13020139CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19050 PRUNERIDGE AVE
CONTRACTOR: DPR SKANSKA, A JOINT
PERMIT NO: 13020139
VENTURE
OWNER'S NAME: APPLE
1450 VETERANS BLVD
DATE ISSUED: 02/27/2013
OWNER'S PHONE: 4082033262
REDWOOD CITY, CA 94063 PHONE NO: (650) 474-1450
JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
❑ LICENSED CONTRACTOR'S DECLARATION
k # � `
T.I. PREP TO EVENTUALLY RECONFIGURE (E) OFFICE
License Class Lic.
SPACE BY MOVING PARTITION WALLS, DROPPED
Contractor ns le,� 4 4 Date
CEILINGS
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
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
Valuation: $100000
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
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: 31606033.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF ORK IS NOT STARTED
correct.: I agree to comply with all city and county ordinances and state laws relating
WITHIN Igo S ERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 D R AST CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
the
Z ��
costs, and expenses which may accrue against said City in consequence of
ue by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9,18. �4 ...
� :•,.,.,-�'—e�_m �`_ Date"
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature..
installed without first obtaining an inspection, I 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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
I, as owner of the property; or my employees with wages as their sole compensation,
do the work, and the structure is'not intended.or offered for sale (Sec.7044,
will
Business & Professions Code)
HAZARDOUS MATERIALS DISCLOSURE
property, rty, am exclusively contracting with licensed contractors to
I, as owner of the roe y g
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
Code, Section 25532(a) should I store or handle hazardous
declarations:
I have and.will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety
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
compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
will maintain
the Health & Safety Code, Sections 25505, 25533, and 25534.
I have and will maintain Worker's Compensation Insurance, as provided for by
for this
Section 3700 of the Labor Code, for the performance of the work which
Owner or authorized agent:
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
p y p p
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
costs, and
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
CITY OF CUPERTINO
r, r, r rerrrnT A TnID — WITTY .711N(: nTVTCInN
ADDRESS: 19050 pruneridge ave
DATE: 0212612013
REVIEWED BY: melissa
APN: 316 06 033
BP#:7 c)
*VALUATION:
$100,0.00
*PERMIT TYPE: Building :Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
PENTAMATION 1 B TI
PERMIT TYPE: A
WORK
T.I. PREP TO EVENTUALLY RECONFIGURE E OFFICE SPACE BY MOVING PARTITION WALLS
SCOPE
DROPPED CEILINGS
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
0
$0.00
$0.00
TOTALS:
0
$0.00
$0.00
MECH, HOURLY 0 Yes No
PLUMB, HOURLY ®i Yes (F) No
ELEC, HOURLY ® Yes No
lfech. Plan Check
Phurrb. Plan Cheek
Elec. Plait Check
A'fech. Permit Fee:
Plumb. Permit Fee:
Flee. Permit ree:
Outer Alec%, In
Ost
ther Plumb fn,,Li
Other Elec. Insp.
111ech. Insp. Fee:
Phaub, hisp, f%ee:
Elea. Insp. Fee:
__.-c_ rr�__.
r-.. �:.... a,....;.,..... cb...•,,,.n;ofa:n� .Qi•bnnr
NO"1E: ims estimate ttoes,nor metuae fees uue to uu,er Lepu.,u.c...o i..�• •••••••s, -�••� • _ -- _, _--.--_ , _ -
District etc.). inese ees are uuseu urt in reunauu.
FEE ITEMS 6Fee Resolution 11-053 Eff 711112)
c.. v....... ...•.•.....
FEE
•.,.•.... -
QTY/FEE
--- ---- ------------
MISC ITEMS
Plan Check Fee:
$0.00
= # Tenant Improvement Prep
$388.00 1TIPREP
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fe.e:Q Reg. 0.0T
0,0
his
$0.00
T7=
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Comtoiction Tax:
Achniriisirative Fee:
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure 0
Travel Doc7nt7entation Fees:
Strong Motion Fee: IBSEISMICO
$21.00
Select an Administrative Item
'Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS
$25.00
$388.00 TOTAL FEE::
$413.00
M� \! MUVISCu. V I/V I/GV IJ