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14080250 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1 INFINITE LOOP CONTRACTOR:XL CONSTRUCTION PERMIT NO: 14080250 OWNER'S NAME: APPLE COMPUTER INC 851 BUCKEYE CT DATE ISSUED:08/27/2014 OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)240-6000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] T.I PREP FOR ILI (NORTH-FIRST FLOOR)(4112 SQ License Class Lien# 071qQyX1_J1 FT). Contractor IL(,(}N�j't`U,'t�V(" Date l 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: Valuation:$16000 BM 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:31602105.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 18 A ��Ir 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 D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgm costs,and expenses which may accrue against said City in consequence of t Z granting of this permit. Additionally,the applicant understands and will comply Issued b ate: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. U RE-ROOFS: Signature yi � j� _ 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. ❑ 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 1 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: =U Date:( ?-711 q permit is issued. 0 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTIN© na (408)777-3228• FAX (408)777-3333•buildingcupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS APN# 6 i6 OWNERNAME /V PHONE fO) �r inlo 10 E-MAIL STREET ADDRESS % CITY, STAiEZIP � FAX CONTACT NAME PHONE �.. E-MAIL u b� S 01„ ap P/C . STREET ADDRESS CITY,STATE, ZIP FAX ri til N f. 0 a N t C ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACPOR NAME LICENSE NUMBER LICENSE TYPE BUS LIC# COMPANY NAME E-MAIL " FAX (� �c&4 be aeA7 hM Y eG� Gv�., epi r STREET ADDRESS .� CITY STATE,ZIP PHONE + ARCHITECT/ENGINEER NAME LICENSE NUMBER 6 BUS LIC# COMPANY NAME E-MAIL FAX 6 31 AP00 HtV11- n, d C- STREET ADDRESSCITY,STATE.ZIP PHONE DESCRIPTION OF WORK + I Dt- G yT �✓D2 EXISTING USE PROPOSED USE/ CONSTR.TYPE #STO S I USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA /�1 i'� NET AREA BAT[iROOM KITCHEN (�1 OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL.DECK-ORCH AREA GARAGE AREA DETACH ❑ATTACH #DWELLING UNITS IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIV Y: T114 AL VALUATION: PLANNING APDL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �. D By my signature below,I certify to each of the following I am the property owner or authorized agent to act on the property owner's behalf, I havdfread this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build g construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: . Date: SUPPLEMENTAL I FORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE-COUNTERBUILDING PLAN REVIEW 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 ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGEFIRE DEPT ❑ Copy,of Planning Approval Letter or Meeting with Planning prior to MAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoe revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 1 Infinite Loop DATE: 08/26/2014 REVIEWED BY: Sean APN: BP#: jI a 'VALUATION: $16,000 r�PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY Commercial Building PENTAMATION 1TIPREP USE: PERMIT TYPE: WORK T.I Prep for 11_1North - First Floor . SCOPE ET-t- NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the Dept Lor addn'1 in o. FEE ITEMS Lee Resolution I1-053 Elf 7,1%131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Tenant Improvement Prep Suppl. PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 $417.00 ITIPREP PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes (j) No $0.00 D Advanced Planning Hee: $0.00 Select a Non-Residential E) Building or Structure Strong Motion Fee: IBSEISMICO $4.48 Select an Administrative Item BldgStds Commission Fee: IBCBSC $1.00 SUBTOTALS: $5.48 $417.00 TOTAL FEE: $422.48 Revised: 07/10/2014