11110029 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10600 N TANTAU AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 1 11 10029
OWNER'S NAME: 10590 TANTAU INVS LLC 851 BUCKEYE CT DATE ISSUED: 12/01/2011
OWNER'S PHONE: 408996 10 10 MILPITAS,CA 95035 PHONE NO:(408)240-6000
LICENSED CONTRACTOR'S DECLARATION r F_
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Classy Lic.#LL r r F
Contractor (��. �'►3'''rY,�LT� MECH RESIDENTIAL COMMERCIAL
Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: APPLE-RELOCTION OF LIGHTING&CONS"fRUCI'ING
NINE(9)NEW CHAMBERS&ONE(I)RELOCATED CHAMBER&
(commencing with Section 7000)of Division 3 of the Business&Professions ANY INCIDENTAL MECHANICAL/ELECTRIC/PLUMBING
Code and that my license is in full force and effect.
I 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. Sq.Ft Floor Area: Valuation:$200000
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 APN Number:31618035.10600 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMfflS
S IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHOF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180 DLAST 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 ,
granting of this pen-nit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/ RE-ROOFS:
Signature Date I2 It L 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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 which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' s 255 5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: L Date:
permit is issued.
1 certify that in the performance of the work for which this permit is issued,l 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,1 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 1 have read this application and state that the above information is
correct.1 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 ARCHITECT'S DECLARATION
and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 1 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
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: 106 0► O'Vk � PERMIT#
OWNER'S NAME: 0PHONE# T42 — S
GENERAL CONTRACTO : L BUSINESS LIC NSE#
ADDRESS: 62O Val CITY/ZIPCODE: 64 no qC
*Our municipal code requires all b sinesses working in the city to have a City of Cuper ino 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. TOP
am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building a cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION X❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# r, (\
PROJECT ADDRESS I�/�n 1 I ""�a n 0.0 AV& APN# i I V O v
OWNER NAME Applet (J In It
J5� �� 0 4 0 8 . 9 9 6 .10�1J 0 E-MAIL
STREETADDRESS 1 Infinite Loop CITY, STATE,ZIP Cupertino, CA 95014 FAX
CONTACT NAME Je ro d C re e s e PHONE 4 0 8 . 240 . 60070E-MAH,
�creese@xlconst.com
STREETADDRESS 851 Buckeye Court crrY,STATE,ZIP Milpitas, CA 95035 FAx 408 .240 . 6001
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT M CONTRACTOR ❑CONTRACTOR AGENT ❑ ARC=cT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME J e ro d C re e s e LICENSE NUMBER 647480 LICENSE TYPE B BUS.LIC# 21836
COMPANYNAME XL Construction E-MAIL jcreese@xlconst.com FAx 408 .240 . 6001
STREETADDRESS 8551 Buckeye Court CITY,STATE,ZIP Milpitas, CA 95035 PHONE408.240 . 6000
ARCHITECT/ENGINEER NAME David Sabalvaro LICENSE NUMBER C-015925 BUS.LIC#
COMPANY NAME Studios Arch E-MAIL FAx 415 .398 .3829
STREET ADDREss 4 0 5 Howard St Suite 588 CITY,STI-ZIP PHONE 415.3 9 8 .7 5 7 5
gan Francisco, CA 94105
DESCRIPTION OF WORK
1Av_ ., 6re-Ia 34 �.A c On OC%
hew cAnmy%66-r-3 dr M 6,er AJ d#vl JA
EMSTINSSE I PRWOSED SE CONSTRE #STOAT€S USE TYPE Oct SQ.FT. VALUATION(S)
EXISTG ^ NEW FLOOR DEMO TOTAL 1M
AREA LL.,(� AREA ♦', 0 AREA /J �O NET AREA 001 OLU
BATHROOM N/A KITCHEN (� OTHER N/A
REMODEL AREA REMODEL AREAN/A REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GABA AREA: DETACH
N/A N/A N/A N/A ❑ATTACH
#DWELLING UNITS' IS A SECOND UNIT ❑YES SECOND STORY ❑YES
N/A BEING ADDED? ®NO ADDITION? NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF 1S THE BLDG AN ❑YES RECEIVED BY: - TOTAL VALUATION:
PLANNING APPL# MNO PLANNING APPROVAL LETTER EICHLER HOME? NO $ p� 1<
-By my sign6turebelow—I certify t�h—f the following: I anti the-property owner or authorized agent-to act on-the-property-owr er'sbzhalf:Thave read(this
Application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ]ding nstruction. I authorize representatives of Cupertino to enter the above entifi d property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL ORMATION REQ RED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for /E11RESS R-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR ❑ S NITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
® TESTING ENGINEERS, INC. FFAN
2811 TeagardenSt. 510-835-3142 0 4 2011510 4-3777 fax
San Leandro,CA 94577 800-660-3142
San Leandro e San Jose Martinez'
INSPECTION REPORT Week Ending: 12/9/11
PROJECT# 55155 TYPE OF INSPECTION:
Proof Load Testing
PROJECT: PLACE OF INSPECTION:
TA4 Install_Chambers'(Apple Project#F 11084) Jobsite
[166_0_0_i4.Tantau-Blvd.1`
Cupertino,CA
Permit#0 X IFI%
�a A=-
DATE 12/7/11
HOURS 4
INSPECTOR M.Ardizzone
Reported to Miguel of XL Construction at the jobsite as requested.
Applied a torque load of 40 foot lbs. to expansion anchors located in the floor for mounting nine(9)chambers on line 1 at G.
Seventy-two(72)anchors of a total of 144 installed were tested representing 50%without visually apparent distress or failure.
The preceding work was,to the best of my knowledge,in compliance with approved plans and specifications,including
revisions by engineer.
Reviewed by: �
-6a_v_id-C_h_ippero
Special Inspection Division Manager
Icc: Apple Computers Inc./K.Larcher
ETS-Lindgren
XL Construction
City of Cupertino/Bldg.Inspection Dept.
This report can be reproduced only in its entirety unless written permission from TEI is obtained.
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