15010165CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19191 VALLCO PKWY I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 15010165
I OWNER'S NAME: APPLE INC 1 1460 OBRIEN DR I DATE ISSUED: 01/28/2015 1
OWNER'S PHONE:: 4084380968
❑ 1A4'-1' LICENSED CONTRACTOR'S DECLARATION
License Class 7 g L D a Lic. #
Contractor �YO Cdlls�r,,,. Date
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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.
1 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.
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 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 may accrue against said City in consequence ofthe
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regula ions per th -Cupertino Municipal Code, Section
9.18. y
Signature Date / S
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
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
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, l
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. 1 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 to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
MENLO PARK, CA 94025
PHONE NO: (650)701 -1500
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
APPLE- T.1 PREP 6100 SQ FT, FOR FUTURE OFFICES,
LAB SPACE AND CONFERENCE ROOM.
Sq. Ft Floor Area: I Valuation: $25000
APN Number: 31620074.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS, , O- M-16AST CALLED INSPECTION.
U
Issued by: Date:
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipa ode, Chapter 9.12 and
the Health &Safety Code, Sections 25505, 255 , a 534.
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Profess
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION rr I
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10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 \`
(408) 777 -3228 • FAX (408) 777 -3333 • building(okupertino.org
L NEW CONSTRUCTION L ADDITION L ALTERATION / Ti L REVISION / DEFERRED ORIGINAL PERMIT #
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❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 1:1 CONTRACTOR 1:1 ACTOR AGENT ARCHITECT ❑� ENGINEER ❑ DEVELOPER ❑ TENANT
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REMODEL AREA
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CONSTR. TYPE
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# STORIES
1
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EEXISTG
AREA 61 DD
NEW FLOOR
AREA (9 / T
DEMO
AREA
TOTAL
NETAREA D
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DOO
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNTIS:
IS A
SECOND UNIT ❑ YES
SECOND STORY []YES
BEING ADDED? ❑NO
ADDITION? []NO
PRE - APPLICATION ❑ YES H YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVE
AL VALUATION:
PLANNING APPL 9 ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
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By Iny signature below, I certify to each of the following: I am the property owner or authorized agent to a 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 Verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building co ruction. I uthorize representatives of Cupertino to enter the above - identified roperty for inspection purposes.
Signature of Applicant/Agent:
Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE . <r
xouzmc si iP
New SFD or Multifamily dwellings: Apply for demolition permit for
❑
❑ sUrLn>TVC PLAN
existing building(s). Demolition permit is required prior to issuance of building.:
oVER TH�cotTIVTER
REVIEW
permit for new building.
❑ EXPRESS
❑ riANNING4PLANREVIEW .'
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ PuBLlcwoxxs
form if any Hazardous Materials are being used as part ofthis project.
❑
❑ FxEnEPTt
_ Copy of Planning Approval Letter or Meeting with Planning prior to
LnRCE
❑ �Lysox ,
❑ saxiTARY sEWERDisTRICT
submittal of Building Permit application.
,. ,
❑ 'ENVIRONMENTAL HEALTH .
BldgApp_2011.doc remised 06121111
X.J14%
IM-7, CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
w-.
ADDRESS: 19191 vallco pkwy
FEE
DATE: 01/28/2015
REVIEWED BY: Mendez
APN:
BP #:
2121 01
*VALUATION: 1$25,000
rPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
Suppl. PC Fee: 0 Reg. 0 OT
0.0
PENTAMATION 1TIPREP
PERMIT TYPE:
WORK
a t.i prep 6100 sq ft for future offices
labs ace and conference room.
SCOPE
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution 11 -053 Eff' 71.'I3)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$417.00
Tenant Improvement Prep
ITIPREP
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
T__T_
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
0
i
Stroh Motion Fee:
IBSEISMICO
$7.00
Select an Administrative Item
Bldg; Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$8.00
$417.00
TOTAL FEE:
$425.00
Revised: 01/06/2015