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13090071CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19050 PRUNERIDGE AVE CONTRACTOR: NCM DEMOLITION & PERMIT NO: 13090071 REMEDIATION LP OWNER'S NAME: CAMPUS HOLDINGS INC 404 BERRY ST DATE ISSUED: 09/11/2013 OWNER'S PHONE: 4087834613 BREA, CA 92821 PHONE NO: (714) 672-3500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License ClaAAsss, Lic. 4 G INTERIOR DEMO TO PREPARE FOR FUTURE BUILDING ��,1(�� r c,r� Rr/ ^ 15ate`�`� �''� l 3113 DEMContractorfV��il)f (83,096 S.F I hereby affirm that I aro 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: $50000 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: 31606033.00 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 180 DA 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 M L 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 Issue Date: granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per th ertino Municipal Code, Section 9.18. �/31� RE-ROOFS: Signature Date 3 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 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 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, Sections 25505 5533, and 25534 - Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:/r 3 I 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 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org ❑ N17W CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT N PROJECT ADDRESS RC 03- 19050 Pruneridge Ave APN# 3( Co .- 06 — 0-33 OWNTRNAME Apple Inc.' ayr, t) O"l (408)783-4613 E-MAIL esandoval9apple. com STREET ADDRESS 1 Infinite Loop CITY, STATE, "LIP Cupertino, Ca. 95014 FAX CONTACT NAME Edith Sandoval PHONE (408)783-4613 E-MAIL esandoval9apple. com STREET ADDRESS 1 Infinite Loop, MS- 21-1 AC2 CITY, STATE, ZIP Cupertino, Ca. 95014 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 13 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Scott Williams LICENSE NUMBER 34469 LICENSE TYPE 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/ENGINEER NAME Wolfgang Wagner LICENSE NUMBER C27550 BUS LIC# COMPANY NAME Foster & Partners E-MAIL wolfgang_wagner@ apple. com FAX STREET ADDRESS 1 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 TYPO OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL O 83,096 AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODF.LAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ ATTACH 0 N DWELLING UN I'TS IS A SECOND UNIT DYES - SECOND STORY []YES ADDED? ONO '.. ADDITION? ONO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS THE BLDG AN 0 YES REQ,' `. y; - G'/jTION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 0 By my signature below, 1 certify to each of the following: m th property otimer or a tzed agent to act on erly owner's behalf 1 have read this application and the information 1 have provi collect. have ad the Description of Work and verify it4i curate. 1 agree to comply with all applicable local ordinances and state laws relating to buildin con traction. I auth rize representatives of Cupertino to enter the abo e -i entified property for inspection purposes. Signature of Applicant/Agent' Date: 11 ION REQUIRED SUPPLEMENTAL INFO:�y PLAN Cl3ECKTYPE � ROUTING SLjT 11 OVER-THE-COUNTER Ell BSIlLEINGPLAN R \11EW New SFD or Multifamily dwellings: "' for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN RENIXEN\' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORIK$ form if any Hazardous Materials are being used as pari of this project. ❑ LARGE: ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to 11 MAJOR � SANITARv sE�i'ER DISTRICT submittal of Building Permit application. ❑ ENVtRONnIFNTAR,xEAlaTal BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer Disfi*4 School Dictrirt_ atr_)_ Thnce feoc are ha.ced an the nrelhninary infnrmatinn availahle and are nniv an estimate. Cnntart the Dent fnr addn't infn_ FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) ADDRESS: 19050 PRUNERIDGE AVE DATE: 08/07/2013 REVIEWED BY: MELISSA APN: 316 06 033 BP#: f 0 (o *VALUATION: 1$50,000 "'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: Suppl. PC Fee: 0 Reg. 0 OT PENTA- ATION 1TIPREP PERMIT TYPE: WORK INTERIOR DEMO TO PREPARE FOR BUILDING DEMO SCOPE �<.s f 621 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer Disfi*4 School Dictrirt_ atr_)_ Thnce feoc are ha.ced an the nrelhninary infnrmatinn availahle and are nniv an estimate. Cnntart the Dent fnr addn't infn_ FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $405.00 Tenant Improvement Prep 1TIPREP Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. C) OT 07 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? ® Yes (D 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 Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $12.50 $405.00 TOTAL FEE: 1 $417.50 Revised: 07/01/2013 so CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 1111ro V AAe- PERMIT # OWNER'S NAME:. W W ) v6 PHONE # (1�5 ti GENERAL CONTRA TOR: NC, ` 9COn M &AM 5 BUSINESS LICENSE # ADDRESS: CITY/LIPCODE: t *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date er / actor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er / actor Signature Date