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14010158CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 3 INFINITE LOOP CONTRACTOR: XL CONSTRUCTION PERMIT NO: 14010158 851 BUCKEYE CT DATE ISSUED: 01/29/2014 OWNER'S NAME: APPLE COMPUTER INC OWNER'S PHONE: 4089961010 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ��// Q,` APPLE 1ST FLOOR- INSTALL (2) NEW CARD READERS AT License Class l Lic. # 6 '"l � O EXISTING DOORS, ADD EXIT SIGNS FOR EGRESS, DEMO / EXISTING DOOR Contractor li V G Date I hereby affirm that I am licensed under the provisi ns 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: 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 Area—performance of the work for which this permit is issued. Sq. Ft Floor 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 APN Number: 31602107.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS FST CALLED INSPECTION. upon the above mentioned property yfor inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, G G� is and expenses which may accrue against said City in consequence of the Date: / 2 7• cos p Y Issued by: granting of this pe . . Additionally, the applicant understands and will comply with all non- t s rce regulations per Cupertino Municipal Code, Section 9.18. L RE -ROOFS: Signature a e I I 1 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. ❑OWNER -BUILDER DECLARATION Signature of Applicant: Date: herebyI herthat I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sect' 505,25 nd115534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:l/-4k y 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address — 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ^ 1 (408) 777-3228 • FAX (408) 777-3333 • building(- cupertino.orq CUPERTINO n NFw CONSTRI ICTION R ADDITION n ALTERATION / TI n REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 3 Infinite Loop APN# OWNER NAME 0 r Il I I NL l PHONE _ (� - I U } j� V(� &MAH STREET ADDRESS ' I I tic I to ( TL STREET oc/r- CITY, STATE, ZIP r� ✓\,C �J �( �l V FAX CONTACT NAME Bryan Eisemann PRONE 805-674-581"77 E-mALbeisemannC@xlconstruction.com STREET ADDRESS T1s F71,6ke ��' CJv2( CITY, STATE, ZIP 'Apt; CITY OF CUPERTINO VrV -PQ•r11%4ATnu _ RIT11 DING. DIVISION NOTE: This estimate does not include fees due to other Departments (Le. rtanntng, ruottc Rorks, fire, uurthary oewc. 30-1 ---1_____1:_... - .. ..:/../,/o n..d oro nnhi nn octimato_ Contact the Dent for addn'1 inra. District, eraZ. mese iees ure uuseu ur< u.c .c......... . FEE ITEMS (Fee Resolution 11-053 Eff 7%1'13) 1' 1J •'L LJ V 1 "h1rnh. I'lu. lee. Plan Check DDRESS: 3 infinite loop DATE: 01/29/2014 REVIEWED BY: Mendez t)(,Iler• Plumb Irish. PAPN: BP#: ��� 'VALUATION: $5,000 aec.Insp. Fee. $0.00 J O $0.00 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building Permit Fee: Hourly Only? ()Yes (D No PENTAMATION 1 GENCOM PERMIT TYPE: USE: 0.0 hrs WORK apple 1st floor- install 2 new card readers at existing doors add exit signs foregress, demo existing SCOPE door NOTE: This estimate does not include fees due to other Departments (Le. rtanntng, ruottc Rorks, fire, uurthary oewc. 30-1 ---1_____1:_... - .. ..:/../,/o n..d oro nnhi nn octimato_ Contact the Dent for addn'1 inra. District, eraZ. mese iees ure uuseu ur< u.c .c......... . FEE ITEMS (Fee Resolution 11-053 Eff 7%1'13) - "h1rnh. I'lu. lee. Plan Check Plan Check Fee: Hourly Only? Yes Q No Elec. Permit Fee: Other Much. Insp t)(,Iler• Plumb Irish. )flier Elea. Insp. 11ech. Insp. f Plumfi. Lrsp. Fey. aec.Insp. Fee. $0.00 PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. rtanntng, ruottc Rorks, fire, uurthary oewc. 30-1 ---1_____1:_... - .. ..:/../,/o n..d oro nnhi nn octimato_ Contact the Dent for addn'1 inra. District, eraZ. mese iees ure uuseu ur< u.c .c......... . FEE ITEMS (Fee Resolution 11-053 Eff 7%1'13) FEE QTY/FEE ---- MISC ITEMS Plan Check Fee: Hourly Only? Yes Q No $0.00 1 1 hours $139.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes (D No $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consirrrction :Tcrs: "idnriiristrcarrVC 1 (Y" O E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure Trm,el Documentation Fees:� Strong Motion Fee: IBSEISMICO $1.05 2.0 hrs $278.00 Inspections ISTINSP 7Inspection, Hourly Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2.05 $417.00 TOTAL FEE: 1 $419.05 Revised: 01/15/2014