13020035 C_I.TY OF'CUPERTINO BUILDING PERIyIIT
BUICD.ING,AD.DRESS: 5 INFINITE',L-6013 FLR 3 CONTRACTOR:,NOVO CONSTRUCTION PERiNIFF'N'O: 13020035
O.NER:'S NAME- APPLE INC 1460 O'BRIEN,DR, DATE.', ISSUED:,05/,23/20'13
:OWN'ER'S PHONE; 65033983.38 MENLOpARK,CA 94025 PHONE NO:(650)701-1500
LICENSEMCONTRACT,OWS DECLARATION r F
BUILDING PER'MIT•INFO:, BLDG ELECT PLUMB'
'License Class Lic..#'
MECM RESIDENTIAL COMMERCIAL
Contractor Date
liereb''',affirm thaf.l anrlicensed under'th'e provrsions4of Chapter 9 JOB DESCRIPTION APPL'L--NORTH.PORTION OF'3RD FI..R:'1�3854SF.
(commencing with Section 7000)of Division•3;of the Business kProfessi'ons
INTERIOR"f,:l.TO COMPLETE OFFICE&LAB:SPACCS,A[�D
Code;and that;my,license is'in full effect;and effecCON FERI NCE:ROOMS&�BRE'AK ROOMS(E).MEP S&FIRE"
5/30/2013-REVISION#'I-REMOVING WALLS'TO 400 SQ PT"GROM:SCOPE OF
1 hereby affr.rm.under penalty of,perjury one,ofthe following[«&(declaration_s: WOkk-ISSD OTC_ 540/2013
I:havc'gand;will maintaiwa.certificate of consent to.self-insure for-Worker's-•
Compensation,.asprov'ided.forby Section 3700 ofthe Labor Code,for_he
performance,ofth'e work,for which this pennit•is issued.
I`..havcEand will maintain''Woiker's Compensation Insurance,as provided for by Sq,FLFIo'or Area: Valuation:,$1500000'
Section:3700 ofthe.LaborCodc,for the performance!of the work for whiidvtliis
permit,'is issued.
APN!N'umber,:.3;16021'09..FL.R-3 Occupancy Type:
APPLICANT CERTIFICATION
.I certify"that 1 have read this application,andatate;that the above information:is
;correct. I agree.toicomply with alleity'•and,county ordinances,andstatc laws,relating
tobuilding construction;and,hcreby authorize,representatives ofihistcity;to,enter PERMIT'EXPIRES IF WORK-ISNOT STARTED
upon thcabove mcntioncd property for inspection purposes. (We)agrecjo save
�indcmnifyandkeep harmless the City of Cupertih&agatns[=liabilities;judgments, WITHIN 180 DAYS OF PERMITISSUANCE. OR
costs+atid,ezpenses whtcl9•may accrue dgamsLsaid Gtyin consequenec•oE,thc 180 DAY'S,FROM LAST CALLED INSPECTION.
`grantm'g"bfthis permit. Additionally, [Wapplicant understands and will comply
wiiha)I no`n-point source regulations per the Cupertino!Municipal'Code;^Section
9.18. Issued.by: Dater
S igmqure- Date
❑ OWNER-BUILDER-DECLARATION RE-ROOFS:
Afl roofs shall be inspected`prior to any(00ling-material being installed )f a roof is
;1 hereby affirm that 1"am exempt.from the Contractor':sticense Law,for one of installed without first,obtamning,an inspection,I agree to remove all new materials I'm
the following,two reasonsa inspection..
I,as owner'of[he,property;or,my employees with wages;as their sole compensation,
will.do the work,and the sfructurc,i's riot,intended or'offered:for'salc(S6c.7044,. Signature of A,pplicanL Data.
Ausiness&,ProfessionsGode),
construct the projt(Sec 7044,Busincss�&Professions,:Code) sto
I,as.owner of the ro ertusivelcontractin with hcensed,conGactor
AL1;HOOF COVE BE CLASS",.v OWBI-1
e ;,am exclEER
I hereby affirm under penal ty'of'perjury,one of the following',three,
declarations: ILAZARDOUS MATERIALS DISCLOSURE
I have�and will maint6ima Certificate ofC-onsentto,self-insuretfor°Worker's I liavc read the fiazardous'rroaferials requirements under Chapter 6'95 of the
Compensation,,as provided fo'rby'Section 37.00:of the,C'abor,Code>.for,the Califonnia.Flealth&Safety.Code,=Seetions 25505„25533,and 25534. ,1 will maintain
•p_ k-for't,which s e_rmit?is�i'ssued, compliance-wiih the,Cuper,"iti'no Nlunic,ipal Code,Chapter 9.12a_ndthe Health&•
1 have and wtllaiiaintam Worker s,Co p
-, tfi i
er orinance,o t, c wor, fitperisa[ion.ln"suratice,as p'r6vide8'for by Safety Cirde Sectiont25531(a)should I store orhandle Fiala,dbus'matci:ial.
GSection'3700 ofthe Labor Code;,for he,pertormance,ofthe�woik for which this Additionally;should I use'equiprnent,or devices which emit ha ardous;air.
eririiYis issued. contarnivants,as defined bythe Bay Area Air Quality Management nistrici,l will
P
maintain complianceHith(he'Cupertino Municipal Code,Chapter 9.12 and the
1 cegif�thatjiijhetperformaaccsof the work-forwh'ich,this'permit•isrfssued,I shall Health&Safety Code,Sections 25505,25533,and.25534.
,not employ'any'person in.any'manner so as'to`become sulijcct to the Worker's
Compensation laws of California. 1175,after makingthis ceftificat6,`dfcxcrrfption, I Owner pr au ihbr,ized;agent:
become;subjectto the Worker°s Compensationprovis_ions oftfie Labor`Code;I„must nate:
forthwith comply With such_pfovisions or this.permicshall be deemed revoked.
CONSTRUCTION' LENDING "LGENCI'
APPLICANT CERTIFICATION. ]:,hereby affirrn`that•there is alconstruction:lending agency for the performance of work's
I ccrti” pp tc tha
a formation is forwhichafiis perinit;is issued(Sec.3097,;Civ°C.)
ty thaGl:have�rcad;this)a� licationand sta, t the above to
correct.'I;agree:to comply witfi.all city and county ordinan,ces and state laws iclating Lender's Name.
to building construction and`hereby�4Lghori7.e representativcs oFihis city toenter
upon the above mentioned property for-in- pectionpurposes.,(We)agree to,save Lender's A"ddeess•
indemnify and keep harmlessalic City%ofCupeitino against liabihties""_Ipdg`nicnts
costs and expenses which m*a'y-,accrue against said City in eonsequcnc6ofthe
' ' _ ARCH►TECt'S DECLARATION
gamiofth!s permit.Addttionall,Y,theapplicantundcrstands and will.com Iy
With'aIl0on point source:regulations"per the Cupertino Municipal Code,Section, I uMe"rstand n ypl'ans,shall be used as public records.
9:18.
LicensedProfessional
Signature Date
- . 'CITV0F'CUPE'RTINO BUILDING PERMIT
BUILDINGADDRESSi 5 fNFINITEIO�
OP FLR=3 CONT_RACTORaNOUO'CONSTR(iCTION PERMIT NO: 13020035
OWNER'S.NAME: CAMPUS HOLDING INC 1460'O'BRIEN°DR DATE ISSUED;05_/23/2013
OWNER'S"'PHONE: 6503398338• MENLO PARK,CA,94025' PHONE;NO (650)701-1500
❑, LICENSED CONTRACTOR'S-DECLARATION JOB,DESCRIP-TION:•AESI-DENTIAL,EJ COMMERCIALE]
Lic' se•Class Lic.# ` '2 APPLE NORTH PORTION'OF'3RD FLR, 13854SF:•
Z '2A/ INTERIOR'T;I TO COMPLETE OFFICE& LAB SPACES,
Contractor&6110 6Ig5rf2?VL;;04. Date. / ADD
Lhereby af6rm,tha't l.a-m licensed under the,;provisions of, 'apter 9 CONFERENCE ROOMS 8i'BREAK'ROOIVIS:(E)MEP'S&
(commencing with ed7000)?of.DiiWon 3 of the Business?&Professions FIRE
Code,and that my-license.is°in,fullforce andzeffect.
Thereby affirm'.'ander penatty�of„perjury one of ihe.following two declarations:
I,have.and will maintain a certificate4c_onsent'to Workers
Compen"sahon,:as provided'for by Se'ciion,3,700 of the Labor Code,forthe
perforrnance of the work forwhich this permit is issued. Sq:Ft.Floor Area:; Veluation::$I500000
[.have and will maintain Worker's Compensation lnsurance.,as,provided;for by
Section3,700`ofthe Laiior Code,for the performance"ofthe work.forwh'ich,this
perm,, iJs°issued..
APN Number;31602109iELR3 Occupancy
APPLICANT CERTIFICATION
`,certify that[have Tad•this aOplicatioii andistate that:the.above,,information,is PERMIT EXPIRES IF WORKJS NOT'STARTED
correct.]agree to complywith all cityand,county'ordinances and state laws�relating
WITHIN 180•DA PERMIT ISSUANCE OR'.
4o bmldnig construction,an hereby authorize`representatives of this city,t-o enter, _
:upon the above mentioned,property,Por inspection purposes (We)agree t- save 180'DAY _ S' CALLED INSPECTION.
�indeinnify and',keep;harmless-the City,ofCupertmo against`habilities,judgments,
'costs,and expenses.whichrmay accrue against said.City in consequence?of the
rantin of this• grmrt Additionally',thelicant understands and will,com I I e Date: 2� 3
w. tha1To4.point souice:r`eguI tion— Cupertino'Municipal Code,;Section
9.,118'
RE-ROOFS-
S_,ignatur Date All<roofs"shall Be'inspected prior toany roofing material being installed. If"a roof is
installed:without frst,obtaining ap inspection,I;agree`to removes[[new;materials for
inspection.
D` OWNER-BUIL_DERDECLARATION__:.
Signature;of Applicant`s Date:
i_hereby affirmIthat,I`arn exempt from ihe^Con tracfor's`Licens_a Law for one,of
the-following;two reasons:
A'LL,ROOF•COVERINGS TO BE CLASS'"A"OR-BETTER
I;,,as:owner f'the property„or my°employees:with wages;as theirasolescompensation,
wiltdo;the work;and the structure,ismot intended or offered for:sale(Sec.7044,,
Business&Professions Code)
I,,as owner of the_.propgrty,am e_zclusively,contracting withxlicensed contractors to HAZARDOUSI'MATERIAIS`DISCLOSURE
construct the.pro'
ject(Sec.7044,Business`&Professions Code). Lhave read the hazardousmater als requirements under'Chapfen6.95 of the
California Health-&,Safety Code;,Seetions 25505,125533,and,,25534: '1 will
1 hereby afii'rm under penalty of; _erju . one,of thesfollowin ;three,
P ty P. _ rY. g maintain compliance with the Cupertino Municipal,Code,Chapfer,9.12 and the
declarations: `
Health&c Safety Code,Section 25532(a)should,I store or handle hazardous
1have and will.maintam a Certificate of Coiisent.to.seff-insure for Worker s. material. Additionally;should;]use equipment or devices which e_mrt Hazardous
'C dirioensation,as
provided,for by Section 3.7.00'of the Labor Code,for the air contaminants as de5ned-by theBay Area A�r`Quality_Managetnent District.I
performance of the work•for,wh:ch�thispeiruit;is issued. will Mai tyith the;Cupc' no Co e;,Chapter 9 lZand:
' ..i'ave•and.will:maintain Worker's�Compensationrinsurarrce,.as provided for,by the Health&•Safety`Code;Sections 25505, 55 ,t n_255
Section;3700 of:the:LaborCode,.for:tlie,performance,of the work for,which this
O.wner-or;auihorized-age` Date: 5A;// _
permit is;issued'.
P
1 c_ertifythatfimthe erformance%of the work;for whi'ch,this,permit=i's<is"sued;L§hall
,notemploy any,person IIwanymanner so as td.become,subject to the Worker's
C_omperisation;laws of California. 1f„after making4his certificate of exemption;,`[ CONSTRUCTION LENDING.AGENCY
become subject to the Worker's Cornpensat
ion:provisions of the:Labor Code;,Lmusf .I hereby'affirm that there is a construction le
nding,agency for,the perforinance'ofl
to rt,hwith•cornply with such,provis ions or this perm itshal1,be•deeincd:revoked. work'sor which,this permit is_,issued(Sec:3097,Civ C.)
work s,
Lender's Name -
2 APPLICANT CERTIFICATION Lender'sAddress
1 ceitify tharl have readitliis application'and,sfate thJulie;above'informafion is
correct,,[agree to:comply with all city,, d;countyordinances and state laws,relating
to-'
o budding con§4u6tioARCHITECT'S'DECLARATION
n and,h&6byauthorize`representatives of this c�ty':to:enter
uponzthe above mentioned;propertyifo"r;mspection purposes (We}"agree o+save
'i�deupp- nifyaandkeep"-harmless;the City of Cupertino against'habilities,judgments, ,
;costs,and expenses which may accrue agamstsaid;City in consequence ofahe, I'uinderstad&my plans shalPbe'used as puNic,records:;
granfIng
;of this.permit,Additioriahy,the applicant understands and'will comply
with all'non pomv§b6rce:iegulations per the Cti ftrfino Municipal Cod-e;,Section Licensed Professional
9.18.
<Signatule -;Date -
MYOF CUPERTINO
�-•. FEE ESTIMATOR•—BUILDTNG DIVISION
F'
V .
ADDRESS: 5•INFINITE,LOOP 3RD FLR DATE:• 02/0:71201.3 REVIEWED BY: ;MEL1 SA,
APN: "316.02 1.09• ` BP#,: *°VAhUATIONc; $1;500,600
*PERMIT TYPE:;, Building Permit, PLAN CHECK TYPE:. Tenanf.lrriprovement
PRIMARY" Commercial Builth PENTAMATION'
USE: ng PERMIT TYPE:, 1'B TI
WORK :APPLE - NORTH PORTION,OF.3RD FLR. IN"fERIOR T.I. TO•COMPLETE OFFICER LAB SPACES
_,'DD
SCOPE ;A - - S. FdRE -
CONFERENCE ROOMS 8i B`REAI<'ROOM (E) MEP`S & SYSTEMS`1NILL BE MODIFIED
TYPE OF FLIZ AREA.
OCCUPANCY TYPE;,` PC FEES PC FEE ID BP FEES BP:FEEID
CONSTR. s.f.
'
B:(T.eriant)riiprovements) II B III-B IV V-B 13,854 $2710::16 IBTIPLNCK $7,461.46 1BTUNSP
TOTALS: 13,854 $2,71016 , $7,4'61 46 a
�MECH OURLY ,a� Yes ,® N°off PLUIVIB .H- OURLI' Yes � No` ELEC HOLT" "
° ..
Vfech: PlaneCheck. i'iiih;b..71u;=C'heck; Flr.c..I'lan'(;h ck -
1-fecfr. T;'ern�it F t�; P,'i.rnth.-PermN.l:ee: Flex. Permit Fce:
other'Vech, Alsp" O!i!'t r A11,1176 lnw.is CIt/ri F Ilec.Insp. Li
Wech.Insp.,Fuv:' an_p!Fere...
NOTE.This'estimafe does not;include fees due,to;o"cher•Departmeints(i.e.•Pla_nniiig,.Public`Works,Eire,Sanitary SewerDistrict, School .
District;etc .' TbeseA ees are.based on they "relimina" ,to ormation available,and are,only,an esliitzate: Coniaci,the,De i' or.iaddn'Cin o.
FEE;ITEIVIS•(Tee-Resolution 11.=1153 Eff`i/1121 FEE QTY/FEE MISC ITEMS
Plan.Check-Fee:. $2,710.16 S'elect,a,;Misc.Bldg/,Stnicture
Su 1.,PC Fee • 'Re OT p;p
Urs or Element of a'.B'uilding
PP g� ® ,' $0.00
PME Plan'Check:; $0.00
Permit,Fee $7,461.46
$Uppl. InspFee. Reg." C) OT 0.0 hrs $0.00
PME Unit,Fee $0.00.
PME Permit Fee!: $0.00
Corrifr-trcli�n Tnx:•
Adrnitiistratrve
Work,Without Permit.? 0 Yes 0, No VIM
.Advanced Planning Fee; $0:00" 'Select a Non-Residential. Q
fi;cr�el l�gc�rtl2enttztr�ri F'�;c ss Building or Structure 0"
i
Strong;Motion Fee: IBSE$R1,CO3 ' '$315.00, :Select an Administrative Item
Vdgr Stds�eommission.Fee: IBCBSC $60:00
��sUBT3oTA�Ls. 1'0,54.6'62 $000 t �ToTLFEE $1i"
.0,546.622.
Revised: 0.1701/2013•