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11020054 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10435 N TANTAU AVE FLR 2 CONTRACTOR:NOVO PERMIT NO: 11020054 CONSTRUCTION OWNER'S NAME: APPLE INC 4025 BOHANNON DR DATE ISSUED:03/24/2011 OWNER'S PHONE: 4089744876 MENLO PARK,CA 94025 PHONE NO:(650)701-1500 LICENSED CONTRACTOR'S DECLARATIONT� r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# Q___2_ r— r r MECH RESIDENTIAL COMMERCIAL Contractor ;)oyo z P,(wvw DateJOB DESCRIPTION:2ND FLR-COMM'L TI(1267SQFT)-MODIFICATION W/ASSOCIATED MECHANICAL,ELECTRICAL&FIRE 1 hereby affirm that I am licensed under the provisions of Chapter 9 PROTECTION WORK.INCLUDE 3 OFFICE CONVERSIONS TO (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$275000 1 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 �C APN Number:31606039.FLR2 Occupancy Type: permit is issued. APPLICANT CERTIFICATION J 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 PERMIT 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 FROM LAST CALLED 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 �2 granting of this permit. Additionally,the applicant understands and will comply Issued Date: with all non-pointsou regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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. I 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 whichthis permit is issued. will maintain compliance with the Cu ertin unicipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 05,2 3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 0 permit is issued. 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person inany 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,1 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 1 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 ZCITY1 02-- CITY OF CITY OF CUPERTINO TENANT IMPROVEMENT CUPERTINO PERMIT APPLICATION FORM "N # Date: Building Address: U u� Mailing Address (if different from building address): Tenant ❑ (If tenant please provide a letter from the building owner approving the tenant improvement.) Building Owner ❑ Are Hazardous Materials being used as part of this project? Yes D No Tenant/Building Owner's Name: Phone#: 4k q-1 Contractor: Phone#. 654.4-7o• wnyn Fax#: Cupertino Business License: State Contractor License#: Contact:-16*,O ROLL.-5 Phone#: 650.365.0600 x i 1 Fax#: 5. Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less,compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft.,a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Job Description(be specific):►rriljiog -1r= IP.)`KT IMP /MopIF1C f1ot�IS W/a p p M-CA^916N- , MWF604- , F, MPT—E FROJEC neN WORK. it yCL LAM 3 OF-r— CoWwv-,--1 oNs To 2 zD1T Surfs , i ()=) ta;i-r sL Ti=. mx94,1siot,4 , & COMMZ7noi`l of uv,4P wzAgt s -ro ^14 CF-) COW- RM . j 2 G -7 (,.59�k eLf- Tenant Improvement Includes Re-Roof: Yes ❑ No&] If yes, number of squares Tenant Improvement Includes Structural Yes V No ❑ Type of Construction(Usage Class): Occupancy Type: 13 1-A, 1-B MHN-A El II/III B, IV-HT,V-B NI Valuation: Project Size: Express N] Standard ❑ Large ❑ Major❑ Green Building: Please complete Leed for commercial interiors checklist& attach it to the application or if applicable,include in plans & sheet index LIKED Points Achieved *** For Office Use Only*** Over The Counter❑ Revised 05/18/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 4-6PERMIT# iq OWNER'S NAME: PHONE# O' 2 GENERAL CONTRACTOR: &,to rBUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date