13100017 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 2 INFINITE LOOP CONTRACTOR:XL CONSTRUCTION PERMIT NO: 13100017
OWNER'S NAME: APPLE COMPUTER INC 851 BUCKEYE CT DATE ISSUED: 10/25/2013
OWNER'S PHONE: MILPITAS,CA 95035 PHONE NO:(408)240-6000
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMMERCIAL
License Class_ Lic.# b L �` APPLE(IL2-IST FLOOR):MICROWAVE LAB TENANT IMPROVEMENT
(5247 SQ FT).
Contractor k1 r��Ysi9��ate �? O REVISION#1-REVISE FIRST FLOOR MICROWAVE LAB-ISSUED 12/10/13
1 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:$1450000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for theperformance of the work for which this APN Number:31602106.00 Occupancy Type:
permit is issued.
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 DAYS OF 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 DAYS FROM ED 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 Is Date: �2 D
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date /Z /O /� All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,l agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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. 1 will
II 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
1 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 25505,2 nd 5
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 1 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT^BUILDING DRB00N
10300 TORRE AVENUE^CUPERTINO,CA 95014-3255 (A La '� '_�
C UPERTINO (408)777-3228^FAX(408)777-3333^building(a)cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑X REVISION/DEFERRED ORIGINAL PERMIT# 13 100017
PROJECTADDRESS 2 Infinite Loop APN#
OWNER NAME Apple Inc PHONE 408 . 996 . 1010 E-MAIL
STREETADDRESS 1 Infinite Loop CITY, STATE,ZIP Cupertino, CA 9501 FAX
CONTACT NAMEDavid Schaefer PHONE 408 .240 . 6000 E-MAIL
dschaefer@xlconstruction.com
STREET ADDRESS 851 Buckeye CT CITY,STATE, ZIP Milpitas, CA 95035. FAX 408-240-600
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME David S chae f e r LICENSE NUMBER 647480 LICENSE TYPE B BUS.LIC a 21836
COMPANY NAME XL Construction E-MAIL dschaefer@xlconstruction.com FAx408 .240 . 6001
STREET ADDRESS 851 Buckeye CT CITY,STATE,ZIP Milpitas, CA 95035 PHONE 408 .240 . 6000
ARCHITECT/ENGINEER NAME David Saba lvaro LICENSE NUMBER C-015925 BUS.LIC#
COMPANY NAME Studios Architecture E-MAIL swinchester@studios.com FAX
STREET ADDRESS 405 Howard St, STE. 588 CITY,STATE,ZIP Pacifica, CA 94044 PHONE 415-3 9 8-7 5 7 5
DESCRIPTION OF WORK Revisions to the First Floor Microwave Lab Tenant Improvement.
EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES
Office&support Functions Office 6 Support Functions B - Office 1 USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOORDEMO TOTAL
AREA 5,247 AREA 5,247 AREA 5,247 NET AREA 5,247
BATHROOM KITCHEN OTHER
REMODEL AREA N/A REMODEL AREA N/A REMODEL AREA N/A
PORCH AREA DECK AREA±..IG
TAL DECKRORCH AREA GARAGE AREA: DETACH
N/A N/AN/A N/A ❑ATTACH
#DWELLING UNITS: "SECOND UNIT ❑YES SECOND STORY ❑YES
N/A I DED? NO ADDITION? ®NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY' TOTAL VALUATION:
PLANNING APPL# ®NO PLANNING APPROVAL LETTER EICHLER HOME? ®NO C _ $ 1, 450, 000
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 have read this
application and the information I have provided is correct. I have read th escription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I orize pre a ives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: ,7 J
SUPPLEMENTAL INFORMATION REQ RED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUILDING 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.
`LARGE FIRE DEPT
—Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp-2011.doc revised 06121111
CITY OF •C!;PERTINO
WERMIFEE ESTIMATOR— BUILDING DIVISION
T
DDRESS: 2 Infinite Loop DATE: 12/05/2013 REVIEWED BY: Sean
PN: BP#: 13100017 *VALUATION: $0
PE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION
USE: PERMIT TYPE:
WORK Revision#1: Revise mechanical layout and install fire proofing sealant.
SCOPE .
rltech. Plan Check Pltilnb. Plan Chock Elec:Plan Check
FWch.Permit Fee: Pbrmh. Permit Fee: Elec. Permit Tela:
Other Mech.1n.rP, 0/he:)-Plunsb Insp. L�� L - -OIher Elec.Insp.
Hech./nsp..Fee. Plumb. hap. Fee:: Elea Insp.Fee:
NOTE:This.estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the Det or addn'l info.
FEE ITEMS(Fee Resolution 11-053 Ef: 7t /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl.PC Fee: E Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. OT O Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax: El
f1(lrninistrative Fee:
Work Without Permit? 0 Yes (•) No $0.00 Q
Advanced.PlanningFee: $0.00 Select a Non-Residential O
"I'ravGl DocumentationF'eczs: Building or Structure
Strom Motion Fee: $0.00 1 # Revisions
Bldg Stds Commission Fee: : $0.00 $834.00 /REvcowi Tenant Improvement
SUBTOTALS: $0.00 $834.00 . TOTAL FEE: $834.00
Revised: 10/01/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 2 INFINITE LOOP CONTRACTOR:XL CONSTRUCTION PERMIT NO: 13100017
OWNER'S NAME: APPLE COMPUTER INC 851 BUCKEYE CT DATE ISSUED: 10/25/2013
OWNER'S PHONE: MILPITAS,CA 95035 PHONE NO:(408)240-6000
LICENSED CONTRACTOR'S DECLARA'T'ION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class % Lic.# 67 4/y Vg O APPLE(IL2-1ST FLOOR): MICROWAVE LAB TENANT
� IMPROVEMENT(5247 SQ FT).
Contractor F!L t�nJyrviGs�iaT� Date
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:$1450000
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:31602106.00 Occupancy Type:
permit is issued.
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 DAYS OF P 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 DAYS FRO SAS ALLED 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 Issued b Date: d 2tS
12
with all non-point source regulations per the Cupertino Municipal Code,Section
9.I8.
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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant; Date:
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 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 25505,255 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: _ Date
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(See.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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION U�
10300 TORRE AVENUE^CUPERTINO,CA 95014-3255
�4JPERTINO (408)777-3228•FAX(408)777-3333•buildin4(ftupertino.org \tl
❑NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION I TI ❑ REVISION I DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 2 Infinite Loop APN# 2 0 Zf V(0,
OWNER NAME Apple Inc PHONE 4 0 8 . 9 9 6 . 1010 E-MAIL
sTREET ADDRESS 1 I n f i n i t e Loop crrY, STATE,ZIP Cupertino, CA. 9501 FAX
CONTACT NAMEDavid Schaefer PHONE 408 . 240 . 6000 E-MAIL
dschaefer@xlconstruction.com
STREET ADDRESS 851 Buckeye CT CITY,STATE,ZIP Milpitas, CA 95035 FAX 408-240-6001
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME David Schaefer LICENSE NUMBER 6 4 7 4 8 0 LICENSE TYPE B HUS.LIC# 21836
COMPANYNAME XL Construction E-NL41L dschaefer@xlconstruction.com FAX 408 . 240 . 6001
STREET ADDRESS 851 Buckeye CT CITY,STATE,ZIP Milpitas, CA 95035 PHONE 408 . 240 . 6000
ARCHITECTIENGINEER NAME David Saba 1 v a r o LICENSE NUMBER C-015925 BUS.LIC#
COMPANY NAME Studios Architecture E-MAIL swinchester@studios.com FAX
STREET ADDRESS 405 Howard St, S T E . 588 crrY,STATE,zrP Pacifica, CA 94044 PHONE 415-398-7575
DESCRIPTION OF WORK Interior Tenant Improvement to non-structural elements of First
Floor Microwave Labs . /14-�,
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
Office s Support Functions Office 6 Support Functions B - Office 1 USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOORDEMO TOTAL
AREA 5,247 AREA S AREA 5,247 NET AMA 5,247 Gee 1A l�cll7
BATHROOM KITCHEN OTHER
REMODEL AREA N/A REMODEL AREA N/A REMODEL AREA N/A
PORCH AREA I DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: DETACH
N/A N/A N/A N/A []ATTACH
#DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY []YES
N/A BEING ADDED? N NO ADDITION? ®NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESRECEIVED Y: TOTAL VALUATION:
PLANNING ADPL# ®NO PLANNING APPROVAL LETTER EICHLER HOME? ®NO
$ 1, 450, 000
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 have read 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 building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: /O' /0/ Z /
SUPPLEMENTAL INFORMATION REQ D PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER T BUILDING PLAN REVIEWexisting 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 El PUBLIC PUBLIC WOR
form if any Hazardous Materials are being used as part of this project. El LARGE FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011,doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 2 infinite loop DATE: 1010112013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: 1$1,450,000
*PERMIT TYPE: Building Permit PLAN CHECK TY E: Tenant Improvement
]PRIMARY Commercial Building PENTAMATION 1 B TI
USE; I I PERMIT TYPE:
WORK apple-11_2- 1ST FLOOR- COMM. TI NON-STRUCTURAL
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-B,III-B,IV,V-B 5,247 $2,388.73 1BTIPLNCK $4,367.57 1BTIINSP
TOTALS: 5,247 $2,388.73 $4,367.57
MECH,HOURLY Q Yes (D No PLUMB,HOURLY C) Yes (F) No ELEC,HOURLY Yes (F)No
Xfmh. Flan Check Phanh. Plun Chock Elec..Plan Chuck
4tecli. Permit Fee: Plumb, Permit 1'ee: E'kx% Permit Fee.,
Other•,kfecrh.Insp. Ocher Plumb Insp, L1 Other Clec.Insp.
Hech.Insp./ire: Pluiub. hap. Fee: Clec,Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
DistrictetG . hese-feesTare based on the relimina information available and are onlyan estimate Contact the De t or addn'1 in o.
FEE ITEMS(fee Resolution 11-053 Ef 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,388.73 Select a Misc Bldg/Structure
Su 1. PC Fee: $0.00 or Element of a Building
PP � Reg. � OT 0.0 hrs g
PME Plan Check: $0.00
Permit Fee: Hourly Only? ()Yes Q No $4,367.57
Suppl. Insp. Fee-0 Reg. () OT [20-_01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction,ETY Ll
.Adinini•str•ative Fee: 0
Work Without Permit? 0 Yes (j) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
or Structure 0
1'1u�c}l Dvccunentutivn Fees: Building A
Strong;Motion Fee: IBSEISMICO $304.50 0.0 hrs Inspections
Bldp Stds Commission Fee: IBCBSC $58.00 $0.00 Inspection,Hourly
SUBTOTALS: $7,118.80 $0.00 TOTAL FEE: $7,118.80
Revised: 08/01/2013
BuHding Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR SUBCONTRACTOR MT
JOB ADDRESS: 9- PERMIT# /.?/000/7
OWNER'S NAME: /e PHONE# 4+or - 2 W
GENERAL CONTRACTOR: Y1- BUSINESS LICENSE#
ADDRESS: o g'/ ����e Cepa CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
ILIO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL HE SC1EI[IEl<DULIEI<D UNTIL T>EI[IE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPIERTINO
BUSINESS LICENSE.
I[am not using any subcontractors:
Signature )(Date
IEiease check appllicWe subcontractors and compete the ffoiiowing information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS ESS LI[CIENSIE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Keating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Conti on ' natu Date
0 01 1
i 0 0
Apple Subcontractor License �,'�
CONSTRUCTION
Subcontractor Cupertino Business License#
Accurate Firestop 34279 41
Canterbury Contractors 25647
Cupertino Electric 697
Daleys Drywall 26451
ICOM Mechanical 21800
Welker Bros. 25264
XL Construction 21836
HAZARDOUS MATERIALS CHECKLIST
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
��������® 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228^ FAX(408)777-3333 a buildingla cupertino.org
PURPOSE
To minimize possible delays that would result for the Fire Department plan review, please complete the
following checklist to determine if an additional level of Hazardous Materials plan review will be
required.
MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING?
PLEASE MARK YOUR ANSWER WITH AN 'X' IN THE YES OR NO BOX ON THE SIDE YES NO
BELOW.
1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases,
hazardous materials, etc.
2. Battery back-up rooms or racks.
3. Propane tanks.
4. Gasoline stations with underground tanks. X
5. Installation or replacement above ground or underground storage of liquid petroleum
products, liquefied petroleum gases, compressed natural gas, explosives or other X
regulated hazardous materials.
6. Gas rooms for dentist, doctors or veterinarians.
7. Generators with back-up diesel or other fuels. �t
8. Large refrigeration systems.
9. Fuel cell systems. Y_
10. Commercial pool systems.
11. Chemical Storage areas. X-
12. Flammable liquid storage.
13. Compressed Gases.
14. Dry cleaners. >�_
15. Print Shops.
16. Auto Repair and Auto Body Shops. >L
17. Research and Development.
For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa
Clara County Fire Department, at (408)378-4010.
HasMat 2011.doc revised 03/07/11