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13010060 :CITY OF CUPERT,INO'BUILDING PERMIT
,BUILDINGYADDRESS: :10435`N TANTAU AVE CONTRACTOR:NOVO-CONSTRUCTION PERMIT.NO:.13016066
OWNERS NAME; APPLE INC- 1460 O'BRIEN�DR DATE ISSUED:0ll15ZN0,
'OWNER'S PHONE.- 4089338836. MENLO PARK,CA 94025 PHONE NO:(650)701-1500
❑"d v LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTIONS RESIDENTIAL Ll COMMERCIAL
License-Class) ic.;#- . j(�Z2 APPLE- IST FLOOR-COMM T.I REPLACE FINISHES AND
LIGHT FIXTURES,RE_LOCATE-POWER FOR LAB
Contractor. D'afe BENCHES
.I herebyaffirm that°I am,licensed underthe provisions^of"Chaptef--9
,(commencinggwith,'Section•7000)of Diyision,3;6f the Bu-sioess'&Professions
Code and'tfiat my'license iii4n full force and effect.
LFier"' ,
etiyrtaffir►n under p"enalty ofperjuryone;of the,followinggtwo,declarations:
'I have and;wdl`maintain a ceiiifcate of.consentito:self;insure.'f6fW6rker'"s
Compensatioh,as.provided:for by Section 370ftf the Labor Code,for the
performance of.'thework'for which this permlt:isassued_ Sg.Ft Floor.Area: Valuation:'$3.7442.5
:I have and;will,maintam'Worker s Conipensation:Insurarice�as�provided,for by
Section,3700 of,the;Labor'Code;for the performance of the work for which this
APN Number:31606039 QO Occupancy Type:
ermit is;issued.
APPLICANT CERTIFICATION
I certifythat'I have read this,applieation and state that the above information is, PERMIT'10PH2ES IFVORK IS`NOT STARTED
correct I agree to;comply with all city and,countyordinances�and'state'laws relating
upon the above mentioned property for msrieci onrerepresentatives of t)is c� to,enter WITHIN 1F OM MLAST
T CED INS EC I,OR
to buildm construction and hereb `au ty PERMIT
indemnify and keep harmless-therty'f of P purposes:• (We)agree toasave 1'g�DA ON
f Cupertino against liabilities;judgments, _
costs andexpenses which may accrue against said City inconsequence of the C
raniin ofthispermit Additionally;the appiicant.understands and,will comply Issued by: Date:'�,�.J�
: g g Additionally', .
with allwnon�point•source'regi lations,per the.Cupertino Municipal Code,Section
9:18:.4
jj RE ROOFS:
Signa-ture:' Date: ll` 1< All roofssshall be;inspected�pnor to any roofing;material being:installed-°lf a roof is
installed w�thout.first�obfainingan inspection„I agree to.remove all new materials:for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature•of Applicant: Date:
I hereby•affitmrthat I am ezenipt:from the Contractor's License.'Law forone of
the folloiMn'gtwo reasons: ALL ROOF,CO}ERINGS'TO BE CLASS'A”OR:BETITR
1,as�owner of the' ro e
p p rty,;ormyemployees.wrth wages;as theirsole.compensation,
will do:the;woik;and.the structure is:Mt intended or'off&red for saJe1(Sec,7044,
Business&Professions Code)
I,as owner of the,property,am'exclusively contracting with�licensed contractors'.to HAZARDOUS'MATERIALS DISCLOSURE
construct the p-6ctj(Sec.7044;.Business&,Professions Code). I`have read the hazardous€materials requirements under Chapter-:6.95 of:the
California Health&Safety Code;'Seciions255-05,.25533;and 25534."I will.
I hereby_,aftirm under penalty oGperjury one;of_the_followingahree maintain"compliance:with the Cupertino Municipal Code,Chapter 9.12•and the
declarations: Health&;Safety,Code,,Section:25532(a),sh-ould'l store or handle hazardous
I have,and.will;maintainia Certificate of Consent,to,salf-insure"for Workers material.,Additionally,•should`I',use equipment:or devices which emit hazardous
Compensation as:provided,", rr.byiSection 3,7,OO of the Labor Code;forthe air contammants_as defined by the Bay Area.AirlQuality 111aoagement:District I,
performance of the wo&,foi which;this,pe-mit:is issued. will maintain compliance with the,Cupertino Municipal Code;Chapter 9.12 and "
.I have an-d wilhmaintain'Workers,Compensation,lnsurance,,,as provided for by the Health&'Safety Code;Sec tions,25505,25533; 4:25534.
-Section 3700ofthe;Labo[Code for the-performance ofthe.workfor'which`this r� 3
.permit is issued
Owner(or authorized agent:. Date
'I cemfy,that in the performance.ofahe�work-for-wliich'this permit is'i'ssued,I,shall �--
,not employ any person m'anymanner so as to;become.subiectto.the Worker's
Compensation Iaws�ofCalifornia. if„after:making this:certificate ofexemption,I CONSTRUC-TION'LENDING.AGENCY. '
become s*w7to,the Workers Compensation,provisions"ofthe Labor Code,-I must ,lhereby`affirm that there is a,construction lendingagency1for the;performancel.of.
forthwitii!comply with suchprovisions or this peinfit`shall.be,deemed,revoked, work's for which;this permit;is�issued(Sec.309.7,CivC:).
Lender's+Name
APPLICANT CERTIFICATION Le
nder's�Address
I,certify:that I have read'thiscappllcation an&state[fiat=the'aboveuinformation is
correct.I'agree to c_omply,with7all cit-y�@i county ordinances and state,laws relating
tobuiiding,construction and herebyaat tho ize representatives,ofthis city i[wenter
upon the above mentioned;property.for;mspection„purposes.(We)agree to,,save
indemni 'and kee-iharrrile-ss°the Cit of Cu erfino a ainsi liabilities ud ments, ARCHITECT'S DECLARATION
fl P Y P g J. .g.-_
costs;;and,expenses'which maraccrue againsysaid City inconsequence of•the I understand myplans shall be used;as public records.
granting:ofthis'permit.:Additionally;the applicant-understands andwill comply
with all non=point source�regulations'per the+Cupertino M-tinicipalCode,Section 'Licensed Professional'
9.1$'. '
Signatiire Date,
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION OWE
10300 TORRE AVENUE•CUPERTINO,CA.9501.-3255 b
(408)777-3228 FAX(408)777-3333• build ngOcuperbno.orq.
CUPEFMNO
❑.NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#_
-PROl HCT.ADDRESS APN:#'
loy3'S i�r (-o Co U
OWNER NAME �} .� .- - _ - '-� PHONE'. EWAIL
PPLO G °� 5 qc) - R3s'- cliR J e_f RPcg:c�x.l
STREW'ADDRESS - CITY, STA'I'F,ZIP FAX
ni Fia�' fz w C vP Sc,i y
CONTACT NAME PHONE. E"-'NIA'IL '
STREET ADDRESS- - - - CII1 SIA'fE, -LIP FAX -
k r
❑OWNER ❑ OWNER-BUIL'DFR ❑ OWNER AGENT IPICONTWACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑F,NGINEFR ❑ DEVELOPER ❑TENANT
CONTRACTOR NANIE 49 .LICENSLNUMB L"R'7 .rozLICENSE TYPE BUS.J_IC-b
'z, .
-COMPANYNANIE� E40AIL
- v d"I L „
STREET ADDRESS CITY,STATE,.ZIP PFIONE
5IiM A5 $
ARCHITECT/ENGINEER NAME LICENSE'NUMBER,
COMPANY NAME E-b.IAIL FAX -
Sr c - a?t s JDlas
'tif- ADDRESS CI-r Y,$'IWTE,LIP PhION1-: - - -
>5'
DL"SCRIPTIONOF WOR
V'f— LAB Si- icy
?EXISTING USE - PROPOSED USE' - CON'STR;1',1'PE N;STORIES� - -
LA,3 I Z usi, TYPE OCC SQ.FT VALL1A'1'ION(Z
L ,
EXIS'I'G NFIV'PLOOR' DEMO TO'r.AL -
AREA ,J ARIirA � AREA, NETARF. 73 z,-5
7-TiROOAI KI'TCFIEN OTHER .
RLiMODELAREA RENIODELARE,A REMODELAUA - ^
I'ORGFI'ARIiADI?CK AREA lYJ'I iV-UECklPORC.H r1REA GARAGEAREA-. QE'fACfl '
ATTACH
___..__..._._NG LI __.___.._—. .—...__O........S..F0..............__.._........_......_:_
—TOWELLING I'fS IS-A%SIiGONI)TIN I'1' ❑1'FS SEGON D'S'I'Olt l" ❑YfiS _
BEING ADDED'/ []NO' ADDITION? [:]NO
PRE-APPLICATION LIGATION ❑YES= Ih 1'ES.PROVIDECOPT'OF ISl'HI BLDG AIV E]YES, RE' 6Y; OT:AL VAI UQTIOM
PLANNING APPLfl E]No PL NNING'APPR01'.\L LF:'I=1'ER EICIIL r R IIQ\I E'.' E]NO , � �. "
37q_.f{ZS
13V my slgnalure b ID>�;,I ceriify'to'each of,the following: I am',tlie property owner orauthorike - the property owneCs beli:df. I have nead this
application and';the information I.have pmvided:is correct. Lhav'e read:the Description of Work ki", '' f is'accuratc. I agree to comply wish all applicable local
otdmances and,tate laws relating tO tiriilding,constrnlcuon 1 nhorize repres_entaliyes ol'CulZel.tl'no'.(o enter the above-identified properh for inspectionpm-poses.
Sigivaure:ofApi)licant/Agent: �" Date.
SUPPLEMENTAL INhORMAT„ION.FL .UIRI=D
T\'PC R0UTlNGcWJpv
New/SFD`OI'M IJItI taIl111yCllVCllingS' Appl1'for(Ie7110ht1(111 pel'lllll t01' ❑� OV I R THI COIIN;P.I R ❑ 13 f!'ll DIAGIP I}'�N RCV ICA1
existing building(s): D6bolition perillit is requiretbprior to Is9uance•ofbui121u1g r "_ o
a C ems'.,
Penult fol=�newl6uilding: ❑� E�Laiss r-' ❑ r i.nNNiNc revv RE�,IEN
Cominer"cial131dgsa ProvideAcorSS"pleted llazardous'Matcrials Disclosure D` sl>noytD I:u�ilrAvoais
Form'ifany Flazardous Matet.ials�are being",used as palit of this project. .
0. I >Hc F ❑ 1 IRE'DEVr.. .
_Copy of`Planning Approval Letter-or Meeting with Planliing;piior to
2, MAJOR, ' a 3❑� _NWARYSEW ER DISTRIC,T'
submittal oFf3uildin- Pernlit-,application. m
" rlN�, t�'Kien�t<I."uc�I rIi
Bladg pp_?0h/..d e revised 0012•I11,I
CITY OF CUPERTINO
FEE.ESTIMATOR,- BUI.LDING DIVISION
ADDRESS:.10435 TANTAU AVE, DATE: 0110912073' VIEWED BY: MENp.EZ
APN: BP#:' -VALUATION: $374;425
3 d/1��,
RERMITYPEB
Y T : uilding Permit PLANCHECK TYPE: Tenant Improvement
:PRIMARY_ PENTAMATION
Commercial Building, 1 B TI
USE: PERMIT TYPE:
WORK APPLE;.- 1ST FLOOR=COMM T:I REPLACE FINISHES AND LIGHT;FIXTURES RELOCATE,POWER'
SCOPE FOR,LAB BENCHES 0
TYPE OF TFLR AREA
OCCUPANCY TYPE: CONSTR.: s:fa PC FEES PCFEE ID BP FEES BP FEE ID
-B,(Tenant Improvements)
11-B.,j11 B,1V,V-B 4;405 $2,261.40. 1BTIPI;NCK $31573:45. IBTINVSP
TOTALS': 4,,405 $2,261.40r $3,573.45
MiECI HOI�TRI;Y ��,9Yes=��li; y PLUMB;HOURI I' `Q Yes Q o ELECT;HOURLY ,2 2
® Yes •�No
%tileclr:,!'lrfn,('beck F'hrn`ih. Ylr,Jr, Chet-'.ti° Eli�c...Pfan('heck
-• 11�u;h. 1'urrrii_f�i�c>.. f'rrrvrr`,>, i? rr+ii;Fac: /!c ..pi�rmlC/-r�,
C�tI,F, l9ech.1n�]': Oj/wr N.urzf;lnsli. 011ier El ^.fnsna
l Lerch .frzsh..Fye: 15hold. 11rsp, FCC" Eic" -,Ins,7- Fiec:
_NOTE: Thtsestimaie does}.notlficlude fees:due to other Departmenis fi.e.Planning,Public Wo_r'ks;,Tire;Sanitary SewerDisir'iet;School
District,ela .. These eesaare'based;on:ike relimii:a,_iii orindtion,aoailalle,and areonl yan.esdinate. Contact the De tjor addn.'l in`o. .
FEE ITEMS(Fee Resolution 11-051 L f-711,/1'2)_ FEE QTY/FEE MISC,ITEMS
Plan Check Fee: ;$2,261.40 Select a Misc Bldg/Structure
Suppl. PC Fee- , Reg. OT "Q0, $0.00
or Element.of a Biuilding
PME,Plan'Qheck:, $0.00
Perniit Fee; $3,573.:45 `
Suppl. Insp.Fee:E).Reg. Q OT 0.0 hrs $.0.00
PME7 Unit Fee-:: $0:00
PW Permit Feer $0.00
['cinslr rT Won.Z.iu:
fl Lirrinistratiy��f"ree.'
Work.Without.'Perrnit? 0 Yes (j)-No $0.00
Advanced°Planning Fee: $0.00- Select a Non-Residential
Ti-uO)ocrrtrrentution f'tcrs: Building.or Structure ©'
Strong.Motion Fee: IBSEISMICO $78:.63 Select an.Administrative Item.
Bldg,Stds,Co'minission Fee:, IBCBSC $1,5:00
SIIB ®TS `
IRMO
n 5TOTALFEE $ ;928:48X5;928.48 $0:00T
Revised: 10/0112012
B,uilding,]),ep:i went'
Cty.QfCupertino..
".10300 Torre-, nue
Cupertino; CA 95014 3, '
Telephone408-7773228
"
CU P E RT 1 BV O . = - _ ;'• Fav 408-777 3333
~COlT�ZAC.�'OR/'S�J�C®l '� iCTOR DIST.:
- t
J.O$ADDRESS:` ) y..31 PER T#.
O.WNER'S NAME P .& - PHONE,#
GENERAL CONTRACTOR
ADDRESSCITY/ZIPCODEr Vb
tour municipal code.re'quires.all:business6s.Workin-g4n tkxityto have a-(06of Cupertino business license:
No- BUILDANQ--TINAL OR' FINAL OCCUPANCI'. I,NSPECTION(S) WILL BE SCITEDULED UNTIE.THE._, `• ,;
GENERAL,CONTRACTOR,AND ALLY SUBCONTRACTORS HAVE OBTAINED A."'CITY` OF..CUPERTINO'
BUSINESS.LICENSE: ' -
I am not using any`subeontract'ors - -
°q - Signature,. ..Date;:
-Cease check applicakile sulicontractors'and,complete 11w.161lowIng informafion r °
✓ . ;SUBCON:TRACTOR- ' B17SINESS NAIVIE B'USIN E
:ESS LICENS #
Cabinets -1Vhllwork
2 '
Cement -s ing:
Electrical` CA,.0c)
Excavation -
Fencing Y -
Flooring_/„Carpe'tingz:
Lin+oleum'%
Glass/Glazing) .�
Insulation v� -
• . - • - Landscaping:. _ ;- .a _ . {., . .
Paintin” T ill aye"r �_
V
Paving
Pla_sterrg
y y...
Pluinbing ,; =�I L 1,' -77
Roofing �
Septic Tank
Sheet Metal �• ;
i Sheet Rock :/„`;o�9 Yl w s
Tile ,
- Owner'/,'Contractor Signatare- .. Da_te _• _
