120101611 1 �
• UAWICO-M
� TT
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19333 VALLCO PKWY CONTRACTOR: DPR CONSTRUCTION, A PERMIT NO: 12010161
0 T
AL
GENERAL
ONVNER'S NAME: APPLE INC
1450 VETERANS BLVD DATE ISSUED: 01/26/2012
OWNER'S PHONE: 4089744876
--TICENSED
REDWOOD CITY, CA 94063 PHONE NO: (650)474-1450
0 1,_ C', �9 "
CONTRACTORS DECLARATION
BUILDING PERMIT INFO: BLDG' ELECT' PLUMB
19 ell,
License Class Lic. #
r r
MECH 11— RESIDENTIAL COMMERCIAL
Contractor ate
I hereby affirm that I am licensed tinder the provisions of Chapter 9
JOB DESCRIPTION: APPLE - 2ND FLOOR - COMMERCIAL TENANT
(commencing with Section 7000) of Division 3 of the Business & Professions
fN4PRO�,EMENT(922SQFT'j;NON-STRUCTURAL-INCL(JDE
I
Code and that my license is in full force and effect.
MECHANICAL/ELECTRIC AL & NO PLUMBING
I hereby affirat 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 Areal:
Valuation: $98000
Section 3700 of the Labor Code, for tire performance of the work for which this
permit is issued.
AP Number: 3162007.5.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that tire above information is
correct, lagree 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this runt. Additionally, the applicant understands and will comply
'o"o, , "' j�"'
DAYS 0 1 1,AST CALLI
180 DAY' M I�AST CALLED INSPECTION.
with all oint source egutations per the Cupertino Municipal Code, Section
source
3.18."I'll
—��
Signature Date_/
,V.
Issu bv: Date:
13 OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I area exempt from the Contractor's License Law for one Of
All roofs shall be inspected prior to any roofing material being installed. If roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new, materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, as owner of the property, ant exclusively contracting with licensed contractors to
construct the project (See.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTE R
I hereby affirm under penalty of petJury one of the following three
—
declarations-
1 have avid will maintain a Certificate of Consent to self -insure for Worker's
ILkZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requireurents under Chapter 6.95 of the:
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505,25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for tire perfornrance of the work for which this
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
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
riot employ any person in any manner so as to becoure subject to the Worker's
Health & Safety Code, Sections 25505,25533, and 25534.
Compensation laws of California, If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
ner 8 or agent:
� MI
forthwith comply with such provisions or this permit shall be deemed revoked.
,- :
r� Date f
I
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction,, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
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
ARCHITECT'S DECLARATION
18,
I understand my plans shall be used as public records,
Signature. Date
Licensed Professional
SCOPE
OCCUPANCY TYPE:
TYPE OF
FLR AREA
PC FEES
PC FEE ID
BP FEES
BP FEE ID
CONSTR.
B (Tenant Improvements)
119B,111-B,IV,V-B
922
$1,945.60
IBTIPLNCK
$972.24
JBTUNSP
TOTALS:
922
$1,945.60
$972,24
L
NOTE. This estimate rues not includefees due to other Departments (i.e. PlanningPublk Works, Fire, Sanitary Sewer District, School
etc.. il:l�'�ill��ii!,I:��!!:!!��'�ii��!! fees are based on the relinfFinai�!,ir ire or Warion available and are only an estimate. Contact the 111! 11,101"It 11W: 2 _L m for addn'l in o.
FEE ITEMS _(Le V11 FEE QTY/FEE MISC ITEMS
L1,1qL5o1ufi,)P _11-053 �Ejff U] ' _77� U7 f
Plan Check Fee: $1,945.60 Select a Mise Bldg/Structure
Suppt. PC Fee: 0 Reg. 0 2LED hrs $0.00 or Element of a Building
A
PIKE Plan Check: $0.00
Permit Fee: $972.24
Suppl. Insp. Fee .e Reg. 0 OTF. _6 I hrs $0.00
PINE Unit Fee, $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (D No $0.00
Advanced Planni Fee:
------ $0.00
Fee: IBSEISWCO $0.50
B,L,d,g Stds Commission Fee:
IBCBSC $1.00
0
Select a Non -Residential (RE
Building or Structure i
Select an Administrative
E
Revised: 1119/2012
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408),777-3228 - FAX (408) 777-3333 - buildinq@cupeqino,!2rg
El NEW CONSTRUCTION El ADDITION El ALTERATION Ti FJI REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT AD
API
OWNER NAME
PHONE E-MAIL
A zpi o
dk
F 'I 1Z i4 P 0 ccj, AM.P,ey f�i
STREET ADDRESS
CITY, STATE, ZIP FAX
1 7 A F :7 A 1" 17 E L c 2
e_ Ul EjE R., j2 kx�'! Qff-voj i�4.
CONTA T NAME
PHONE
I
&1A
J
#3AP)(-
C!, �2 2
STREET ADORE IS
CITYE, ZIP
, ItT
FAX
2-
Ila
6'DC
❑ OWNER ❑ OWNER -BUILDER 11 OWNER AGENT
El CONTRACTOR 1:1 CONTRACTOR AGENT 0 ARCHITECT 11 ENGINEER 0 DEVELOPER ❑ TENANT
CONTRACTORNAME
LICENSE NUMBER
BUS. LIC
13 3t, 2_
___AP2AZ
COMPANY NAME R( XT1
nk
E-MAIL
FAX
STREET ADDRESS
UD.fe
CITY, STI,'E, ZIP -2
PHONE,
14S c,
llre,
ARCH17C3) NGINEER. NAME
LICENSE NUMBER
BUS. LIC
COMPANY rME
E-MAI<�
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
".A 9,'LL,�
6g%
0 c, Rv 1 0
i�L.OA
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE,
TYPE
Occ.
SQFT.
VALUATION
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
I _
k
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
DETACH
ATTACH
_], IS A SECOND UNIT YES
SECOND STORY 0 ES
BEING ADDED? NO
ADDITION? ONO
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
IS THE BLDG AN 0 YES
TOTAL VALUATION:
PLANNING APPL # ONO PLANNING APPROVAL LETTER
EICHLER HOME? ONO
By my 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 Ihave orov'ded is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
0 v ordinances and state laws rei'atniv5tu to co structlow-ftathouze representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicantlAgel I
/ —
Date:
SUPPLEMENTAL INFORMATION REQUIRED
New SFD or Multifamily dwellings: Apply for demolition permit for
building(s). Demolition is issuance building
eXisting permit required
prior to of
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
N
Copy of Planning Approval Letter or Meeting with Planning prior to
Building Permit
submittal of application.
2
I
BldgApp_201 Ldoe revised 06121111