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11060015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10600 N TANTAU AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 11060015 OWNER'S NAME: APPLE,INC 851 BUCKEYE CT DATE ISSUED:06/02/2011 OWNER'S PHONE: 4089744876 MILPITAS,CA 95035 PHONE NO:(408)240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# /pry, �,q �� \ 6� o � MECH r RESIDENTIAL r COMMERCIAL r Contractor V l.e+"7Nk(-t Iyr" Date 7/ 1 1 hereby affirm that I am licensed under the provisions of Chapter.9 JOB DESCRIPTION: DEMOLITION COMMERCIAL OFFICE/LAB (commencing with Section 7000)of Division 3 of the Business&Professions SPACE(21,770SQFT) Code and that my license is in full force and effect. NON-STRUCTURAL INTERIOR ONLY 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 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 Sq.Ft Floor Area: Valuation:$200000 permit is issued. APPLICANT CERTIFICATION APN Number:31618035.10600 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and exp e es which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this rmit. A itiona11 the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-poin source a ulation per the Cupertino Municipal Code,Section 9.18. Signature Date Zl G) Issued by: Date: G 2 L( ❑ NER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. conteinant defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall main in co pi ance h the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Healt &S fe Cod ,Sections 25505,25533,and 25534. 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 Owne or t rize agent: forthwith comply with such provisions or this permit shall be deemed revoked. —Date: t/ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I h e y affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for ich this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 GUPERTINO (408)777-3228 - FAX(408) 777-3333.-buildinga-cupertino.org / Jkl PRO]ECL ADDRESSJO/�_` APN N k \p k� 0 ��' 0 ('0 OWNER NAME /�� J�C_ . PHONE Db E-MAIL 1 a�l.1^2 r' le ccw. 9 , Dk!fA%L STREET ADDRESS I I t CrrY,SPATE,ZIP ,^ l FAX l CONTACT NAME y V PHONE ( , 1�r1 �1,��Ca E-M�-1 1C\o A�, _^ STREET ADDRESS 1 „ �p CrPY,STATE, ZIP U ' [� "\'l 1 1 I FAX r r_-,1�,I✓17-r- lir , t OWNER. Cl OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrIECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME \ M +\ \ LICENSE NUMBER G ACV �l LICENSE TYPE BUS.LIC q t COMPANY NAME E MAII '�t,v�/�f_�CA^ , Ct(V" FAX STREET ADDRESSTIt� I fJ V& ` ' � 6� t CITY,`A ZIP G PHONE L(vv� DESCRIPON OF WORK 17 Vw O �— � "'�J rl�`N--C- c t/F--'►`�L �... t--�- � L-�'1U tri RESIDENTIAL FMLUNrrS77 DWELLING FLOOR AREA •' 1t-.TAMRF1' COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION #STORIES AQMD JOB NUMBER _ TOTAL VALUATION: J#: By my signature below,I certify to eac the fo g: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information T have p vided' co I hav read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil g cons ion. I aut4orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Date: `7 uo SUPPLEMENTAL INFOTI N REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMTf _=__=E11E+$€ Provide Job Number from Bay Are it Quality Management District wvnv.baacimd.org(cry 415-749-4762. ? e Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade. —Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. —Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter co be initiated by person(s) y '- certified in asbestos,mercury and/or hazardous material examination. Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. Provide letter of clearance of all vermin from a licensed pest control contractor. Applicant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling"inspection. Provide signed Debris Bin and Recyclable Materials form. ' �:. r —Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system review, x:=��,_�,•�_r:�.'....•p,'� ;� ; DemoApp_2011.doc revised 03/16/11 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: Q T<� PERMIT# ZZ 6 OWNER'S NAME: PHONE# GENERAL CONTRACTOR: _q��Q �} BUSINESS 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