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13100070 CITE{ OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10590 N TANTAU AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 13100070 OWNER'S NAME: 10590 TANTAU MVS LLC 851 BUCKEYE CT DATE ISSUED: 10/09/2013 OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)240-6000 AmLICENSED CONTRACTOR' DECLARATION JOB DESCRIPTION. RESIDENTIAL 0 COMMERCIALLI License Class Lic.ff �'_�NMG ADD 2(N)HVAC EQUIPMENT FOR CHAMBER LAB IN(E) yy'� BLDG Contractor rY� Date 1' �^ . 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. 1 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:$148000 t } have and will maintain Worker's Compensation Insurance,as provided for by Rection 3700 of the Labor Code,for the performance of the work for which this APN Number:31618035.10590 Occupancy e: permit is issued. p y Typ APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 18Q DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save I$a DA T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, eosts,and expenses which may accrue against said City in consequence of the granting of this nm Additionally,the applicant understands and will comply with all non16 1 h la nt so regulations per the Cupertino Municipal Code,Section 9.18. Signature � Date ��' ��1i.� 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. ❑ O ER-BUIL ER DECLARATION I hereby affirm that I 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 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOIQS MATERIALS DISCLOSURE construct the project(Scc.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 695 of the California Health&Safety Code,Sections 25505,25533,and 25534. I 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 532(a)shouldI store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,shoal I u e equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as def ncd b the ay Arca Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit the upertirio Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S ctians 5 �rV 53a nd 534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent:, Date: 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,l CONSTRUCTION LENDING AGENCY 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 I 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 stale 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 applieant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. GENERAL PERMIT APPLICATION ��C) MEP ELI] COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION '00 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 `O CUPERTINO (408)777-3228- FAX(408)777-3333-build ingecupertino.om misc \"! [:]PLUMBING MECHANICAL ELECTRICAL // ❑MISCELLANEOUS 9 PROJECT ADDRESS N ' 7NI3 { T.J I S O 3 S� {U S! D vJA o T n t>r 1 TJ ! owNERNAMB ler Tnc. �j PHONE E-MILAIML lioB- CkqCe - IoI O 0.11e�@ o PP1e• Co,,, STREET ADDRESS +/05110 Al' / CITY, STATE,ZIP FAX ZCt��A�1C (-Do C-&Q,(Vm CA �JOI�I CONTACT NAME 11 PHONE H-MAIL Lk a's-Q2-1- ro Z ttOUf [ LCa C' STRELrt'ADDRESS CITY,STATE,ZIP FAX SI eka&k's N 050n15.2uo-Goo i ❑OWNER ❑ OWNER-BUILDFR ❑ OWNERAGENT CONTRAC70R ❑CONIRACTORAGENT ❑ ARc=cr ❑ENGmE'ER ❑ DEVELOPER ❑TENANT 11111A119 LICENSE NUMBER LICENSE TYPE IiUs.LIC ff c Mur hn Gu LlfSo 21�3G COMPANY NAME E-MAE FAX U Qo c" STREETADDRESS CITY,STATE,ZIP PHONE �`3I Q c4.e a cT M� C Q6035 PHONE -24o-Goo ARCHTTEtT/FNGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAEL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF D SFD or DUPLEX ❑ MULTI-FAhIILY PROJECT IN WILDLAND ❑ YEs PROJECT IN ❑YES T77HE BLDG AN ❑YES HUnDING: COMMERCIAL URBAN WTERPACEAREA NO FLOOD TONE I NO ELCIII-ERIIOW NO DESCRIPTION OF WORK `Z G Ta xv — t-r-S, TOTAL VALUATION: tY 4`1$t O O V RECE By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope s behalf I have re application and the informationvu- ordinances e provided is correct. I have read the Description of Work and verify it is accurate. I to comply with ali applicable local and state laws retsbuildingc structi . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/AgentDate: IV/+/13 SUPPLEMENT kt INFORMATION REQUIRED OFFICE USE ONLY W VER-THE-COUNTER �o. �" ❑ V KESS U U pmp� ❑ STANDARD C� ❑ LARGE a• ❑ "OR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10590 N TANTAU AVE DATE: 10/09/2013 REVIEWED BY: MELISSA APN: 316 18 035 BP#: *VALUATION: 1$148,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration 1 Addition I Repair PRIMARY Commercial Building PENTAMATION FURNIAC USE: PERMIT TYPE: 19 WORK ADD 2 N HVAC EQUIPMENT FOR CHAMBER LAB INE BLDG SCOPE APPLIANCE f EQUIP TYPE FEE ID QTY UNITS BP FEES A1C Units (>10K cfm) 2 # $27.8 TOTALS: $278.00 Mech.Plan Check 0.0 hrs $0.00 Pharlb. Plan Check Elea Plan Check Mech.Permit Fee: 1MPERMIT Phanb.Permil Tec: (:lac. Permit Fc e: Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Oder Elec.Insp. MCC/).Insp.Cee: Plualb. hup.Fee: L;lec Insp, Fee: NOTE.This esdinate does not includejees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ea are based on lire relindna in ormation available and are onl an estimate Contact the De t or add 11 in o. FEE ITEMS (Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: Supl,71. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl, Insp Fee PME Unit Fee: $278.00 PME Permit Fee: $47.00 C.onso-action Ta Administrative Fee: (ADMIN $44.00 Work Without Permit? C) Yes (F) No $0.00 advanced Planning Fees•: Travel Documentation Fee: ITRAVDOC $47.00 Strona Motion Fee: 1BSEIS20ICo $31.08 Select an Administrative Item B1dp,Stds Commission Fee:_ IBCBSC $6.00 SUBTOTALS: 1 $453,081 $0.00 TOTAL FEE:T $453.08 Revised: 1010112013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone:408-777-3228 CUPERTINO Fax:X408-77 -3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS:10590 Tantau Ave. PERMIT# 0 OWNER'S NAME:Apple Computers PHONE#408-621-6261 GENERAL CONTRACTOR.-XL Construction BUSINESS LICENSE#21836 ADDRESS:851 Buckeye Ct CITY/Z I PC 0 D E:Milpitas CA 95035 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please cheelc applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Redwood Electric Group 21108 Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass/Glazing Heating United Mechanical 27361 Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal eet Rock Ti e caner I Contractor Signature Date