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B-2017-0344CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0344 10101 N DE ANZA BLVD CUPERTINO, CA 95014 (326 34 071) HOLDER CONSTRUCTION GROUP LLC ATLANTA. GA 30339 OWNER'S NAME: WATERDRAGON 289 LLC OWNER'S PHONE: 408-974-5951 DMIJ 01 1 1 \Y I : a 1 1 1 License Class 11 Lic. #977963 Contractor HOLDER CONSTRUCTION GROUP LLC Date 10/31/2018 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. 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. 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 of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupe; ifo Municipal Code, Section 9.18. .hA c • fl�!li,�tl.�� l\��fii�i�illf ' • . - 1 mfzi�7 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: - 1. I, 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) I, 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: 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. 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, I 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 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 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 03/10/2017 ISSUED: 03/10/2017 NO: (770) 988-3289 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTLAL X COMMERCIAL JOB DESCRIPTION: APPLE; 3RD FLOOR; T.I. - SECURE VESTIBULE AT THE ELEVATOR LOBBY AND REMODEL OFFICE AREA (640 S.F.) Sq. Ft Floor Area: I Valuation: $20000.00 APN Number: Occupancy Type: 326 34 071 1 B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST Issued by: Date: 03/1 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 ofApplicant: Date: 03/10/2017 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 Municipal Code, Chapter 9.12 and the Health & Safety Code''Sections 25505, 5 and 255.34. r Owner or authorized agent.' Date: 03/10/2017 CONSTRUCTION LENDING A3ENCY I 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 I understand my plans shall be used as public records. Licensed Professional fr0, Z0�'-- tet' CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 up s TINO F. (408) 777-3228 • FAX(408) 777-3333 • building@cupertino.org INWC0N,R'TRTTC..TT0N 18) I 1 AnT)TTT(-)m 1 1 AT TFT? A'T TnXT TT FI DL'A7rernwT 1r UrUDDTI- -T —TAT T, PROJECT ADDRESS 4 ! * �Q Antok - APN # 2524P ,., - Z)14 — 0:41 OWNER NAME PHONEA of — S! J E MAi%b p v O U` STREET ADDRESS1 X11= NO i TT-- t/o© P CITY, STATE, ZIP 11FAX CONTACT NAME ChY�5 Y. PHONE jn�•+� a{�rL`t1 `CZIP � +no1 E-MAILc���°�j4i il�ri�Q�p91p•!4� t Y STREET ADDRESS ` (�n � � � CITY, STATE, CA,99b\4 FAX 11OWNER ElOWNER-BUILDER 13OWNER AGENT 11CONTRACTOR EICONTRACTOR AGENT ElARCHITECT ❑ ENGINEER ❑ DEVELOPER TENANT CONTRACTOR NAME/A� A s LICENSE NUMBER X7796 3A LICENSE TYPE BUS. LIC# 36391 COMPANY NAME�LJ // es/l�@J� Low* E-MAIL C.i"�toYtr : Cp FAX (An5 r,.,r �mn OLA STREET ADDRESS �rsV ffWOc9� ��� y� 33 •f 337 CITY, STATE, ZIP f S®� �f4n (9 PHONE S64-14) 63 ARCHITECT/ENGINEER NAME q I _ j^��j� LICENSE NUMBER BUS. LIC # COMPANY NAME �ka e -6 �� '! �•eis '[,� E-MAIL 0kSV�aa e �* Om FAX STREET ADDRESS /f ��j —0T. CITY, STATE, ZIP PHONE/�� DESCRIPTION OF WORK 1 �Y��ho✓ �.v�c:�r1_ 1 _�i�n�- o� +Aa 3�- -�1aa d� C� � -tin inyol� avt ad f-Kcn- o a wwyy. Ae a- `E�o ete/a y t&tt4r Avid Yt�o+n(/fi�4�(ca�'n�oF ��� U.. *room • evt5�l�a} Lt 0 k"% 4. tst EXISTING USE f PROPOSED USE CONSTk TYPE # STORIES • �" USE TyP OCC. SQ.FT. VALUATION ($) AREA AREA NEW FLOOR AREA DEMO AREA NETAI. NET AREA `•gyp _ o- CAO BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEINGADDED? ❑NO ADDITION? - ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO��- RE - x ED BY; TOTALV(A�LUATION: IN 9 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on thelproperty owner's behalf. I have read this application and the information I have prow' ed 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 buildi g construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL WORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP 11OVER-THE-COUNTER'I� �, i► BUILDING PLAN REVIEW _ 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑l, WORKS form if any Hazardous Materials are being used as part of this project. F-1LARGE ��PUBLIC Er F'TRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to p MAJOR El SANITARY sEWERDISTRICT submittal of Building Permit application. ❑ ENVIRONATENTAL HEALTH BldgApp 2011.doe revised 06121111 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 10101 N De Anza Blvd, Cupertino, CA 95014 PERMIT # B-2017-0344 OWNER'S NAME: Apple Inc. PHONE # 864-906-6350 GENERAL CONTRACTOR: Holder Construction Company BUSINESS LICENSE # 36391 ADDRESS: 2025 Gateway Place, Suite 320 CITY/ZIPCODE: San Jose, CA 95110 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Redwood Electric 400156 ✓ Excavation Fencing Flooring / Carpeting ProSpectra Contract Flooring 34775 r/ Linoleum /Wood Glass / Glazing Walters & Wolf 400 5R— Heating Insulation California Drywall 26077 Landscaping Lathing Masonry Painting /Wallpaper California Drywall 26077 ✓ Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock California Drywall 26077 Tile Fire NrotectlonSuperior Sprinkler �L --- Owner / Contractor Signature 6464 5/24/17 Date