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B-2017-0533CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10001 N DE ANZA BLVD CUPERTINO, CA 95014-2263 (326 34 074) OWNER'S NAME: TAMBELLINI DEANZA PROPERTIES LLC OWNER'S PHONE: 415-277-6836 LICENSED ONT TOR'S DECLARATION AR ATION License Class A. C36, C10 Lic. #730349 Contractor BURR PLUMBING AND PUMPING INCDate 12/31/2018 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 hav and will maintain a certificate of consent to self -insure for Worker's '09mpensation, as provided for by Section 3700 of the Labor Code, for the ormance 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 Cuppfio Municipal Code, Section 9.18. Signature Date 04/04/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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. 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. 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 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 04/04/2017 CONTRACTOR: PERMIT NO: B-2017-0533 BURR PLUMBING AND PUMPING INC SAN JOSE, CA 95125 DATE ISSUED: 04/04/2017 PHONE NO: (408) 287-2877 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: APPLE - UNDERGROUND PARKING AREA, DE ANZA SIDE; REMOVE AND REPLACE BACK WATER VALVE Sq. Ft Floor Area: I Valuation: $12000.00 APN Number: Occupancy Type: 326 34 074 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM Issued Date: 1 ON. RE -ROM: 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: 04/04/2017 "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 Munic' ode, Chapter 9.12 and the Health & Safety Code, Sections 2 33, and 25534. Owner or authorized agent:/ , Date: 04/04/2017 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ' ( 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 t PERifNC? (408) 777-3228 • FAX (408) 777-3333 • buildinaC�cuperdno.arg .73 7,01 - a533. m I S LC'k PLUMBING I t� IMECI-IANICAL nRT.RC'TRU-AT. FjN/fTcrFTI A-ITP(TTc PROJECT ADDRESS APN # OWNERNA\E/� rye/® HO ®`� A STREET ADDRESS „�p�✓O ��r�� r IpY, STAT P � 1 ' G �j13t 7 "L Yy CONTACT NAME PHONE E-MAIL yS .— ZQ, 7 7 STREET ADDRESS CITY, STATE, ZIP FAX El OWNER El OWNER -BUILDER 1:1 OWNER AGENT-JiCON1RACTOR ❑ CONITRACTOR AGENT❑ ARCHITECT I] ENGINEER 1:1 DEVELOPER El TENANT CONTRACTOR NAME g r f> (� a `J t yWlp LICENSE M�B`E v- CENSE BUS. LIC # J 2 COMPANY NAME E-MAIL FAX STREET ADDRESS ,IfA p �F'1t�AK1. CITY, STATE,IIP� �, / � PHUNE -6-,7- �P ARCHITECT/ENGINEER NAME LIC SE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS 4 CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA iJ' NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ 1TS EICHLER HOME-.? j NO DESCRIPTION OF WORK( TOTAL VALUATIONT: 2 RE By my signature below, I rtify to each of the following: I am the pro owner or authorized agent to act on the property o r s b have rea application and the information I have provided is correct. I hav e Description of Work and verify it is acc comply with all applicable local ordinances and state laws relating to building constructio a e representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: _ ._-- Date: C 7 S MENTAL INFORMATION REQUIRED OFFICE USE ONLY U: R -TBE -COUNTER.. . ❑ EXPRESS = ' STANDARD <.-' - ❑, 1-4RGE ❑ mAJOR MEPMiscApp 201 ].doe revised 06121/11 .y �7r I FLOOR PLAN I L — Aix -,r S� — — — — — — — — — — — — -J GENERAT NOTES. SCOPEO—RESPROJECTINFORNSKNON -TALI �5 R[_NOUT RT a�a[x, - TIN—Al D-11AND NATAL a oAx,[2. UT a"w'T"SAN TAI s[wca ur[DAF SILL e[ D S'NN[Dr[D AND Po RT Nc[ LD N. PID AT T" Fomns[D cacury Dw or— N[waaoP—LN[cLLANOUT PO Nr IRA WLL TAT 1 IONN "T ON AND D ATR 'T OF ,,NOT YDN.ATRIT NSMARK TLT Noor DNDFn11TOR FOR � NSP[DroN PaioaroMR D.T APPROVAL r rss� - - O , . . .. ..- FOUR CORNER PROPERTIES 339 S SAN ANTONIO ROAD SUITE 213 LOS ALTOS, CA 94022 P-ES7 ADDRESS APPLE INC. DE ANZA 5 10001 N. DE ANZA BLVD. CUPERTINO, CA 95014 (AP"> BURR PLUMBinc 1645 ALMADEN RD. SAN JOSE, CA 95125 408-287-2877 APR_ -roc .71 ISALE P-ES7 ID DRAIN EY PLUMBING COVER SHEET, DETAILS AND NOTES P-0 \ �actiwties tlatawuoracwutrucl sM1are tlnah paffiidliffM � marenfal dv®� ¢xw.tl by Yous WWwpraCds o- eaWoriv'�s FOUR CORNER PROPERTIES 339 S SAN ANTONIO ROAD SUITE 213 LOS ALTOS, CA 94022 P-ES7 ADDRESS APPLE INC. DE ANZA 5 10001 N. DE ANZA BLVD. CUPERTINO, CA 95014 (AP"> BURR PLUMBinc 1645 ALMADEN RD. SAN JOSE, CA 95125 408-287-2877 APR_ -roc .71 ISALE P-ES7 ID DRAIN EY PLUMBING COVER SHEET, DETAILS AND NOTES P-0 PROPERTY LINE O EXISTING 4' SEWER N. DE ANZA BOULEVARD PLUMBING FLOOR PLAN NEW BACKWATER VALVE 0 B REPLACE EXISTING 4" SANITARY SEWE PROPERTY CLEANOUT PER DETAIL EXISTING 4"SEWER SCALE: %s T-0" FOUR CORNER PROPERTIES 339 S SAN ANTONIO ROAD SUITE 213 LOS ALTOS, CA 94022 PRDJEC7 ADDRESS APPLE INC. DE ANZA 5 10001 N. DE ANZA BLVD. CUPERTINO, CA 95014 BURR PLUUIBIUG 1645 ALMADEN RO. SAN JOSE, CA 95125 408-287-2877 IDALE -1 PRDJEC7 ID DRAWN BY PLUMBING FLOOR PLAN P-1