B-2016-2808CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2808
18920 FORGE DR CUPERTINO, CA 95014-0701(316 09 030)
TRUEBECK
CONSTRUCTION INC
REDWOOD CITY, CA
94065
OWNER'S NAME: APPLE INC
DATE ISSUED: 10/20/2016
OWNER'S PHONE: 408-996-1010
PHONE NO: (650) 227-1957
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class $ Lic. #903798
Contractor TRUEBECK CONSTRUCTION INC Date 09/30/2017
X BLDG _ELECT -PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
MEDICAL TRAILER TO SUPPORT AC2 PROJECT (720 SQ FT).
I hereby affirm under penalty of perjury one of the following two declarations
1. 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.
tkr -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
Sq. Ft Floor Area:
Valuation: $120000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
31609030
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 againstliabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code, Seotior 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Sigriature1��- �.� c . _ Date 10/20/2016
Issued by: Abb�+Ayende
OWNER-BUH,DER DECLARATION""""
Date: 10120/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 10/20/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health &Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code,.Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall7
be deemed revoked.L°
Owner or authorized agent:®A�
t
Date: 10/20/2016 °t
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree.
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal
ARCHITECT'S beused DECLARATION
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 10[20/20,16
Professional
CONSTRUCTION PERMIT APPLICATION
EM,
COMMUNITY DEVELOPMENT DEPARTMENT • ILDIN DIVi$:ION
10300 TORRE AVENUE . CUPERTINO, CA 95014-3255
CU P-ERTisa (40} 7 -3 • F (4 i3} I77-.3333 - tq:rLlcmerrinmarq
NEW CONSTRUCTION n tACRIiTIIIN � AITl=PA 'I''AMi-*r€ � xrxx,•€Eari�r.;n vrrnx: �r�rn:n. . .
:PRf)7EC:T. Di R)~Sc..-. 18920 For .: QriV - 6-(iM3�I. _.
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OWNER r. it Campus Holdings,. Inc.. PTIO IP: 408-996-1(
rnmill l xom
-'S BEET-rADDRESS('€TY,
1 Infinite Loop, MS21-1 AC2.
SIh'f`ki..;r'E€' Fsik :..�...�.... .
Cupertino, CA 95014
CfTlffWT NNAME Mike Vilis
401&783-6665 MITI l lS'41apple-coo
S'TkEilrADDRESS 1 Infinite Loop M521--1 AC.2CITY.STAT13-
Z" Cupertino, CA -95014
FAX -_._
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CONTKAC'd;e,}MNANfL-: t Lj � lrara.(i1C i cf$`�i:
t(t'F'vR%.NUMBER
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P3U5.:LJC"x 34914
903798
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CC3 iPA ` d ilk" Truebeck
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L- IAIL Paul.Ci1nnir3q} am(,�trtlebeck:com
I'AX +_ -
:STR:ETA??RLSS :24 1 Redwood $iCrESPKWY
Redwood Cityr CA 94065
Piit7 vE 650-227"1 95 7
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LIC['NSE-.NUMBER
COMPANY NANJE -
E-MAIL
FAX
STREETA}'3DRYSS.
tiT§. STATE, L?i'
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DESCRIPTION OF WORK RK Site prep fir nne�fical trader to support Apple Cara us 2. Work inclt�cies utility work.and
installation of 1 r eclical trail r<
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-rXISTINfi USE. -
PROE',O%ED USk":. ; . -
C'0?vS�TR.'TY E
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Medical "iri�ile',
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a tw'
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w LtAT10N (5)
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:wRL:A 720 s ft nxF-', 720 sgft
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17201 Clfi
$1201,000
23.4TIIRftt3Pci
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RL4IODEL AREA,
"...Di"AREA
REMf,}#ii:} , tREA
PORCHA€F',A
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TOTAL, DECKPOR.%:E.1_-ARkA;C.e
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UTACTI
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3 - ES PROVIDEOr {C3 i' € iS'LaLF iiL.iat 4Y
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Pi.Y ui€NG €NL+? NO Pd. NI:af+AP€�Rov""'L LEITER 'E'104L.ER Lit5:4T}: NO CT
By Lilt Signature bLlowV I ccrtity to each of the following, lain the [fToper y cixner or authorized agent to act on the prol'«E rty owner,, behalf, i i7'sLk+t fCS#� [iE3
application and have provided 1$ correct i have read the Description of•Work and vcrif it is accurate_ i a�mze;itx CG€Iljti'Y-�'11{l,ftii ��Ti1�iCc�LT�C �4a.u.�
ordiriantY e,.', and .staie, laws re alirdg to Wilding Constr&tioti- i authofte representatives et• Cupertino to enterthe abfi'4Ci0 riledT)NrIvr inspeCtioll pnrpo"es.
.n1i4,±[dalUlL.(3f`Xili2iiL°a9Yif!iil`cl.:. -.:..._..: ____... - .. _� _ .................i}2,te....:.. ._..-...:..._._�
SUPPLEMLNITAL INFORMATION REt Q1RED.
PiA4�q"
New SFD or'Multi#amily dwellings: Apply for demolition peraiit lar
�> QVER-TI COUNTF�
arPr azs Vit . _
"
-. oxisting- buildhig(s), Demolition permit ES ref.]ULTed prior,to issuance of buff(fing
� _ . • -
: : ..
permit .f or nenewbuilt"lin
l�€'
drE--•mm€-:� �:i 'luss_s
ir'*+G' P[.ak<' R%rV[,d"•iX' ..
Commercial Bitigs: Providea. completed Hazardous Materials Disclosure
srLNa'k
form if:any l' azardous .,Matf'-;:.rWs are t5t hig used a'i part of this project.
C'op > of"Planning Appro4`al Getter or Meeting with Planning fine}r to
�. MAJOR
SAVMi32YStwkLL�Ri�J
submittal of Building Perntdt application.
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