11050111CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19310 PRUNERIDGE AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 11050111
OWNER'S NAME: APPLE INC
851 BUCKEYE CT
DATE ISSUED: 06/16/2011
OWNER'S PHONE: 4082406438
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: ` 'r r r
License Class— Lic. # 4 �7 go
BLDG ELECT PLUMB
r-
MECH RESIDENTIALCOMMERCIAL
Contractor r u ✓ Date �7 hL /I
1
I hereby affirm that I am licensed under t e provisions of Chapter 9
JOB DESCRIPTION: INSTAL NEW I-IVAC ROOF MOUNTED EQUIPMENT WITH
(commencing with Section 7000) of Division 3 of the Business & Professions
NEW
Code and that my license is in full force and effect.
DUCT INSTALLATION, FENCE SCREENING
I hereby affirm under penalty of perjury one of the following two declar ' n
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: $110000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 31606051.00
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature _ DateA
U-1 E
Issued by: Date:0 �t
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked,
Own r , u % and agent:
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of NNork's
Io building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
;ranting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
).18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
F&M__7 FEE ESTIMATOR - BUILDING DIVISION
ka,
ADDRESS: 19310 pruneridege
DATE:
REVIEWED BY:
APN:
BP#:
'VALUATION: $110,000
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
install new HVAC roof mounted equipment with new duct installation fence screening.
SCOPE
Mech. Plan Check 0.0 hrs $0.00�x,„�7,.
Mech. Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $42.00
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1r7,�»)fc. t�rsp.Li
NOTE. These ees are based on the prellininar information available and are oniv an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resohition 09-051 F '. 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No
$0.00
hours Plan Check, Hourly
$252.00 ISTPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
0 # Mechanical
$126.00 IBCAIRHA Air -Handling (<=10K cfm)
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. 0 OT
0.0
hrs
$0.00
1= # Mechanical
$126.00 IMCRAA Heating System
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
40 l.f. Fence
$380.00 IFENCE>6FT Fence, Non-Masomy >6'
Acoustical Fee: 0 Yes E) No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Platming Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
i
Travel Documentation Fee: ITRAVDOC
$42.00
Strong Motion Fee: IBSEISMICO
$23.10
Select an Administrative Item
Bldg; Stds Commission Fee: IBCBSC
$5.00
SUBTOTALS:
$112.10
$884.00 TOTAL FEE:
$996.10
Revised: 04/29/2011