11040031CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10200 N TANTAU AVE FLR 1 -2 I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 11040031
ONVNER'S NAME: APPLE INC. 1 4025 BOHANNON DR I DATE ISSUED: 06/06/2011
f '— 4ER'S PHONE: 4088620902
L LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #T((y_22- Z
Contractor C.ONSP?U070IU Date CD &
I 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.
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 S
Compensation, as provided for by Section 3700 of the Labor Code, for the
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.
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 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,
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 - points urce ulations per the Cupertino Municipal Code, Section
9.18.
Signature Date / ( -�A
OWNER - BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
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.
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.
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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 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,
costs, and expenses which may accrue against said City in consequence of the
ting of this permit. Additionally, the applicant understands and will comply
all nun -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature
Date
MENLO PARK, CA 94025
PHONE NO: (650)701 -1500
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH'I— RESIDENTIAL r- COMMERCIAL
JOB DESCRIPTION: FLOOR I & 2 - COMMT TI(54,900SQFT) INCLUDES
MECHANICAL /ELECTRICAL /PLUMBING & STRUCTURAL. SITE
ADA UPGRADES & RESTROOM UPGRADES & NEW ROOFTOP
Sq. Ft Floor Area: Valuation: $5000000
APN Number: 31619061.FLR1 -2 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bv�� Date: o'
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Appl
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
O}yt,Z!r a horized agent: t
j
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO BUILDING PERMIT t -� . - G�
BUILDING ADDRESS: 10200 N TANTAU AVE FLR 1-2 CONTRACTOR:NOVO CONSTRUCTION PERMIT NO: 11040031
OWNER'S NAME: APPLE INC. 1460 O'BRIEN DR DATE ISSUED:06/06/2011
i
OWNER'S PHONE: 4088620902 MENLO PARK,CA 94025 PHONE NO:(650)701-1500
LICENSED CONTRACTOR'S DECLARATION F
BUILDING PERMIT INFO: BLDG' ELECT PLUMB
License Class Lic.# r
MECH RESIDENTIAL COMMERCIAL
Contractor ���Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FLOOR 1&2 -COMM'L TI(54,900SQFT)INCLUDES
(commencing with Section 7000)of Division 3 of the Business&Professions MECHANICAL/ELECTRICAL/PLUMBINGUPGRASTRO &STRUCTURAL.SITE
Code and that my license is in full force and effect. ADA UPGRADES&RESTROOM UPGRADES&NEW ROOFTOP 9/29/2011-REV#1-
ACCESSIBILITY CHANGES TO FRONT RAMP,ADD ELECTRIC CAR CHARGING
I hereby affirm under penalty of perjury one of the following two declarations: STATION-12/10/12 REVI ISS'D
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.
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:$5000000
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 and state laws relating APN Number:31619061.FLR1-2 Occupancy Type:
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,
costs,and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section WITHIN 180 DAYS OF PERMIT ISSUANCE OR
9.18. 180 DAYSFROMLAST CALLED INSPECTION.
Signature Date
Issued by: a Date. a
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: RE-ROOFS:
I,as owner of the property,or my employees with wages as their sole compensation, All roofs shall be inspected prior to any roofing material being installed.If a roof is
will do the work,and the structure is not intended or offered for sale(Sec.7044, installed without first obtaining an inspection,I agree to remove all new materials for
Business&Professions Code) inspection.
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: Date:
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I certify that in the performance of the work for which this permit is issued,I shall Additionally,should I use equipment or devices which emit hazardous air
not employ any person in any manner so as to become subject to the Worker's contaminants as defined by the Bay Area Air Quality Management District I will
Compensation laws of California. If,after making this certificate of exemption,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
become subject to the Worker's Compensation provisions of the Labor Code,l must Health&Safety Code,Sections 25505,25533,and 25534.
forthwith comply with such provisions or this permit shall be deemed revoked. O! 'o•author}'a�d a ent:
_�® Date: 2 /e
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of«ork's
upon the above mentioned property for inspection purposes.(We)agree to save for which this permit is issued(Sec.3097,Civ C.)
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Name
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply Lender's Address
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ARCHITECT'S DECLARATION i
Signature Date I understand my plans shall be used as public records.
Licensed Professional
I
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10200 N TANTAU AVE DATE: REVIEWED BY: LARRY S
APN: BP#: VALUATION: Iso
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Buildin PENTAMATION 1 B TI
USE: __Tg PERMIT TYPE:
WORK REVISION TO PLANS-ACCESSIBILITY CHANGES TO FRONT RAMP ADD ELECTRIC CAR
SCOPE CHARGING STATIONS
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. L
B (Tenant Improvements) II-B,111-B,IV,V-B 1 $1,912.00 IBTIPLNCK $536.00 1BTIINSP
i
TOTALS: 1 $1,912.00 $536.00
MECH,HOURLY 0,Yes (E) No PLUMB,HOURLY QYes Q No ELEC,HOURLY 0 Yes (D No
NOTE. This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.).
Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(f. 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,912.00 Select a Mise Bldg/Structure
Suppl.PC Fee: (F) Reg. 0 OT 0.0Ehrs $0.00 or Element of a Building
PME Plan Check: $0.00 �2 # Alternative Energy System
Permit Fee: $536.00 $200.00 ICHRGSTA EV Charging Station
i
Suppl.Insp.Feer Reg. 0 OT ro.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
i
`rt7dslr'tki'f7L17t Tax
F I
i
Work Without Permit? Q Yes E) No $0.00
Advanced PIanning Fee: $0.00 Select a Non-Residential
Building or Structure
i"F`3F ! 1. L)1.) 7,{• �7LfT) L !S, r�r�.. �` ,
Strom Motion Fee: $0.00 R vision
Bldl>.Stds Commission Fee: $0.00 $0,00
IREVSFDWL SFDWL
SUBTOTALS:' $2,448.001 $200.00 TOTAL FEE: 2;4' -Oq r
Revised: 09/02/2011
i
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION t
ADDRESS: 10200 n.tantau ave. 1st&2nd DATE: 04/05/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $5,000,000
'"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 B TI
USE: PERMIT TYPE: t
WORK [t.i comm. offices ace structural MEPs. Exterior access. upgrades.
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-A,111-A,V-A 54,900 $6,899.93 IBTIPLNCK $24,500.87 1BTIINSP
TOTALS: 54,900 $6,899.93 1 $24,500.87
MECH,HOURLY 0 Yes E) No PLUMB,HOURLY 0 Yes Q No ELEC,HOURLY Q Yes Q No
ii,w,
E3
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS Tee Resolution 09-OSI Eff. 7/1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $6,899.93 Select a Mise Bldg/Structure
Suppl.PC Fee: G Reg. 0 OT0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $24,500.87
Suppl.Insp.Feer Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes G No $0.00
Work Without Permit? 0 Yes G) No $0.00 G
Platming Fee: $0.00 Select a Non-Residential
Building or Structure 0
Strong Motion Fee: IBSEISMICo $1,050.00 Select an Administrative Item
Bld€,,Stds Commission Fee: 1BCBSC $200.00
SUBTOTALS: 32,650.80 $0.00 TOTAL FEET $32,650.80
Revised: 01/15/2011