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14030104 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19333 VALLCO PKWY CONTRACTOR:DEVCON PERMIT NO: 14030104 CONSTRUCTION INC OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED:04/08/2014 OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)942-8200 90 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ g� INSTALLATION OF(1)TEMP CONSTRUCTION TRAILER. License Class 4� �`I� Lie.# Q Ff Contractor m! Date 1 hereby affirm that 1 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. 1 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:$1500 l 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:31620075.00 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 WITHIN0 AYS 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 DAY OM LAST CALLED INSPE ON. 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 by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date �4 46 ®4/ 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 1 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) 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 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 1 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,Sectio 55 ,255 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 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 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 ELI] COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE^CUPERTINO, CA 95014-3255 C4JPERTIP!® (408)777-3228^ FAX(408)777-3333^buildinc;Pculpertino.orgr� ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRES APN k IR e OWNERNAME PH a ® E-MAIL STREET ADDRESS a CI FAX CONTACT NAME PHONE E-MAIL O&!�194�� idlsdv__._ 0 STREET ADDRESS CTT ,S ATE P F ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA1,F LICB R� LICENSE TYPE BUS.LIC N COMPANY NAME E-MAIL FA me STREET ADDRESS Lgo IT',ST E, 1P P ! ARCHITECTIENGINEER NAME LICENSE NUMBER C4D 7,04, BUS.LIC 0 COMPANY NAME e E-MAIL ,J�/1FAX STREET ADDRESS �7 O Ci T E Z ]&E 7-7 DESCRIPTION OF WORK 11a li:w Ir EXISTING USE PROPOSED USE CONSTK TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: ISA SECOND UNIT []YES SECOND STORY [ YES BEING ADDED? ❑NO ADDITION? []NO 11 PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY- TOTAL VALUATION: PLANNINGAPPLH ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized ag' e n the property owner's behalf. I have read this application and the information I haverovi ed is rrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat o b Idin co s uction. I authorize representatives of Cupenino to enter the abo e-ide tified property for inspection purposes. Signature of Applicant/Agent: Date: 14- SUPPLEMENTAL , FO ATION RVIUIRED PLAN CHECKTYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OvP-THE-COUNTER , BUILDING PLAN REVIEW existing building(s). Demolition pen-nit is required prior to issuance of building .- permit for new building. EXPRESS ❑' PLANNING PLAN REVIEW ' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARID ❑ 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 to13MAJOR 13 SANITARY SEWER DISTRICT ' submittal of Building Permit application. "❑ ENVIRONIIIENTAL HEALTH " BldgApp_2011.doc revised 06/21/11 MY OF cCUP ERUNO FEE IES TMATOR— BUI LWNG ]Dff VffSffON ADDRESS: 19333 vallco pkwy DATE: 03/17/2014 REVIEWED BY: Mendez APN: BP#: �� `VALUATION: $1,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1GENCOMd WORK installation of 1 temp trailer SCOPE n Plvall, Pfim Chcc% Elec. Plan Check Phimh. Pc+%nil V"(:. 1s'lac. P""'il Fec:: Ull+crP1r,n+hlrst,. Other Elvc.Imp. Lj Elec.Imp.FCC: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are baser/on the relimina information available and are onlE an estimate. Contact the De t or addn'l info. ]FEE ITEMS (Fee Resolution 11-033 Ef" 7/f 1113} ]FEE QTY/FEE MMISC ITEMS Plan Check Fee: $0.00 0 # Temporary Structures Suppl. PC Fee: ) Reg. 0 OT 0.0 hrs $0.00 $417.00 ITEMPSTR PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes E) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) "1 t Building or Structure r-r.-e11)c,c r+�itF�;nfulic,rt .'�:'s: g d Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item B1d�z Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $417.00 TOTAL FEE: $418.50 Revised: 01/15/2014