11030094 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10231 BUBB RD CONTRACTOR:ADIMPACT PERMIT NO: 11030094
OWNER'S NAME: APPLE INC 19772 MACARTHUR BLVD DATE ISSUED:04/19/2011
OWNER'S PHONE: 4089844876 IRVINE,CA 92612 PHONE NO:(949)723-0187
❑ LICENSED CONTRACTOR'S DECLARATIONr
��J (j BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C/VY- Z Lic.# ` %G`� / f—
%/ MECH RESIDENTIAL COMMERCIAL
Contractor ]J14-1Date `
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APPLE LOGO&ADDRESS-INSTALLATION OF 1
(commencing with Section 7000)of Division 3 of the Business&Professions NON-ILLUMINATED MONUMENT SIGN
rrd that my license is in full force and effect.
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 Sq.Ft Floor Area: Valuation:$5000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35720007.00 Occupancy Type:
APPLICANT CERTIFICATION
reftify 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
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. Issued by: Date:
Signature - � Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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 sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,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
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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,I Owner o ori a agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: l w
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CWPERT|NO
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
1U300TORREAVENUE ^CUPERT|NO.CA85O14-3255
(4O8)777'022O^FAX (4OO)777'3333^
(/\—��(3 (—)I
PROJECT ADDRESS 7APN
ff
OWNER NAME
PHONE
EqA -7 (1
STREET ADDRESS
CI STATE, ZIP
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADD
CITY, STATE, Zip
T F7
0 OWNER El OWNER -BUILDER El OWNERAGENT 0 CONTRACTOR El'CONTRACTOR AGENT 11 ARCHITECT El ENGINEER El DEVELOPER 11 TENANT
CONTRACTOR NA LICE SE NUMBER LICENSE TYPE BUS. LIC #
COMPANYNA,
E-MAIL
FAX
STREET DDkE S
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUN113ER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
USE OF S or Duplex E] Multi -Family
ILLUMINATED
SIGN TYPE
NO.OF
SIGN AREA
VALUATION
,��F
STRUCTURE: Commercial
(Y/N)
(CODE)
SIGNS
(SQ. FT.)
M
SIGN TYPE CODES:
B - BANNER SIGN MONUMENT (GROUND) SIGN
-7
1-
D DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI DIRECTIONAL SIGN T - TEMPORARY
READERBOARD, W1 - WINDOW SIGN
[RECEIVED BY:
TOTAL VALUATION:
By try signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this
application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constructfou. I autbofize representatives ofCupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Z Date:
SUPPLEMENTAL INFO R ),
MATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
Sign Details - including UL listing(s) applicable
0 STANDARD
PLANNING PLANREVIEIV
Structural Calculations (ifapplicable)
0 LARGE
OTHER:
Copy of Planning Approval Letter or Meeting with Planning prior to
0 MAJOR
submittal ofBuilding Permit application.
@g»*v.J0//.noorevised 0]V0D/
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:/ 12j -Z A
CITY/ZIPCODE: Z16 -
— -- -1—Al—val —ur, 1 uqun us aji ousinesses 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
CITY OF CUPERTINO
190-0-1 FEE ESTIMATOR - BUILDING DIVISION
ikADDRESS:
10231 bubb rd.
DATE: 03/21/2011
REVIEWED BY: bobs.
s
I APN:
BP#:
*VALUATION: 1$5,000
'�,PERMIT TYPE: Building Permit
T"
71711
PRIMARY Sign
USE: I
PENTAMATION 1 CEAP5
PERMIT TYPE:
wopw I
instan new non illuminated monument sign
SCOPE
F_
SIGN TYPE
FEE ID
QTY/FEE
QTY
ISUPPKFEE
SIGN FEE
JESIGN
El
F ec. Permit Fee: IEPERMIT
Wall Sign, Non -Electric
1SIGNWNONE
OtherElec.Insp. 1 0.0 $42.00
$126.00
$253
Permit Fee:
$253.00
Suppl. Insp. Fee:G Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$42.00
PME Permit Fee:
$42.00
Consowciiw�
r-
Sign Master Plan: 0 Yes 0 No
$0.00
i
$0.00
TOTALS:
Travel Documentation Fee: I TRA VDOC
1 $253.001
Strong Motion Fee: IBSEISMCO
NOTF.- These fers are hased on the nreliminary information available and are onlv an estintate. Contact the Dept for addnl info.
FEE ITEMS (Fee Resohition 09-051 Eff, 7/1110)
FEE
QTY/FEE
# Branch Circuits $42.00
ISUPPKFEE
JESIGN
El
F ec. Permit Fee: IEPERMIT
Suppl. PC Fee: (E) Reg. 0 OTFT
0]
OtherElec.Insp. 1 0.0 $42.00
$126.00
NOTF.- These fers are hased on the nreliminary information available and are onlv an estintate. Contact the Dept for addnl info.
FEE ITEMS (Fee Resohition 09-051 Eff, 7/1110)
FEE
QTY/FEE
MISC ITEMS
ISUPPKFEE
Suppl. PC Fee: (E) Reg. 0 OTFT
0]
hs
$126.00
Permit Fee:
$253.00
Suppl. Insp. Fee:G Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$42.00
PME Permit Fee:
$42.00
Consowciiw�
Sign Master Plan: 0 Yes 0 No
$0.00
Work Without Permit? 0 Yes G No
$0.00
Travel Documentation Fee: I TRA VDOC
$42.00
Strong Motion Fee: IBSEISMCO
$1.05
Select an Administrative Item
—1
Bldg Stds Commission Fee: IBCBSC
$1.00.
SUBTOTALS:
$507.051
$0.00� TOTAL FEE:
1 $507,05
Revised: 01/15/2011