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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 _• _