12100015 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18920 FORGE DR CONTRACTOR:THERMA CORP PERMIT NO: 121000I5
OWNER'S NAME: APPLE INC 1601 LAS PLUMAS AVE DATE ISSUED:02/21/2013
OWNER'S PHONE: 4152845700 SAN JOSE,CA 95133 PHONE NO:(408)347-3400
LICENSED CONTRACTORS/DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIA
License Class �'� Lic.# �/ Q�p Y� INSTALLATION OF EXHAUST SYSTEM TO SUPPORT
a a NEW FUME
Contractor 4�Bate HOOD IN ROOM 507 FOR LASER CUTTING TOOL
I hereby affirm that I am licensed under the provisions of apter 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:
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. 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 WITIIIN 180 DAYS OF PERMIT 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 CALLED INSPECTION.
indemnifyand keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in eonsequence of the granting of this ennit. Additionally,the applicant understands and will comply lss : Date:
with all non-pit source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature ate All roofs shall be inspected prior to any roofing material being installed.if a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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&Profession's Code)
1,as owner of the property,.am exclusively contracting with licensed contractors toHAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). l have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. l will
I 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 I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should l 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 l
performanceof the work for which this permit is issued. will maintain compliance wit he Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain.Worker's Compensation Insurance,as provided for by the Health&Safety Code,S c ons 25505 5 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized age Date.
certify that in the performance of the work for which this permit is issued,1 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,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I 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
I certify that I have read this applieation 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 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 CUPERTINOL�015
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 18920 Forge Drive DATE: 10/02/2012 REVIEWED BY: Sean
AN: BP#: 1 S *VALUATION: 1$20,000
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY Commercial Building PENTAMATION 1CMAP5
USE: PERMIT TYPE: A
WORK Installation of exhausts stem to support new fume hood in room 507 for laser cutting tool.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Hood, Mech. Exhaust 1MCHOOD 1 # $133
TOTA LS: $133.00
Mech.Plan Check 0.0 1 hrs $0.00 Phrmh. Plan Check Flec. Plan Chcak
Mech.Permit Fee: IMPERMIT Phamh. Permit 1'ee: f7ec. Permit Fee:
Other Mech.Insp. Loj
hrs $45.00 Ocher Plumb Insp. 011ier Elec.Insp,
1Viech. Insp. T te, . Phnnb. Insp. 17c,e: Eiec. Insp. Fee:
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 only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolulion 11-053 L . 7/1/112 FEE QTYIFEE MISC ITEMS
Plan Check 1%ee:
SaiPpl. .PC Fee
PME Plan Check: $0.00
Permit Fee:
Supp!. lnsP Fee
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Conslr-tiction Tax:
T I
Administrative Fee: !ADMIN $42.00
Work Without Permit? Yes Q No $0.00
Aclvanr:ecl Phrrrning Fees:
Travel Documentation Fee: ITRA VD0C $45.00
Strong Motion Fee: IBSEISMICO $4.20 Select an Administrative Item
BldP Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $270.20 $0.00 TOTAL FEE: $270.20
Revised: 07/01/2012