11070164CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: I INFINITE LOOP CONTRACTOR: REDWOOD CITY ELEC PERMIT NO: 11070164
OWNER'S NAME: APPLE INC 2775 NORTHWESTERN PKWY DATE ISSUED: 07/22/2011
OWN'ER'S PHONE: 4089961000 SANTA CLARA. CA 95051 PHONE; NO: 650369-55-55
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
2 Ii1:OLUCAn IT I:XISI ING SI"fli LIGI I TING POLE -INCLUDES
License Class_ _-_� l,ic. #- 7 �U T ELECTRICAL
Contractor a o(CyVyg21Vte_��--2- /Lz
hereby affirm that 1 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: Sq. Fl floor Area: Valuation: $350(1
1 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 APN Number: 31602105.00 Occupancy Type:
performance of the work for which this permit is issued.
2 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
permit is Issued PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION.
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 Ute above mentioned property for inspection purposes. (We) agree to save Issued bye—"Dat,-,7-7 2,
indemnify and keep harmless the City o1 -Cupertino against liabilities, judgments,
costs, and expenses which/iotner
against said City in consequence of the
granting of this permit t ant understands and will comply with
all non -point source r, i u o Municipal Code. Section 9.18. RF, -ROOFS:
All roots shall he inspected prior to any roofing material being installed Ila rool'is
Signature bate 'L l installed without first obtaining an inspection. I agree to remove all new materials 101-
inspection,
iirinspection.
❑ OW R-BUIL )E12 DECLARATION
Signature of Applicant: Datc:
I 1 v affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE; CLASS "A" OR BEH ER
t )wing two reasons:
1 I. 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 IIAZARDOUS MATERIALS DISCLOSURE
sale (Sec 7044. Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the
2 I. as owner of the property, am exclusively contracting with licensed contractors to California Ilealth & Safety Code, Sections 25.505, 25533, and 25534. 1 will maintain
construct the project (Sec 7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
hereby affirm under penalty of perjury one of the following three declarations: Additionally, should 1 use equipment or devices which emit hazardous air
I have and will maintain a Certificate of Consent to sell' insure for W'orker's contaminants � 6%defined by the Bay Area Air Quality Management District 1 .will
Compensation, as provided for by Section 3700 of the Labor Code, for the maintain conApance with Cupertino Municipal Code, Chapter 9.12 and the
Flcalth & S, ty .od S cti s 25505, 25533, and 2-5534.
performance of the work for which this permit is issued.
2 1 have and will maintain Worker's Compensation Insurance, as provided for by Orvne r tf r' •d -a
Section 3700 of the Labor Code, for the performance of the work for which this Date:
_-J�/
permit is issued.
3 1 certify that in the performance of the work for which this permit is issued. I shall
CONSTRUCTION LENDING ACENC'Y
not employ any person in any manner so as to become subject to the Worker's
1
Compensation laws of California. If, after making this certificate ofexemption. I Hereby alilnn that there is a construction lending agency for the pert ormance of �orl:;
become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Scc 3097, Civ C)Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked. Lender's Address
APPLICANT CERTIFICATION ARCHITECT'S DECLARATION
I certif) 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 1 understand my plans shall be used as public records.
to building construction, and hereby authorize representatives of this city to enter Licensed Professional
upon the above mentioned property for inspection purposes. (We) agree to save ----
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 permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
9RNE
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 1 infinite loop
DATE: 07/22/2011
REVIEWED BY: bobs.
APN: 3 p a �D5
BP#:
"VALUATION:
$ 00
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE! Alteration / Addition /Repair
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
[PERMIT TYPE:
WORK
relocate Stinq site pole structural includes electrical.
SCOPE
NiOTF.r Th.-.v.- fees are hated an the nreliminary infarmatinn availahle and are nn1v an estimate_ Cnntaet the Dent far addn'l info.
FEE ITEMS (Fee Resolution 11-0531:. 711111)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
0 hours
$130.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:@ Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
0 Yes (F) No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning_Fee:
$0.00
1 #
$392.00
Lighting Pole
> /� 7< D
Q
0
Strong Motion Fee:
IBSEISMICO
+I
0.5 hrs
$41.00
Admin./Clerical Fee
IADMIN
Bldg, Stds Commission Fee: IBCBSC
1,DDG$2-06
Revised: 07104/2011