13080040R�
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10955 N TANTAU RD
CONTRACTOR: NCM DEMOLITION &
PERMIT NO: 13080040
REMEDIATION LP
OWNER'S NAME: CAMPUS HOLDING INC
404 BERRY ST
DATE ISSUED: 08/06/2013
OWNER'S PHONE: 4087834613
BREA, CA 92821
PHONE NO: (714) 672-3500
❑ LICENSED CONTRACTOR'S DECLARATION
�DE(S�/ DESCRIPTION: RESIDENTIAL COMMERCIAL ll
JOB
License Class_ Lic. # 4 6
2l1isr3ifV& INTERIOR DEMO TO PREPARE FOR FUTURE
&C-m Demo hTicr gvro krlm �ce�r�'
� 21 ��
BUILDING DEMO
Contractor g
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. H Floor Area:
Valuation: S�0000
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
,CPN Number: 31607044.10955
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
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSP CTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date: ZZ 3
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.
¢/
ROOFS:
Signature Datey
All roofs shall be inspected prior to y roofing material being installed. If a roof is
any r
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)
1, 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
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, 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.
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 (��v
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 /J O
CUPERTINO CV�V
(408) 777-3228 • FAX (408) 777-3333 • building(cDcuoertino.org `']
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDREss HP 45 10955 Tantau Rd.
APN # 3 l 6 — D -7 - O y Y, d 9 SS
OWNER NAME Apple Inc.R /�,y.
PHONE (408)783-4613
E-MAIL esandoval@apple.com
(GGLL
R
STEET ADDRESS 1 Infinite Loop
CITY, STATE, ZIP Cupertino, Ca. 95014
FAX
CONTACT NAME Edith Sandoval
PHONE (408)783-4613
E-MAILesandoval@apple.com
STREET ADDRESS 1 Infinite Loop, MS- 21-1 AC2
CITY, STATE, ZIP Cupertino, Ca. 95014
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Scott Williams
LICENSE NUMBER 34469
77N 7ETYPE BusineS
BUS. LIC# 34469
COMPANY NAME NCM Demolition and Remediation, LLP
E-MAIL SWilliams@ncmgroup.com
FAX
STREET ADDRESS 6644 Sierra Lane
CITY, STATE, ZIP Dublin, Ca. 94568
PHONE (925)307-1500
ARCHITECT/ENGINEER NAME Wolfgang Wagner
LICENSE NUMBER C27550
BUS. LIC#
COMPANY NAME Foster & Partners
E-MAIL wolfgang_wagner@apple .COM
FAX
STREET ADDRESS Infinite Loop, MS 21-1 AC2
CITY' STATE' ZIP Cupertino, Ca. 95014
PHONE (408)306-6172
DESCRIPTION OF WORK
Demolition of furniture office partitions and computer flooring to allow access to preform
abatement work.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC,
SQ.FT. VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NETAREA
y�
CCS/
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
GARAGE AREA: DETACH
LTOTALDECK/PORCHAR-EA
[3 ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY []YESBEINC
ADDED? []NO
ADDITION? []NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YE ,VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EI LER HOME? 5o O a X
By my signature below, I certify to�eaofing: 1am th property owner or a ed agent to act on the property owner's behalf. I have read this
application and the information l hrect. I have ead the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating t'on. I MIT orize representatives of Cupertino to enter the*oLdentifir rty for inspection purposes.
Signature of Applicant/Agent: _ Date:
SUPPLEMENTAL FOR TION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwel pply 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
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
l'?titnn. i.,
t )tl.er i feet. irs.:/�,F-1 I /'=rrn.r• Isr. ;n. ;car ', ... In,sp,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the mreliminary information available and are onlv an estimate. Contact the DeDt for addn7 into.
FEE ITEMS (Fee Resolution 11-053 Eff.' 711112)
10955 N TANTAU RD
DATE: 08/06/2013
REVIEWED BY: MELISSA
jwdADDRESS:
APN: 31607044.10955
BP#: 3Q�j
*VALUATION: 1$50,000
KEERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
Suppl. PC Fee: ) Reg. 0 OT
PENTAMATION 1TIPREP
I PERMIT TYPE:
wORK 1208,380
S.F. INTERIOR DEMO TO PREPARE FOR FUTURE BUILDING DEMO
SCOPE
l'?titnn. i.,
t )tl.er i feet. irs.:/�,F-1 I /'=rrn.r• Isr. ;n. ;car ', ... In,sp,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the mreliminary information available and are onlv an estimate. Contact the DeDt for addn7 into.
FEE ITEMS (Fee Resolution 11-053 Eff.' 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$405.00
Tenant Improvement Prep
ITIPREP
Suppl. PC Fee: ) Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee. -E) Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Q
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
�,
Strong Motion Fee:
IBSEISMICO
$10.50
Select an Administrative Item
1
1
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$12.50
$405.00
TOTAL FEE:
$417.50
Revised: 07/01/2013