/ ;yaQ G _ 9 PHONE 1 � A ^ F T ` 5 7 ARCHITECT/ENGINEER NAME _ LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX �--- STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ ;MULTI -FAMILY PROJECT IN wILDLAND ❑ YES PROJECT IN ❑ YES YES BUILDING: COMMERCIAL URBAN INTERFACE Af2EA a j NO I FLOODZONE RNO n EICHLER HOME? NO DESCRIPTION OF WORK TOTAL VALUATION: &'I-� (�1� �c RECEIVE BY`.� _ By my: signature below, I certify to each of the following: Iain the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent:--777--Date: 1- 0961 SUPPLEMENTAL INFORMATION REQUIRED MEPMiscApp_20.11.doc revised 06121111