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09120092PERMIT # PROJECT ADDRESS APPLICANT oa ► Ao m DATE 4 -IS� t'ev. OWNER .. .ter i .. ■-- ■ PUBLIC WORKS __-- NINE NEW • • r -- -- mm mmmm APN# el l (— 2�— O�?S ftp - RES. (LVNG) (GARAGE) COMM. SQ. Fr. (NEW) // T.I. SQ.FT. RES. REMODEL CONTACT B -r'�h � n PHONE# G.r -4 — �� — rtg 2 FAX _ VALUATION (Cost of Project) NOTES: REQD. PAID CONSTRUCTION TAX (Y) (N) • SCHOOL FEES (Y) (N) HOUSING MITIG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED BY DATE TOTAL FEES CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19333 VALLCO PKWY I CONTRACTOR: DPR CONSTRUCTION INC I PERMIT NO: 09120092 OWNER'S NAME: APPLE INC OWNER'S PHONE: 4089745951 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 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: t. 1 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. 2. 1 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 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: t. 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) 2. 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. 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. 2. 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. 3. 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. Signature Date 1450 VETERANS BLVD DATE ISSUED: 03/23/20 10 REDWOOD CITY, CA 94063 I PHONE NO: (650)474-1450 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ LIFE SAFETY REPORT Sq. Ft Floor Area: Valuation: $25000 APN Number: 31620075.APL 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(s) 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 authorized 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 Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 15,0K.-I CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # -! P — .�) o _ o L Date: Building Address: 19333 \/AUco?Kjy Mailing Address (if different from building address): t srAn+e Goy P . Are Hazardous Materials being used as part of this project? Yes No ❑ HOA:(Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Owner's Name: Phone #: q-�q_ gq!—) Contractor: Phone: lvS10-896S - 5a3Z 'P%P, Ca,ST�COa\� Fax: Contractor License t 5q4,8444. Cupertino Business License #: 133oz Contact: J VstfN4 yAIA, � Phone: Fax: Residential Commercial Job Description: t 1FE c.�Af-ff� peT og 1 Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Z'6 Occupancy Type: 21�5 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V-B [v]� Valuation: Square Footage: Project Size: Express ❑ Standard E3'— Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.org Revised 07/14/09 S+�. .-- CITY 0, CUPEI�TINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 11313OILERI For the installation or relocation of ea M boiler/compressor to & including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h (29.3kw 1 BBOILER2 Installation /relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption sys over 100,000 Btu/h 1 BBOILER3 Install ation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h 1 BBOILER4 Instal lation/relocation of ea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to & incl 1,750,000 Btu/h 1 BBOILER5 Instal lation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h 113APPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. 1 ELECINSP Other Electrical Inspections (per hour) E 1 MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing & Gas Inspections P (per hour 1 MEETING I HR Application Meeting B 2 of 5