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13090072CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19310 PRUNERIDGE AVE CONTRACTOR: NCM DEMOLITION & PERMIT NO: 13090072 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 171 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. # I �b� INTERIOR DEMO TO PREPARE FOR FUTURE BUILDING Contractor /y M ,�l+�, "f)rh a•{Mwoity�nDate `�,� 3%/ DEMO (91 80 S.F) 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: $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 permit is issued. APN Number: 31606051.00 Occupancy Type: 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 DAY 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 DA iJ ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, r costs, and expenses which may accrue against said City in consequence of the / granting of this permit. Additionally, the applicant understands and will comply sued by: Date: with all non -point source regulations per the Cupertino cipal 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, I agree to remove all new materials for inspection. 171OWNE -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 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 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 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a0cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION / DEFERRED ORIGINAL PERMIT k PROJECT ADDRESS RC 07- 19310 Pruneridge Ave -7^PN" 31 b —06 _ O S OWNER NAME Apple Inc. CWyr P tl5 (d,,1 &HONE (408)783-4613 7 E -MAIL esandoval9apple. com STREET 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 5014FAX❑ CITY, STATE, ZIP Cupertino, Ca. 950114—F- 11OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Scott Williams LICENSE NUMBER 34469 TLICENSETYPE Busines BUS.LIC0 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 ARCHITECTIE.NGCNEER NAME Wolfgang WagnerVV LICENSE NUMBER C27550 BUS. LIC N COMPANY NAMEFoster O Partners E-MAIL wolfgang_wag ner@ apple. corn 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 CON STI. TYPE N STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL 91,280 AREA AREA AREA NET AREA '.. BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREEBF TOTAL DECK/PORCH ARE.. GARAGE AREA DETACH ❑ ATTACH NDW FEEING UN6S SECOND UNIT []YES SECONDSTORY []YES C ADDED? E]NO ADDITION? []NO PRE -APPLICATION ❑YES IF YES. PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VAI UATI N: PLANNING ADPL N ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO S (/� By my signature below, I certify to each of the following: I a. t property owner or authorizedjgKto act ow elroperty owner's behalf. I have read this application and the information 1 have proide is rrect I ve ead the Description of Work and verify i accurate. I agree to comply with all applicable local ordinances and state laws relating to build) g co strucoction. 1 uth rize representatives of Cupertino to enter the abov -ide tided property for inspection purposes. Signature of Applicant/Agent �-�- Date ( L. SUPPLEMENTAL FORION UIRED CIJECK �r ROUTING ^ iP E] t¢u1,LV1NG PLAN REVIEW New SFD or Multifamily dwellin Apply or demolition permit for[AVER-THE-COUNTER existing building(s). Demolition permit is r i ed prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING, PLAN REVIV1W 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 DRPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY S911.'ER DISTRICT submittal of Building Permit application. © t NVIRONNIENTAL tIFAt Ttt BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO Fm_� FEE ESTIMATOR - BUILDING DIVISION _0 i9ADDRESS: 19310 PRUNERIDGE AVE DATE: 08/07/2013 REVIEWED BY: MELISSA APN: 316 06 051 BP#: 5o yo� 'VALUATION: 1$50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: Suppl. PC Fee: (F) Reg. C) OT0.0 PENTAMATION 1TIPREP PERMIT TYPE: WORK INTERIOR DEMO TO PREPARE FOR BUILDING DEMO (91,280 S.F. SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School nicfrief ofr ) Thoco fooc nro hncod nn tho nrolifainnry infnrfnn/inn nvnilahlo and nro nnly an vc/imp/o. Cnn/nM /he non/ fnr aildn'I infn_ FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.001= # $405.00 Tenant Improvement Prep 1TIPREP Suppl. PC Fee: (F) Reg. C) OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. C) OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ., 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Strong Motion Fee: 1BSEISMICo $10.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $12.50 $405.00 TOTAL FEE: 1 $417.50 Revised: 07/01/2013 (( CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 'Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 07 PP -(,A01 av Rv-E PERMIT # 3 C) 1 0 0 OWNER'S NAME:%t- dA?M -$ / PHONE # 1'�f2°t; v7:7 /57-0 GENERAL CONTRACTOR: N6I77.'SC.ef7-/ BUSINESS LICENSE # 9 V-q�, ADDRESS: ` CITY/ZIPCODE: Al&? -f Ai L,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 6/ 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 'r� Date