B-2017-0419 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0419
19333 VALLCO PKWY CUPERTINO,CA 95014-2506(316 20 075) NOVO
CONSTRUCTION INC
MENLO PARK,CA
94025
OWNER'S NAME: APPLEI DATE ISSUED:03/14/2017
OWNER'S PHONE:408-974-4551 PHONE NO:(650)701-1500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#791022 X BLDG _ELECT _PLUMB
Contractor NOVO CONSTRUCTION INC Date 02/28/2019
MECH RESIDENTIAL X COMMERCIAL
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. JOB DESCRIPTION:
TI.-APPLE-FIRST FLOOR LAB#A183 (795 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
Y 'i. I have and will maintain Worker's Compensation Insurance,as provided for by
..a-/ Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$300000.00
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 316 20 075 B(Tenant Improvements)
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 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,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur A'/ Date 03-14-2017 Issued by:Kim Dunbar
Date:03/14/2017
OWNER-BUILDER DECLARATION
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 roofmg 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:03-14-2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I 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. I certify that in the performance of the work for which this permit is issued,I Health 8z 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 shall
be deemed revoked. Owner or authorized agent,:, ,
APPLICANT CERTIFICATION Date:03-14-2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
I hereby affirm
correct.I agree to comply with all city and county ordinances and state laws that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
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 ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 03-14-2017 Professional
ei-N\a / CONSTRUCTION PERMIT APPLICATION
B
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
41.15.4, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a.cupertino.org b,2011, oq 1 of
CUPERTINO
0 NEW CONSTRUCTION 0 ADDITION . ALTERATION( )0 REVISION/DEFERRED ORIGINAL PERMIT I
PROJECT ADDRESS 19333 Vallco Pkwy, Cupertion APN# 3167.:, ,2t.)...,.. 0 .,5,--
"NE""R Apple Inc '1'408-974-5951 E-MAIL emolloy@apple.com
STREET ADDRESS 1 Infinite. Loop CITY, STATE,ZIP Cupertino, CA 95014 FAX
CONTACT NAME Skyler Murphy PHONE 831-246-1583 E-MAIL
smurphy@novoconstruction.com
STREET ADDRESS 1460 O'Brien Dr CITY,STATE,ZIP Menlo Park, CA 94025 FAX
Ei OWNER 0 OWNER-BUTLDER 0 OWNER AGENT ...)<CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME Skyler Murphy LICENSE NUMBER 791022 LICENSE TYPE
B BUS.LIC g.9, f
COMPANY NAME Novo Construction E-MAIL smurphy@novoconstruction.com FAX
STREET ADDRESS 1460 Obrien Dr CITY,STATE,ZIP Menlo Park, CA 94025 PHONE
ARCFI1TECT/ENGINEER NAME Scott Colson LICENSE NUMBER C-20117 BUS.LICE
COMPANY NAME H GA E-MAIL scolson@hga.com FAX
STREET ADDRESS 96 North Second St. CITY,STATE,ZIP San Jose, CA. 95113 PHONE 408-288-7833
DESCRIPTION OF WORK
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EXISTING USE PROPOSED USE CONSTR.TYPE i4 STORIES
I USE TYPE OCC, SQ.FT. VALUATION(5)
EXISTO NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA $300,000.00
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH
0 ATTACH
k DwuriNG uNrrs; is A SECOND UNIT DYES SECOND STORY 0 YES
BEING ADDED? ONO ADDITION? ONO
PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS THE BLDG AN DYES RE D H TOTAL VALUATION:
PLANNING APPLE ONO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO L ' $300,000.00
By my signature below,I certify to each of the following: I sin the property owner or authorized agent to act on the property owner's behalf. I have read this
application,and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to,12.114dini,conitruction. I authorize r presentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: (----7fre-. Date:
SUPPLEMENTAL INFORMATION REQUIREI'l PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
El,OVER-THE-COUNTER CI BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. CI EXPRESS 0 PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD CI PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
0 LARGE 0 FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
0 MAJOR 0 SANITARY SEWER DISTRICT
submittal of Building Permit application.
0 ENVIRONMENTAL tfEALTH
BldgApp_2011.doc revised 06/21/11