12090048 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: ,18920 FORGE DR. CONTRACTOR:THERMA CORP PERMIT NO: 12090048
OWNER'S NAME: APPLE INC 1601 LAS PLUMAS AVE DATE ISSUED:02/21/2013
OWNER'S PHONE: 4152845700 SAN]OSE,CA 95133 PHONE NO:(408)347-3400
I i LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License ClassB.1 - Lir.4 C3�-20 G qy� APPLE-ROOM 507 INSTALL NEW EXHAUST SYSTEM TO
Contractor-7- /gyp/ vt
�.,�, Date Cq_O2 SUPPORT NEW FUME HOOD
1 I
1 hereby affirm that 1 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.
1 hereby affirm under penalty of perjury one of the following two 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 ibis permit is issued. Sq.Ft Floor Area: Valuation:$20000
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 APN Number 31609030.18920 Occupancy Type:
permit is issued.
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 WITHIN 180 DAY IT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS T CALLED INSPECTION.
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 is permit. Additionally,the applicant understands and will comply Iss e: Z
with all n oint source regulations per the Cupertino Municipal Code,Section
9.18.
to of, 4 RE-ROOFS:
Signat a Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,'!agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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)
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
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ' ns 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: d te: 3
['certify that in the performance of the work for which this permit is issued,I shall j;
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If,after making this certificate of exemption,l CONSTRUCTION LENDING AGENCX
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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
1 certify that I have read this application and state that the above information is
correct. 1 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 18920 FORGE DR DATE: 0910712012 REVIEWED BY: MENDEZ
APN: BP#: O 'VALUATION: $20,000
;'PEP-MITTYPE: Building Permit PLAN CHECKTYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1CMAP5
USE: __7PERMIT TYPE:
WORK APPLE- ROOM 507- INSTALL NEW EXHAUST SYSTEM TO SUPPORT NEW FUME HOOD
SCOPE
Mech.Pian Check 4.0 1 hrs $532.00 Phunb. Plan Check F_lec. Plan Ch:ck
IMECPLNCMech, Permit Fee: INIPERMIT Phnnb. Permit Mize: Eh>c. Permir(c<e
Other Mech.Insp. OA hrs $45.00 011ier Plumb Insp. Other lace. Insp.
E17-
illecl). Insp. Fee: Plumb, Cnap. Fee: Elec. Insp. Frac:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are onl an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $133.00 IMCHOOD Hood,Mech. Exhaust
PME Plan Check: $532.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: _FT $45.00
Consiruction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? Yes (j) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $45.00 1
Building or Structure 0
Strong Motion Fee: IBSEISMICO o. 0 Select an Administrative Item
Bldy,Stds Commission Fee: IBCBSC $1.00 ,CN
SUBTOTALS: $669.20 $133.00 TOTAL FEE: .20
Revised: 07/01/2012