The URL can be used to link to this page

14010165CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19191 VALLCO PKWY CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 140/0165 OWNER'S NAME: APPLE INC 1460 O'BRIEN DR DATE ISSUED: 01/30/2014 OWNER'S PHONE: 6506901660 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ APPLE- 1ST FLOOR REAR LOBBY- CREATE OFFICE IN '\ License Class Lic. #_(V 22 EXISTING OFFICE SPACE 75 SQ Contractor ;dd 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: 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 Sq. Ft Floor Area: Valuation: $20000 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 APN Number: 31620074.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 WIT YS O IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA FROM LAST C LED INSPECTION. 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 Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date �i 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: I hereby affirm that 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 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 wit1 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 1 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, Sections 25505, 25533 add 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: E Date: 3� / permit is issued. 1 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 CONSTRUCTION LENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 ICIUPERT'INO — I I NFW CIIN'A'fRI ICTTnN CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)) 777-3228 • FAX (408) 777-3333 • buildiinn7g(a)cupertino.org I I ADDTTTnN �TFRATTIIN/Ti I rI RFVT.CiIIN/1)FFFRRFI� 1 a 0 t�\ IIRT(:TNAT. PERMIT B PROJECT ADDRESS V APN H 31 to 2 O � / L LCLb OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX I , rw,' r s� CCr(A e r� CONTACT NAME e Aq rl L Z r PHO ('o �� • (G O E-MAII, Nt�.T.x STREET ADDRESS CITY, STATE, ZIP 7FAX 1'iGao o �. M 25 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT *CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME E LICENSE NUMBEIZ LICENS TYPE BUS. LIC H2 ., ZZ .3671 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINFIR NAME LICENSE NUMBER BUS. LIC H wigpi 7"Et COMPANY NAME. E-MAIL FAX S / STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Ti EXISTING USE 6 •� � PROPOSED USE CONSTR. qLe of �� TYPE H STORIES % v, USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREAJe_C 7-5 Aon BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA _JayREMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH ❑ ATTACH H DWELLING UMTS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? ❑NO YES IF YES, PROVIDE PLANNINGAPPLOH ❑NO OF IS THE BLDGAN ICHLERHOME? E] YES ItECfi1VED� �� %�rr!i/u��//1i/ �/�/�i�%� f% TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act o roperty 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 i ccu te. I agree to comply with all applicable local ordinances and state laws relating to building construction. I ag.140presentatives of Cupertino to en the abo -identified property for inspection purposes. Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION RE UIRED Q ,.o, rr,;,iwra,,/„%;//rionijf%l� r% /,;Pr,eiTl,ctTi?rli/I%/ l//y%%/% ' %/flf iov/;i",n!/10/„a/J,r,,, I/ cirtLr;(//r/F/// ;,!r 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. P Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.,,�i�//��/�%y�j,�j%'- ' o r Copy of I'Iallning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ilril/i j/„��//J a��%o��l// / ,r , �� /��jl�,��'l�✓y�///��,��!!' fry%; BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO P M71 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n tfriet_ otr_) Thoto foot aro ha.ced an the nroliminary infarmatinn availahle and are nn1v an estimato_ Cnntart the Dont for addn'1 info_ FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) ADDRESS: 19191 Vallco Pkwy DATE: 01/30/2014 4 APN: BP#:r�� REVIEWED BY: Mendez "VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building 2 hours $278.00 PENTAMATION PERMIT TYPE: 1GENC0 WORK a le- 1 st floor rear lobby- create office in existinq offices ace 75 s SCOPE hrs $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n tfriet_ otr_) Thoto foot aro ha.ced an the nroliminary infarmatinn availahle and are nn1v an estimato_ Cnntart the Dont for addn'1 info_ FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTYIFEE MISC ITEMS Plan Check. Fee: Hourly Only? 0 Yes Q No $0.00 2 hours $278.00 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 Q No $0.00 Suppl. Insp. Fee:(Q Reg. Q OT 1 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 �A"cen,,"N'•, n ;:n. wrt�� vat4v Fcc, 7 0 E) Work Without Permit? 0 Yes , E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure 0 i Strong Motion Fee: IBSEISMICo $4.20 5.0 hrs $695.00 Inspections 1STINSP Inspection, Hourly Bldg Stas Commission Fee: 1BCBSC $1.00 SIJBTQIAti $5.20 $973.00 ``orAL` iE. $978.20 Revised: 01/15/2014