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13090068CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20525 MARIANI DR CONTRACTOR: DEVCON PERMIT NO: 13090068 CONSTRUCTION INC OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED: 09/11/2013 OWNER'S PHONE: 4088629799 MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL Lic. N � �qPLE- License Class / //p � 2ND FLOOR T.I PREP 1250 S FT INTERIOR APOQ TXPe cool J % .111IZ3 DEMO Contractor o Date 1 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. 1 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: $9500 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 14gr Code, for the performance of the work for which this APN Number: 32656001.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 1 DAYS OF PERMIT 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 DAY I LAST CALLED 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 1141 t?///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 / All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 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). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 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 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio 505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. 1 certify that in the performance of the work for which this permit is issued, 1 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, 1 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 expcnses which may accrue against said City in consequence of the 1 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 CITY OF CUPERTINO Fm_�FEE ESTIMATOR - BUILDING DIVISION NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolu/ion 11-053 Eff 7/1113) ADDRESS: 20525 MARIAM DR DATE: 09/11/2013 REVIEWED BY: Mendez APN: BP#: 'VALUATION: $9,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: I Suppl. PC Fee: Q Reg. Q OT PENTAMATION 1-FIPREP I PERMIT TYPE: WORK APPLE- T.I PREP 1250 SQ FT INTERIOR DEMO SCOPE NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolu/ion 11-053 Eff 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $405.00 Tenant Improvement Prep ITIPREP Suppl. PC Fee: Q Reg. Q OT FO.01 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 E) Work Without Permit? O Yes (F) No $0.00 Advanced Planning Fee.-Residential$0.00 Select aNon :1 Building or Structure I �1'(!) L'i I)r?L lIN7r11I10f i+m }`t.'f'1": Strong; Motion Fee: IBSEISMICO $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.00 $405.00 TOTAL FEETF $408.00 Revised: 08101/2013 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(o-kupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT N PROJECT ADDRESS I PN a VO tr) cLJ !,5 ONE OWNER NAMEg65!2,5 1. E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADORES$ CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEo co " LICENNSSE NUMBER LICENSE TYPE BUS. LIC 9 tel/ J COMPANY NAME /� 4/ei✓&VGond E-MAIL S g �2 G�"t/Ge� SCJ FAX STREET ADDRESS CITY, STATE, ZIP PHONE Q mlz/' /v 17-& c 13 `) � X60 ARCHTTECT/ENGINEER DIAME LICENSE NUMBER -7 6 BUS. LIC N COMPANYNAME (%� V (��/�� E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK n d Vce/J da�0 e��/ L� EXISTING USE ROPOSED USE CONSTR. TYPE 0 STORIES JTOiz, I (-Ai& ,Si✓Oy USE TYPE OCC. SQ.FT. VALUATION {$) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA/ L� V NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH d DWELLING UMTS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? �NO ADDITION? $2NO PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YFS(, , 4 TOTAL VALUATION: PLANNINGAPPLN ❑NO PLANNING APPROVAL LETTER EICHLER HOME? 72 NO TVC (D6 J By my Signature below, I certify to each of the following: I am the property owner Or authorized agent to act on the property 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 b g cons authorize epresentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL RMATION REQUIRED rLavrcae %, ,%,o TING SLIP P TI3LrCOUNTER BUILDING PK AN REViRW 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 PLANkEy1EW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ,, ❑ STA]YDARD ❑PUBLIC _ form if any Hazardous Materials are being used as part of this project. RKS LAIR Ell,IRE DEPT i 'i� u�/F„iii Copy of Planning Approval Letter or Meeting with Planning prior to ❑ submittal of Building Permit application. MAJOR ❑ SANITARY SEWEN DtSTRIGTt ❑” ENVIRCFNMENTAli HEALTI# - �, BldgApp_2011.doc revised 06/21/11