15010107 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19333 VALLCO PKWY CONTRACTOR:DEVCON PERMIT NO: 15010107
CONSTRUCTION INC
OWNER'S NAME: APPLE INC 690 GIBRALTAR DR DATE ISSUED:01/21/2015
OWNER'S PHONE: 4089745951 MILPITAS,CA 95035 PHONE NO:(408)942-8200
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
BLDG C- 1S FLOOR-CONSTUCTION OF REINFORCED
License Class CA- (�;, L Lic.# 9e)l(v-7i CONCRETE PIT FOR FUTURE EQUIPMENT UNDER
Contractor
4 -.-Date 2c ttj PERMIT#
pts�c n r�S �.o�i 15010061
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:$70000
�i 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"f'ype:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT E RES] R IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 AYS Off' PE 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 LAS LLED 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 by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
2l 1 S RE-ROOFS:
Signature Date i 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
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. 1 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 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,Section 5 _,25533 25534.
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,1 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 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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 19333 Vallco Pkwy DATE: 01/21/2015 REVIEWED BY: Sean
APN: BP#: 15010107 VALUATION: $70,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARYPENTAMATION
USE: Commercial BuildingT PERMIT TYPE: 1GENC0
WORK BLDG C-1ST FLOOR CONSTRUCTION OF REINFORCED CONCRETE PIT FOR
SCOPE FUTUREEQUIPMENT UNDER PERMIT #15010061
NOTE: This estimate does not include fees due to other Departments(i.e. 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 De t or addn'l in b.
FEE ITEMS (Fcc Rcsohmon I1-053 Elf: 7/,1-3 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes No $0.00 F--17 hours Plan Check, Hourly
Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $143.00 ISTPLNCx
A
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes (j) No $0.00
Suppl. Insp. Feer Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
F71
0
Work Without Permit? 0 Yes 0 No $0.00 0
Ad\ancedPlanniim., ec: $0.00 hours Inspections 0
$429.00 ISTINSP Inspection, Hourly 0
Strom—, Motion Fee: IBSEISMICO $19.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $3.00
SUBTOTALS: $22.60 $572.00 TOTAL FEE: $594.60
Revised: 01/0612015