1309007419320 PRUNERIDGE AVE
13090074
D/P
THE SOBRATO ORGANIZATION
SCANNED BOX #607
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19320 PRUNERIDGE AVE
CONTRACTOR: NCM DEMOLITION &
PERMIT NO: 13090074
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 Class Lic. it I 1 q 6� ,�
INTERIOR DEMO TO PREPARE FOR FUTURE BUILDING
n/r�M ll�t(� u.rr1 �r^+aljg3t•h IP
DEMO
Contractor date
(40,180 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
APN Number: 31606050.02
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 ERMIT 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 AS LLED 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
granting of this permit. Additionally, the applicant understands and will comply
Iss Date:
with all non -point source regulations per the C ertino Municipal Code, Section
9.18.
%�,
Signature Date / /I
RE -ROOFS:
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
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).
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(x) 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 , 25533, and 2553
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agen Date:
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
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
1 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
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT H
PROJECT ADDRESS RC 06- 19320 Pruneridge Ave.
APN# 3[ � - 06 - 0 50
OWNER NAME Apple Inc lavh �S lJi HONE (408)783-4613
E-MAIL esandoval 9 apple. com
STREET ADDRESS 1 Infinite Loop
CITY, STATE, ZIP Cupertino, Ca. 95014
FAX
CONTACT NAME Edith Sandoval
PHONE (408)783-4613
FE -MA 11esandoval@apple.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
STREET ADDRESS 6644 Sierra Lane
CITY, STATE, ZIP Dublin, Ca. 94568
PHONE (925)307-1500
ARCH ITECT/ENGIN EER NAME Wolfgang Wagner
LICENSE NUMBER C27550
BUS. LIC#
COMPANY NAME Foster 8r Partners
E-MAIL wolfgang_wag ner@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 TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
�t
AREA
AREA
AREA
NET AREA
`10,180
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCHAREA DECKAREA TOTAL DECK/PORCH AREA GARAGEAREA. DETACH
[]ATTACH
t
# DWELLING UNITS: IS A SECOND UNIT []YES SECONDSTORY ❑YES
BEINGADDED? []NO ADDITION? []NO
PRE-APPLICATOON OYES IF YES, PROVIDE COPY OFIS
THE BLDG AN E] YES
TOTAL -VALUATION
PLANNING APPI., # ❑ NO PLANNING APPROVAL LETTER
E 1OME? ❑ NO
1_41151
SS 177o K_
By my signature below, I certify to each of following 1 am the p pert er oriz en n the property owner's behalf. 1 have read this
application and the information I have pro ided correct. I have rea th scriptlon of and y it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi con ruction. 1 authori a representatives of Cupertino to enter the above idem fled property for inspection purposes.
Signature of ApplicanUAgent _ .� a��a.. Dale _........
SUPPLEMENTAL I OR TION REQUIRED
PLANCIIECK `E
ROUTIIVGSLIP
s
El ovER-THE-COUNTER
❑ BUILDING PLAN REview
New SFD or Multifamily dwelli gs: AppV for demolition permit for
existing building(s). Demolition perm fired prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PI ANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PIJULICAVORKS
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
❑ SANlrARV SEWER DISTRICT
submittal of Building Permit application.
❑ ENyFIRPNMENTA4HEALTH
BldgApp_20/l.doc revised 06121111
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 District, School
ni_ctriet_ etc )_ Thaw fops m•e hnced nn the nreliminary inforinatinn availahle and are nnly an estimate_ Cnntact the Dent for addn'l infn_
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12)
ADDRESS: 19320 PRUNERIDGE AVE
DATE: 08/07/2013
REVIEWED BY: MELISSA
APN: 316 06 050
BP#: 3 d ll�O �
VALUATION: 1$50,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
Suppl. PC Fee: 0 Reg. 0 OT
PENTAMATI ON
PERwIITTYPE: 1TIPRE
WORK
INTERIOR DEMO TO PREPARE FOR BUILDING DEMO (40,180 S.F.
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
ni_ctriet_ etc )_ Thaw fops m•e hnced nn the nreliminary inforinatinn availahle and are nnly an estimate_ Cnntact the Dent for addn'l infn_
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$405.00
Tenant Improvement Prep
ITIPREP
Suppl. PC Fee: 0 Reg. 0 OT
FO,0
F hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.001
Select a Non -Residential
Building or Structure
0
A
Strong Motion Fee:
IBSEISMICO
$10.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$12.50
$405.00
TOTAL FEE: $417.50
Revised: 07/01/2013
CUPERTINO
p-e4e. 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:
PERMIT# Z309009 -V
OWNER'S NAME: 171/
r
P H 0 N E # Cil �3,V-7 - / 6
GENERAL CONT
BUSINESS LICENSE# �30bl
ADDRESS:
CITY/ZIPCODE:A
*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 Date
Please check applicable subcontractors and complete the following information:
V
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
��dractor Signature
Date