13110148CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19191 VALLCO PKWY CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 13110148
OWNER'S NAME: APPLE INC 1460 O'BRIEN DR DATE ISSUED: 11/21/2013
OWNER'S PHONE: 6506901660 MENLO PARK, CA 94025 PHONE NO: (650)701-1500
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB r—
License Class__ Lie. to 7 9 10 Z-Z-
� MECI-I r RESIDENTIAL � COMMERCIAL
Contractor Alftlb Cbl4JrXV0-1 tW Date r—
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions JOB DESCRIPTION:
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. 1 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.
2. 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
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source Wulations per the Cupertino Municipal Code, Section 9.18.
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
t. 1 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.
2. 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
permit is issued.
3. 1 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 Califomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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,
zosts, and expenses which may accrue against said City in consequence of the
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.
Signature Date
APPLE- INSTALL (2) DOORS WITH CARD READERS ON 2ND
FLOOR TO CREATE SECURE AREA
Sq. Ft Floor Area:
APN Number: 31620074.00
Valuation: $7500
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN
180 DAV.
Issued by:
DAYS OF PERMIT ISSUANCE OR
OM LAST CALLED INSPECTION.
Date,//W-`/`.7
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the California
Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with
the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section
25532(a) should I store or handle hazardous material. Additionally, should I use
equipment or devices which emit hazardous air contaminants as defined by the Bay Area
Air Quality Management District I will maintain compliance with the Cupertino
Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and
25534.
Owner or authorized agent: Date:
CO RUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's for
which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION 1
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION b\
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 �\
(408) 777-3228 - FAX (408) 777-3333 - buildingPcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ZALTERATION l TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
7
PROJECT ADDRESS
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OWNER NAME
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CITY, STATE, "ZIP pp /I�� q FAX
CONTACT NAME
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ACONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEY
LICENSE NUMBER
,7�If
LICENSE TYPE
BUS LIC d 80T
COMPANY NAME
evAJsr' iZudi
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCMTECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC M
COMPANY NAME a�17
E-MAIL
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FAX
STREET ADDRESS
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CITY STATE, ZIP
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DESCRIPTION OF WORK
2 2 b s od ?A ib —'
o e Ac
EXISTING USE
PROPOSED USE
CONSTR. TYPE
N STORIES
pFF/G
cyc:'KGi'( I
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
r
D>✓��G
2
/J
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGE AREA DETACH
❑ ATTACH
4 DWELLING UNITS ISA SECOND 641T____OYES SECOND STORY YES
BEING ADDED? ONO ADDITION? ONO
PRE -APPLICATION OYES IF VES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECFIV [)
TOT,JL VALUATION:
PLANNING APPL 9 ONO PLANNING APPROVAL LEITER
EICHLER HOME? ❑ NO
71�!
By my signature below, I certify to each of the following: I am the property owner or authori . d ent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work Aiid verity it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to building cons tr n I a ize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: dZ 3
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
a_OVER-TTJE.COUNTER
ZrBUILIDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for'"
existing building(s). Demolition permit is required prior to issuance of buildin
permit for new building.
❑ EXPRESS
❑ PLA,NNINGPLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ sT#NDARD
❑ 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
El MAJOR
Cl SANITARY SEWER DISTRICT
submittal Of Building Permit application.
i
❑ ENVIRONMENTAL IJEALT1J
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 19191 vallco pkwy
FEE
DATE: 11 1/2013
REVIEWED BY: MENDEZ
APN:
BP#: 3
`VALUATION: 1$7,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
hrs
PENTAMATION 1GENCOM
I PERMIT TYPE:
WORK
a le- install 2 doors with card readers on 2nd floor to create secure area
SCOPE
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
nistrirt_ ote )_ Thoso fooc aro ha.ced an tho nreliminary intarmatian availahle and are only an estimate_ Cantart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-051 Eff 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? C) Yes Q No
$0.00
2 hours
$278.00
Plan Check, Hourly
1STPLNCK
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? C) Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Co ns(r °chin 1`tc -'
A'Jinill strata(° Fec:
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure 0
i
fr<:rbd` i�r�c°2rr�Ect/� tirrrr°`err�z;�:
Strong Motion Fee: IBSEISWCO
$1.58
= hrs
$417.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
STJ$TCITALS;
$2.58
$695.00
, "TOTAL FEE:
$697.58
Revised: 10/01/2013