11060015 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10600 N TANTAU AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 11060015
OWNER'S NAME: APPLE,INC 851 BUCKEYE CT DATE ISSUED:06/02/2011
O R'S PHONE: 4089744876 MILPITAS,CA 95035 PHONE NO:(408)240-6000
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C Lic.# 6 two MECH r RESIDENTIAL r COMMERCIAL
Contractor �L �'"71 N `l6tj Date (p !1
JOB DESCRIPTION:DEMOLITION COMMERCIAL OFFICEILAB
I hereby affirm that I am licensed under the provisions of Chapter 9 SPACE(21,770SQFT)
(commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL INTERIOR ONLY
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.
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 Sq.Ft Floor Area: Valuation:$200000
permit is issued.
APPLICANT CERTIFICATION APN Number:31618035.10600 Occupancy Type:
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 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and exp e es which may accrue against said City in consequence of the
granting of this rmit. A itionallyp the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-poin source a ulation per the Cupertino Municipal Code,Section
9.18.
/-I,,/t1 Issued by Date:
Signature Date
❑ NER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my'employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. Vich
defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall pl ance h the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's ety Cod ,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this,certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must t rize agent: l
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is m that there is a construction lending agency for the performance of vwrk's
correct.I agree to comply with all city and county ordinances and state laws relating s permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
ups^the above mentioned property for inspection purposes.(We)agree to save .
i nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
c.. .,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional