11060071CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10201 N DE ANZA BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 11060071
CONSTRUCTION, INC
OWNER'S NAME: APPLE
1711 DELL AVE
DATE ISSUED:06/09/2011
'NER'S PHONE: 4089744874 1 CAMPBELL, CA 95008 PHONE NO: (408)379-5$00
❑ LICENSED CONTRACTOR'S DECLARATION Q
License Class 6 Lic.4 369 1 q
Contractor Sotrn+ (SAY 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 decla pt}�ns:
I have and will maintain a certificate of consent to self -insure for Worker's YU
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 :;-� V--- Date f7 11 1 111
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).
1 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, 1 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,
s, and expenses which may accrue against said City in consequence of the
ling of this permit Additionally, the applicant understands and will comply
—in all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
BUILDING PERMIT INFO: BLDG f— ELECT r- PLUMB
MECH f— RESIDENTIAL F_ COMMERCIAL
JOB DESCRIPTION: FLOOR 1 - COMMERICAL TENANT IMPROVEMENT
OFFICE
SPACE(33LINEAR FT) ADD SECURITY DOOR & INTERIOR
NON -LOAD BEARING PARTITION TO THE FIRST FLOOR
Sq. Ft Floor Area: Valuation: $12500
APN Number: 32634070.10201 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bDate: er�l- f(/
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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or au horized agent:
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 Profession
F-M-M
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
JW..4_:A2Ar
ADDRESS: 10201 n. de anza bled.
DATE: 06/09/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
1$12,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
"mercial offices ace add demosing wall and new security card reader door.
SCOPE
ve;'tk. t� i77) (.h-., 1�
'�i-'itl{ :, 1�(rxr. ,. I7C"C'k'
NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 09-051 E . 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (F) No
$0.00
0 hours Plan Check, Hourly
$126.00 ISTPLNCK
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
0 # New Door Opening
$253.00 IDOORNONST I Non -Structural
Permit Fee:
$0.00
Suppl. Insp. Fee'O Reg. 0 OT
0.0
1 hrs
$0.00
33 If Interior Partitions
$538.00 IPARTICOMM
PME Unit Fee:
$0.00
Permit Fee:
$0.00
jfPME
7_1
Acoustical Fee: 0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes E) No
$0.00
Plan.nin, Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
7
.iJ'•cil'c; ..F,'*.:7r",f:"�;pg{,y:r.tar /'fc.'.):
Strong Motion Fee: IBSEISMICO
$2.63
0.5 hrs Admin./Clerical Fee
$39.00 IADMIN
Bldg; Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$3.63
$956.00
TOTAL FEE:
$959.63
Revised: 04/29/2011