14100093 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19333 VALLCO PKWY CONTRACTOR:CUPERTINO ELECTRIC PERMIT NO: 14100093
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OWNER'S NAME: APPLE INC 1132 N 7TH ST DATE ISSUED:01/16/2015
OWNER'S PHONE: 4088088000 SAN JOSE,CA 95112 PHONE NO:(408)991-1000
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
�/�1 TEMP INSTALLATION OF GENERATOR LOCATED IN
LicenseClass L✓m Lic,N � —7 Li tD-Jl PARKING
Contractor�4'` O C xrLL�(,L�� Date l� LOT AREA
I hereby affirm that[am licensed under the provision of C pter 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:$65000
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:31620075.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I 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 180 DAYS 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 M LSA CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgmen I
costs,and expenses which may accrue against said City in consequence of
granting of this permit. Additionally,the applicant understands and will comply Issued Date:
with all non-poi urce regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed. If 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)
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. 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 2 5,255 d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this l
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,r 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 shalt 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
i GENERAL PERMIT APPLICA►ION ��'} E P
C0MMUNITY, DEVELOPMENT DEPARTMENT• BUILDING DIVISION'
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zpplicaiion and the info;,anon I have >ided 1 o _,e;ead the Desc-i7;ion of\ti'o-k and��e,-;y it is acc=ate. 12 ieo to co Dply vnd a!I zpplicabk local
ordiaanceS L-)d State laws relating t ,:I ,_c . I r ,-?-representatives of Cupe;.-ino to enter ane above-identi=,ed prope;- for Msec mn pu7poses.
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• h�!'hhsc�p�_201.7.docr_I,•'sed 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ai
DDRESS: 19333 VALLCO PKWY DATE: 10/16/2014 REVIEWED BY: MELISSA
PN: 316 20 075 BP#: `VALUATION: 1$65,000
PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY Commercial Building PENTAMATION 1 CEAP8
USE: PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE 1D QTY UNITS BP FEES
Generators 1 BREMPOWER 1 # $179
TOTALS: $179.00
Elec. Plan Check 0.0 hrs $0.00
Elec.Permit Fee: IEPERMIT
, ElOther Elea Insp. 0.0 hrs $48.00
�1'—h hi'l, icc Nnj;d'i hip
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NOTE: This estimate does not include fees clue to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School
District, etc). These ees are based on the preliminar information available and are only an estimate. Contact the Det or addn'1 info.
FEE ITEMS (Fce Resolution 11-053 Eff 7/1113) FEE QTY/FEE MISC ITEMS
"in C'fwc 7,!e
PME Plan Check: $0.00
PME Unit Fee: $179.00
PME Permit Fee: $48.00
C onslr w-l ior1 1 cls.
Administrative Fee: 1ADMIN $45.00
Work Without Permit? 0 Yes (j) No $0.00
Travel Documentation Fee: ITRA VDOC $48.00
Strong Motion Fee: IBSEISMICO $18.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $3.00
SUBTOTALS: $341 .20 $0.00 TOTAL FEE: 1 $341 .20
Revised: 0812012014