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11030076COVER SHEET 11030076-D 10201 N DE ANZA BLVD PERMIT # 67d DATE PROJECT AJA '�)oar' e ADDRESS d 2 APPLICANTOWNER mod MMMIM A" 3 3 `f --o-? o RES. (LVNG) (GARAGE) COMM. SQ. FT. (NM. T.I. SQ.PT. RES. REMODEL CONTACT � �1'-t� ,131rrll? PHONE# PAX 3'7q-3Z� VALUATION (Cost of Project) / REQD. PAID NOTES: �M/ CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSING NMG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED BY 1 DATE 12, l TOTAL FEES CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10201 N DE ANZA BL.VD FLR I CONTRACTOR: SOUTH BAY PERMIT NO: 11030076 CONSTRUCTION CO INC OWNER'S NAME: APPLE INC 170 KNOWLES DR DATE ISSUED: 04/25/2011 OWNER'S PHONE: 4089744876 LOS GATOS, CA 95032 PHONE NO: (408)379-5500 ❑ LICENSED CONTRACTOR'S DECLARATION License Class IJ Lie. # 3 Contractor �.rr! ST Date 2 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. 144-I Tirm 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 ce`�Ittlfat 1 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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). 1 hereby affirm under penalty of perjury one of the following three declarations: 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 f— PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: FLOOR 1 - INSTALL NEW SECURITY DOOR MODIFY EXISTING PARTITIONS 24 LINEAL FEET Sq. Ft Floor Area: Valuation: $12500 APN Number: 32634070.FLR1 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 1 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. Qpv4er or th rize agent: �� I —+� 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. Signature Date Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildingsacuoertino.org ❑ NEW CONSTRUCTION ❑ ADDITION/ALTERATION ❑ REVISION/DEFERRED SUBMITTAL PROJECT ADDRESS 4 O Z D 1 `-- PeF A O?A •. n e Sr F _ APN N /r'� -7 OWNER NAME keP LC � L 0ef- �e �Dt4e PHOI O �- C E-MA1L -7 - STREET ADDRESS CITY, STATE, ZIP FAX - APPLICANT NAME �-y) u � (� � An `1 PHONE J•1 ( t- L_D V'•YE1C-_l`-'1 STREET ADDRESS C&rA P LL CA VQ FAX 406-3-7-'3z76 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT X CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME t-I`NfS:s V F- LICENSE NUMBER LICENSE TYPE BUS. LIC q COMPANY NAME �J"�4 Y 1 'r: � -��✓✓bMl bU C7 FAX 0$-27 -32 ✓ STREET ADDRESS Cr Y, STATE, ZIP PHONE - ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE llESCRIETIONO%:woiuc - .�,��i,..� 1 c.. =�' �C �-_ i�• r w� lei 'iet6K. r- r. _ ♦7 V AI EXISTING U PROPOSED USE CONS 7p STQ7RIES EXISTG NEW FLOOR DEMO TOTAL •4�'- �: AREA AREA AREA NET AREA �> - ='. �: • .c :.. BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑ DETACH- - _ -5:�„r�.�Y'� • .:.� _ �:- K�%d - ❑ ATTACH - ,{ DWELLING UNITS: ISASECOND UNIT YES SECOND 5T00.Y ❑YES - " a 1. BEING ADDED? NO ADDfC10N7 NO tip• ' _ y.�h*" PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNER'S NAME RECErvEn B.Y I ` J Fri , LV EJA'r1N 1� PLANNINGAPPLA ❑ NO PLANNING APPROVAL LETTER - '• '. .' 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 I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 3-. — SUPPLEMENTAL INFORMATION REQUIRED Q � ,t�oi�ce�vs�i.41��,.�v��-��• _ New SFD or Multifamily dwellings: Apply for demolition permit for existingbuildin s . Demolition permit is required prior to issuance of building _ ' ,;: C�yTviER•; '?1� r permit for new building. _ Commercial Bld s: Provide a completed Hazardous Materials Disclosures form if Materials being this oB THE �- �. , , a any Hazardous are used as part of project. jsr;DAltn �GgI ICKoitres _ _:- Copy of Planning Approval Letter or Meeting with Planning prior to EILARGE D-05'E DEIT submittal of Building Permit application. MAJOR. -' ENVIRONMENTAL HEALTH BldgApp_20//.doc revised 03103111 � CITY OF CUPERTINO ffim FEE ESTIMATOR - BUILDING DIVISION 10201 n. de anza blvd. 1 st floor DATE: 03/15/2011 REVIEWED BY: bobs. IlaADDRESS: APN: BP#: "VALUATION: 1$12,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION 1GENCOM PERMIT TYPE: WORK install new security door modify existing partitions 24 lineal feet. SCOPE NOTE: These fees are hated an the nreliminary information availahle and are only an estimate_ Contact the Dent for addn 7 info. FEE ITEMS (Tee Resolution 09-051 E f.' 71'11101 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $253.00 New Door Opening IDOORNONST Non -Structural Suppl. PC Fee: (F) Reg. () OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 24 If $443.00 Interior Partitions IPARTICOMM Permit Fee: $0.00 Suppl. Insp. Fee{' Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consirli'lion I C? Acoustical Fee: 0 Yes 0 No $0.00 Q Work Without Permit? 0 Yes O No $0.00 Planning pee: $0.00 Select a Non -Residential Building or Structure E) 0 ?'? ri tllync:rrr,�rrnrrrticfr %''e s: Strong- Motion Fee: IBSEISWCO $2.63 Select an Administrative Item Bldg: Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.63 $696.00 TOTAL FEE: $699.63 Revised: 01 /15/2011