13080038 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 5 INFINITE LOOP CONTRACTOR:NOVO CONSTRUCTION PERMIT NO:13080038
OWNER'S NAME: APPLE COMPUTER INC 1460 O'BRIEN DR DATE ISSUED:08/06/2013
OWNER'S PHONE: 415710063 MENLO PARK,CA 94025 PHONE NO:(650)701-1500
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class/ Lie.# 79 1 ® T.I.PREP ON 3RD FLR,SOUTHWEST WING
ContractorJylf(e' t �*odri ,uz:• " i Date 3
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:$90000
liave 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:31602109.00 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 a R34IIT 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 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
with all non-point source regulk tions per th Cupertinq Municipal Code,Section
9.18.
RE-ROOFS:
Signa -Date 3 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. 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 I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal C de,C apter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533 n 4.
Section 3700 of the Labor Code,for the performance of the work for which thisate:
permit is issued.
Owner or authorized agenf
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 5 INFINITE LOOP DATE: 08/06/2013 REVIEWED BY: MELISSA
APN: 316 02 109 BP#: "VALUATION: 1$90,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1TIPRE i
WORK ��EP ON 3RD FLR SOUTHWEST WING
SCOPE
�Lfach.Plan Check Plusrh.Plun Check Elec.Plan Check
Fl_fc1, Perwil Fee: Plumb.Permit Fee: Elec.Perrnir Fee:
Other Aiech.Lisp. Li I Other-Plumb Insn, Li Other Elec.Insp.
1tlech.Lnsp.Fee: Plzrrnb. Insp.Fee: Elec.Insp,Fee:
NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are onL an estimate- Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 # Tenant Improvement Prep
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $405.00 ITIPREP
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-(D Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C0nSt!-11CZi0n 147V:
Adininisr"ar ivC Hee: 0
Work Without Permit? Q Yes (j) No $0.00
Advanced Planning Fee. $0.00 Select a Non-Residential E)
Travel Documonztcation gees. Building or Structure 0
i
Strom Motion Fee: IBSEISWCO $18.90 Select an Administrative Item_-
Bld,�z Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $22.90 $405.00 TOTAL FEE: $427.90
Devised: 07/01/2013
L