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11040088CITY OF CUPERTINO BUILDING PERMIT, BUILDING ADDRESS: 6 INFINITE LOOP FLR 1 -4 CONTRACTOR: XL CONSTRUCTION PERMIT NO: 11040088 OWNER'S NAME: APPLE INC 851 BUCKEYE CT DATE ISSUED: 05/03/2011 OWNER'S PHONE: 4089744876 MILPITAS, CA 95035 PHONE NO: (408) 240 -6000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class FLRS 1 -4 - RETROFIT EXISING DOORS WITH SECURITY Lie. #� CARD READERS. 2 NEW W/HEADERS & 26 CHANGE OUT Contractor A. (fn �► ate / NO/HEADERS DOORS THROUGHOUT THE BUILDING IST THRU 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. Deferred #1- Change to corridor doors on Floors 1 thru 4 for East and West Wings 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 Sq. Ft Floor Area: Valuation: $120000 performance of the work for which this permit is issued. V' 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 permit is issued. APN Number: 31602110.FLR1 -4 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for ins ection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of pertino against liabilities, judgments, costs, and expenses which may c e aga st said City in consequence of the granting of this p it. Additi all understands and )) t1 J ' Issued by:. /e �r�%'��iy Date: l "�� ,the plicant will comply with all non -p 'nt s urce r 1 do pert " e Cupertino Municipal Code, Section Signatur /�® / S RE- ROOFS: Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for ❑ OWNER- BUILDER DECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Health & Safety Code, Section 25532(a) should I sto e r handle hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment o de i es which emit hazardous air contaminants as defined by the B Area Air Qu i Management District I performance of the work for which this permit is issued. will maintain compliance with the up tino nic' Code, Chapter 9.12 and 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 the Health & Safety Code, Secti 255 5, 5 , fid 4. permit is issued. O authorized wner or auorze agent Date: 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. 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 I'MRCITY OF CUPERTINO o FEE ESTIMATOR — BUILDING DIVISION 1AADDRESS: 6 Infinite Loop DATE: 08/27/2015 REVIEWED BY: PAUL 1•Icch. Permit Nee: APN: 316 02 110 BP #: 11040088 *VALUATION: 1$8,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building I -.IPC. Insp. Fee: PENTAMATION PERMIT TYPE: 1 GENCOM WORK Deferred #1 - Change to corridor doors on Floors 1 thru 4 for East and West Win s SCOPE na ,Tech. Plan Check Plumb. Plan Check Elec. Plan Chet:k 1•Icch. Permit Nee: Plumb. Pentair Fee: Elec. Permit Fee: Other Affech. Ina'P• 01her Phan .Lnsp. Other i lec. lusp. Vech. hasp. Fee: Plumb. Insp. Fee: I -.IPC. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 Ef'. 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (a No $0.00 hours $286.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (E) No $0.00 Suppl. Insp. Fee :Q Reg. O OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: AcIn inlstrative Fee: 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential E) Building or Structure 0 A .Travel Dnctrrnerrrurion Fees: Strong; Motion Fee: IBSEISMICO $2.24 2.0 hrs $286.00 Inspections ISTINSP Inspection, Hourly Bldg; Stds Commission Fee: IBCBSC $1.00 f suBTOTArs' _= $3.24 $572.00 ToTaL SEE $575.24 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT R&O BUILDING ADDRESS: 6 INFINITE LOOP FLR 1 -4 CONTRACTOR: XL CONSTRUCTIOI ATE PERMIT NO: 11040088 - s /. L OWNER'S NAME: APPLE INC 851 BUCKEYE CT DATE ISSUED: 05/03/2011 OWNER'S PHONE: 4089744876 MILPITAS, CA 95035 PHONE NO: (408) 240 -6000 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lich # ( / • 1 4h �� CrU� �+� ItiJ��(t, Contractor Date 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 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expe ses which may accru against said City in consequence of the granting of this ermit. A • ionally, ;the applicant understands and will comply with all non -poin ource gu ations er the Cupertino Municipal Code, Section 9.18. Signature Date El I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, 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. Date BUILDING PERMIT INFO: BLDG F ELECT J_ PLUMB r- MECH RESIDENTIAL r COMMERCIAL r— JOB DESCRIPTION: FLRS 1-4 - RETROFIT EXISING DOORS WITH SECURITY CARD READERS. 2 NEW WMEADERS & 26 CHANGE OUT NO/HEADERS DOORS THROUGHOUT THE BUILDING 1 ST THRU 10/27/2011 - REV #1 - REVISE DOORS AT ELEVATOR VESTIBULE LOBBIES ON ALL FOUR(4)FLOORS- 11/30/2011 REV #1 ISS'D Sq. Ft Floor Area: Valuation: $120000 APN Number: 31602110.FLR1 -4 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the.Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maint in compl' it cc w the Cupertino Municipal Code, Chapter 9.12 and the Health: Safety ode, Sf lions 25505, 25533, and 25534. Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6 INFINITE LOOP FLR 1-4 C ,R'S NAME: APPLE INC CONTRACTOR: SOUTH BAY I PERMIT NO: 11040088 CONSTRUCTION CO INC 170 KNOWLES DR DATE ISSUED: 05 /03/2011 OWNER'S PHONE: 4089744876 I LOS GATOS, CA 95032 I PHONE NO: (408)379 -5500 I ❑ LICENSED CONTRACTOR'S DECLARATION License Class �> Lic.# -� 4 Contractor —Date 5 I 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 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 permit is issued. 2_ j APPLICANT CERTIFICATION 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, 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_ ure BUILDING PERMIT INFO: BLDG F ELECT r– PLUMB r MECH r RESIDENTIAL r COMMERCIAL JOB DESCRIPTION: FLRS 14 - RETROFIT EXISING DOORS WITH SECURITY CARD READERS. 2 NEW W/HEADERS & 26 CHANGE OUT NO/HEADERS DOORS THROUGHOUT THE BUILDING I ST THRU Sq. Ft Floor Area Valuation: $120000 APN Number: 31602110.FLR1 -4 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Date 1.'3 I ( I Issued by: ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 iilding construction, and hereby authorize representatives of this city to enter i 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. Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or a orized agent: r Date: S 3�L N CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professiona CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6 INFINITE LOOP FLR 1-4 OWNER'S NAME: APPLE INC OWNER'S PHONE: 4089744876 ❑ LICENSED CONTRACTOR'S DECLARRATION License Class Lie. #C} ` Contractor >� O i t Date�5jl { 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 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 die work for which this permit is issued. APPLICANT CERTIFICATION 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, 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 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, 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. CONTRACTOR: SOUTH BAY CONSTRUCTION CO INC 170 KNOWLES DR LOS GATOS, CA 95032 PERMIT NO: 11040088 DATE ISSUED: 05/03/2011 PHONE NO: (408)379-5500 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: FLRS 1-4 - RETROFIT EXISING DOORS WITH SECURITY CARD READERS. 2 NEW W/HEADERS & 26 CHANGE OUT NO/HEADERS DOORS THROUGHOUT THE BUILDING 1 ST THRU Sq. Ft Floor Area: Valuation: $120000 APN Number: 31602110.FLR1-4 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner Aaorized agent: , Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 1wrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date I Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6 INFINITE LOOP FLR 1-4 CONTRACTOR: XL CONSTRUCTIOL),A,'TF,,,`PERMIT NO: 11040088 "1 OWNER'S NAME: APPLE INC 851 BUCKEYE CT DATE ISSUED: 05/03/2011 OWNER'S PHONE: 4089744876 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # 6AAWO Contractor U'v ��/t I �'v Date 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 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 permit is issued. APPLICANT CERTIFICCATION 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, costs, and expe ses which may accru against said City in consequence of the granting of this emmit. Acjd' ionally, the applicant understands and will comply with all non-poin ource { gu ations er the Cupertino Municipal Code, Section 9.18, 11 Signature / Date ❑ OINW]JR-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, 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. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB MECH r RESIDENTIAL F COMMERCIAL r JOB DESCRIPTION: FLRS 1-4 - RETROFIT EXISING DOORS WITH SECURITY CARD READERS. 2 NEW W/HEADERS & 26 CHANGE OUT NOMEADERS DOORS THROUGHOUT THE BUILDING 1 ST THRU 10/27/2011 - REV#1- REVISE DOORS AT ELEVATOR VESTIBULE LOBBIES ON ALL FOUR(4)FLOORS- 11/30/2011 REV#1 ISS'D Sq. Ft Floor Area: Valuation: $120000 APN Number: 31602110.FLRI-4 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements corder Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. Iwill maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maint in compF ice wit the Cupertino Municipal Code, Chapter 9.12 and the Health O Safety ode, S fktions 25505, 25533, and 25534. Owner utho 'zed ag nt: /� ll Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of -,wrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO MS, ' FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 6 infinite loop DATE: 10/26/2011 REVIEWED BY: bobs. APN: BP#: '"VALUATION: 1$300,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: PENTAMATION 1GENCOM PERMIT TYPE: WORK [SCOPE revise doors at elevator vestibule lobbies on all 4 floors. ` a �r:.'c., t'JFi7F}�.., NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preltninar in oranation available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (lee Resolution 11-053 E(f 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT O Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ,1,/ ("On."Ivilctiol? ax 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 , f fl}� '�'f.':_#j.{)/ f %�...>.�i�'�i }1(c;'.`ii �Llllii}d ,i�. Strong Motion Fee: 1BSEzsMZCO $63.00 1 # $783.00 Revision 1REVCOMT7 Tenant Improvement Bldg Stds Commission Fee: IBCBSC $12.00 SUBTOTALS: $75.00 $783.00 TOTAL, FEE: $858.00 Revised: 10/01/2011 _ __ CITY OF CUPERTINO ti _ TIFF, FCTIMATOR — BUILDING DIVISION LO[ ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: Iso —� rPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building1()T USE: (L „ PTOOR .41h 1, APPLICATION TYPE: 1 B TI MECHANICAL 0 Yes No PLUMBING 0 Yes (D No ELECTRICAL 0 Yes E) No �W a cc �:U OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s .ft. 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 A,k( h. 1,1(m Ow t k h, Po mir F_ 0//w ` Ab,ch, hl sp, Plltmb. Phm C:'hvck Ph1mb, Pormil /'cep Oihcr Ph1mh. lay. Floc Plow Chcrl; Elcr. hwmil Ftcr' ("11hrr� Dec' htsh. n�nml, . 'rl. F , l.nona n" M, nralis firanry i"fnrm"flnrj nvnilnhlp ty"d nrP only an Pstimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 Eff.' 711109) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 43 $1,010.00 Window / Sliding Glass Door IWINRBP Replacement Suppl. PC Fee: G Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslrl,lcihui T"I' : Acoustical Fee: 0 Yes D No $0.00 E) Work Without Permit? 0 Yes (D No $0.00 Plamiing Fee: $0.00 Select a Non -Residential G Building or Structure I1,01,C/ Uocnitic'111t11ion Fcc;: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: 47 a$0:0 SUBTOTALS: $0.00 $1, 1.0:00 TOTAL FEE: Revised: 6/30/2010 �. " Z-0