11040012CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 19333 VALLCO PKWY
OWNER'S NAME: APPLE INC
OWNER'S PHONE: 4089745951
11 LICENSED CONTRACTOR'S DECLARATION
License Class ejg Lie. # S '9 1
Contractor Date, fiAv
I hereby affirm that I am licensed under the provisions of C 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.
I have and will maintain Worker's Compensation Insurance, as provid or by
Section 3700 of the Labor Code, for the performance of the work for Mhiorthis
permit is issued. �F j,
APPLICANT CERTIFICATION ' I certify that I have read this application and state that the above i o ation is
correct. I agree to comply with all city and county ordinances and 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
0 OW`ER-B�LDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
permit is issued.
I 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, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9,18,
CONTRACTOR: DPR CONSTRUCTION INC PERMIT NO: 11040012
1450 VETERANS BLVD DATE ISSUED: 05/19/2011
REDWOOD CITY, CA 94063
BUILDING PERMIT INFO: BLDG I
PHONE NO: (650)474-1450
I— r—
ELECT PLUMB'
MECH r— RESIDENTIAL F COMMERCIAL F
JOB DESCRIPTION: SITE ACCESS, CONSTRUCTION OF NEW ACCESIBLE
WALKWAY
AND CURB RAMPS. MINOR PAVEMENT CONFORMS AND
LANDSCAPING MODIFICATIONS, EXTERIOR ONLY
Sq. Ft Floor Area: I Valuation: $67339
APN Number: 31620075.00 1 Occupancy Type:
KQ V I so I "In w- 111
e VUB 1XW&1J of t"010 I W.33
Issued by:
Date:
RE -ROOFS:
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.
Signature of
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505,25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505,25533, and 25534.
Owner or authorized agent:
te:X A
NSTRUCTION LENDING AGENCY
, �01
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (See. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTITIO
It= FVV F_qTI1,r,&T*V, — W-Tx14-A)1VG _)11V1S1*'V
19333 vallco prkwy.
im
04104/2011
REVIEWED BY: bobs.
JADDRESS:
APN:
I BP#: 11040012
'VALUATION:
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
Commercial Building
USE:
I Ll
PENTAMATION IGENCOM
PERMIT TYPE:
WORK
site access. upgrades for exterior oniv, landscape modificatio.
SCOPE
F"',71uh, lluvm�,, Fee,:
k.,:xr, AzTee
NOTE: These fees are based on the Prellminary information available and are only an estimate. Contact the Dept for adan 11 info.
FEE ITEMS (Eee Resolution 09-051 Eff
7/1/10)
FEE
QTY/FEE I
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes
E) No
$0.00
hours Plan Check, Hourly
Suppl. PC Fee: E) Reg. 0 OT
0_._0_
hrs
$0,00
$504.0
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. C OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i�,.,fiow T".YX
Acoustical Fee: 0 Yes
0 No
$0.00
0
Work Without Pen -nit? 0 Yes
0 No
$0.00
G)
Planning Fee:
$0.00
Select a Non -Residential
E)
Building or Structure
A
Stror�:M:otion Fee: IBSEISMCO
$14.14
2.0
hrs
Inspections
Bldg 'Stds Commission Fee:
IBCBSC
$3.00
$252.00
iiNspmis Standard Inspections
SUBTCITALSz
$17.14
$756.00
T
$773.14
Revised: 01/15/2011