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13080041CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11000 N WOLFE RD CONTRACTOR: NCM DEMOLITION & PERMIT NO: 13080041 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 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL .' License Class_ Lic. # N00 19 ,,438 S.F. INTERIOR DEMO TO PREPARE FOR FUTURE /1 `p � ContractorMb�?a BUILDING DEMO 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: N'aluation: $50000 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 APN Number: 31607044.11000 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 WI'ITITIN 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 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 Z� Date: 3 granting of this permit. Additionally, the applicant unders ds and will comply Issued by: with all non-point source regulations per the Cupe unicipal Code, Section 9.18. `, / RE-ROOFS: Signature Date `�`'! 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. [3 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 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. 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 the Health & Safety Code, Sections 25505, 25533, and 5634" 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 Owner or authorized agent: Date: / 1 permit is issued. I certify that in the performance of the work for which this permit is issued, l 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 CUPERTINO M wH.I �nMQ'roi 11­11na CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinaCilcuaertino.org FAFIT)ITInN AI.TRATiON/TII171 REVISION / DEFERRED ORIGINAL PEiRMIT # PROJECT ADDRESS HP 42 11000 Wolfe Rd. AIN' 314, y c ll Q60 OWNERNAME Apple Inc.� PHONE (408)783-4613 E-MAIL esandoval@apple.com vs �4 STREET ADDRESS 1 Infinite Loop CITY, STATE, ZIP Cupertino, Ca. 95014 "AX CONTACT NAME Edith Sandoval PHONE (408)783-4613 E-MAI.Lesandoval@apple.com STREET ADDRESS 1 Infinite Loop, MS- 21-1AC2 CITY, STATE, ZIP Cupertino, Ca. 95014 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER El DEVELOPER ❑ TENANT CONTRACTOR NAME Scott Williams LICENSE NUMBER 34469 LICENSETYPE Buslne5 BUS.LIC# 34469 COMPANY NAME NCM Demolition and Remediation, LLP E-MAIL SWilliams@ncmgroup.com FAX STREETADDRESS 6644 Sierra Lane CITY,STATE,ZIP Dublin, Ca. 94568 PHONE (925)307-1500 ARCHITECT/ENGINEERNAME Wolfgang Wagner LICENSENUMBERC27550 BUS. LIC# COMPANY NAME. Foster 8t Partners EMAIL wolfgang_wagner@apple.com FAX STREET ADDRESS 1 Infinite Loop, MS 21-1AC2 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 I # STORIES USE TYPE OCC. SQ,F'I'. VALUATION (S) NEW FLOOR AREA NET AREA 196,458 AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I ATTACH I H DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY VES BEING ADDED? [3NO ADDITION? [3NO PRE -APPLICATION ❑YES IF YES. PROVIDE COPY OF PLANNING APPL # ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RF.0 TOTAL VALUATION: , By my signature below, 1 certify to each of the following:the property owner or authorized agent to on the property owner's behalf. I have read this application and the information 1 have prfVi-dNJs correct. I ave read the Description of Work and veri it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil co tru tion. authorize representatives of Cupertino to enter the above -identified pr pe for ' spection purposes. Signature of Applicant/Agent: Date: _ SUPPLEMENTAL IN ORMA ION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: 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 E) STANDARD El PUBLICWORKS 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 El MAJOR El SANITARYSEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06/21/11 —�;�-� CITY OF CUPERTINO 105-- d1 FEE ESTIMATOR — BUILDING DIVISION ik� ADDRESS: 11000 N WOLFE RD DATE: 08/06/2013 REVIEWED BY: MELISSA Plan Check Fee: APN: 31607044.11000 BP#: 1308Zb *VALUATION: 1$50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building 1"'."e:. hl.ip. Fee: PENTAMATION PERMIT TYPE: 1TIPRE WORK 196,458 S.F. INTERIOR DEMO TO PREPARE FOR FUTURE BUILDING DEMO ---- --- -- SCOPE NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, Sanitary Sewer District, School AlcMet olr_ ! Theca foes are hated an the nreliminary information available and are only an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Tenant Improvement Prep $405.00 ITIPPEP (Wwr 1Liech. lay. ,F-1 I %11J r' 1''w7d., Insp,Ll Other I:.l,.!,., Insp. Ifech. TrR/7. 1'c c': 1"!r?M!%. /1""'n I'Cg; 1"'."e:. hl.ip. Fee: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, Sanitary Sewer District, School AlcMet olr_ ! Theca foes are hated an the nreliminary information available and are only an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Tenant Improvement Prep $405.00 ITIPPEP Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Supp/. Insp. Feee. Reg. ©OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 sjrt trrtc.'i' ljat 7irx: O G) Work Without Permit? Yes No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential G) Building or Structure O f.'> I L)l�crrr,�e r:l�ttivrr .1 '�:>t t: Strong Motion Fee: IBSEISMICO $10.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 SUBTOTALS: $12.50 $405.00 TOTAL FEE: $417.50 Revised: 07/01/2013