B-2018-0935 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0935
19333 VALLCO PKWY CUPERTINO,CA 95014(316 20 076) NOVO
CONSTRUCTION INC
MENLO PARK,CA
94025
OWNER'S NAME:APPLE INC DATE ISSUED:07/06/2018
OWNER'S PHONE: PRONE NO:(650)701-1500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class @ Lic.#221922
Contractor NOVO CONSTRUCTION INC Date 02/2812019 X BLDG X ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
ADD(N)52 TON CHILLER WITH ASSOCIATED PIPING;(N)10'4'
I hereby affirm under penalty of perjury one of the following two declarations: ROOF SCREEN;(N)400 AMP DISTRIBUTION PANEL;(N)
L I have and will maintain a certificate of consent to self-insure for Worker's CHAMBER;(N)COMPRESSED AIR,DEIONIZED WATER,
Compensation,as provided for by Section 3700 of the Labor Code,for the CONDENSATE DRAIN PIPING
performance of the work for which this permit is issued,
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
permit is issued. Sq.Ft Floor Area: Valuation:$700000.00
APPLICANT CERTIFICATION
I certify that I have read this appllcatlon and state that the above
Information Is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 20 076 A(Tenant Improvemems),A(Tenant Improvereents),A
representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant bnprovements),A
Inspection purposes.(We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A
City of Cupertino against Ilabies,j�dgmenis,costs,and expenses which (Tenant Impmvemmts),A(Tenant Improvements),A
may accrue again Carty In co iseq once of the granting of this permit. (Tenant Improvements),A(Tenant bnprovements),A
Additionally,the ca t un erstands and III comply with ail non-point (Tenant Improvements)
source re tion er a pertino MunicI al Code,Section 9.18.
Slgnaf
DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that 1 am exempt from the Contractor's License Law for one of the
following two reasons: Issued by:SEAN HATCH
L I,as owner of the property,or my employees with wages as their sole Date:07/06/2018
compensation,will do the work,and the structure is not intended or offered for
<a1e_(.erS 7044, sa&Prnfecsiona Cod, RE-ROOFS:
x. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is
contractors to construct the project(Sce.7044,Business&Professions Code), installed without fust obtaining an inspection,I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations: inspection,
r. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,m provided for by Section 3700 of the Labor Code,for the Signature of Applicant:
performance of the work for which this permit is issued. Date:7,6.18
x. 1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Cade,for the performance of the work for which this ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
permit is issued.
s. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE
shag not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California.If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534.I will
exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(x)should I store or handle hazardous
be deemed revoked. material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as4the
e Be Area Air Quail Management District I
APPLICANT CERTIFICATION will maintain compperp oM c pal Code,Chapter 9.12 and
I certify that I have read this appllcatlon and state that the above information is the Healtde Secti s 5,25533,and 2 534.
correct.I agree to comply with all city and county ordinances and state laws
relating to building construction,and hereby authorize representatives of this cityto enter upon the above mentioned property for inspection purposes.(We)agree Owner or authorizto saveindemnify and keep harmless the City of Cupertino against liabilities, Date: 6 8judgments,costs,and expenses which may accrue against said City In DCconsequence of the granting of this permit.Additionally,the applicant understands I hereby affirm thatnst ctlon lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is ssued(Sec.3097,Civ C.)
Code,Section BAB. Lender's Name
Lender's Address
Signature Date 7.6.18
ARCHITECT'S DECLARATION
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0935
19333 VALLCO PKWY CUPERTINO, CA 95014 (316 20 076) NOVO
CONSTRUCTION INC
MENLO PARK, CA
94025
OWNER'S NAME: DATE ISSUED: 07/06/2018
OWNER'S PHONE: PHONE NO: (650) 701-1500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. #791022
Contractor NOVO CONSTRUCTION INC Date 02/28/2019 X BLDG X ELECT X PLUMB
_
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X MECH RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
ADD (N) 52 TON CHILLER WITH ASSOCIATED PIPING; (N) 10'-0"
�- I have and will maintain Worker's Compensation Insurance, as provided for by CHAMBERS - ISSUED 1/14/19
Section 3700 of the Labor Code, for the performance 'of the work for which this
permit is issued. Sq. Ft Floor Area: Valuation: $700000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction, and hereby authorize 31620076 A (Tenant Improvements),A (Tenant Improvements),A
representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A (Tenant Improvements),A
inspection purposes. (We) agree to save indemnify and keep harmless the (Tenant Improvements),A (Tenant Improvements),A
City of Cupertino against liabilities, judgments, costs, and expenses which (Tenant Improvements),A (Tenant Improvements),A
may accrue agai id City, i consequence of the granting of this permit. (Tenant'Improvements),A (Tenant Improvements),A
Additionally, th applic nt d rstantlaan will comply with all non-point (Tenant Improvements)
source Code, Section 9.18.
PERMIT EXPIRES IF WORK IS NOT STARTED
Signatur Date 1/14/19 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
O L ER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby f m that I am exempt from the Contractor's License Law for one of the
following two reasons: Issued by: SEAN HATCH
1. I, as owner of the property, or my employees with wages as their sole Date: 07/06/2018
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code) RE-ROOFS:
2. I, as owner of the property, am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed. If a roof is
contractors to construct the project (Sec.7044, Business & Professions Code). All
without first obtaining an inspection, I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations: inspection.
1. 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 Signature of Applicant:
performance of the work for which this permit is issued. Date: 1/14/19
2. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If, after making this certificate of California Health & Safety Code, Sections 25505, 25533, and 25534. I will
exemption, I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous
be deemed revoked. material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay ea Air Quality Management District I
APPLICANT CERTIFICATION will maintain compliance with the C erti o Municipal Code, Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health & Safety Code Sect' s 25505, 25533, and 25534.
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 Owner or authorized agent-
to save indemnify and keep harmless the City of Cupertino against liabilities, Date: 1/14/19
judgments, costs, and expenses which may accrue against said City in CONS RUCTIONE D AGENCY
consequence of the granting of this permit. Additionally, the applicant understands I hereby affirm that there i n ruction lending agency for the performance
and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this perm is issued (Sec. 3097, Civ C.)
Code, Section 9.18. Lender's Name
Lender's Address
Signature Date 1/14/19
ARCHITECT'S DECLARATION