15100071 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15100071
19191 VALLCO PKWY CUPERTINO CA 95014(316 20 074) CUPERTINO
ELECTRIC INC
SAN JOSE,CA 95112
OWNER'S NAME: (APPLE INC) DATE ISSUED:05/12/2016
OWNER'S PHONE:408 996 1010 PHONE NO:(408)808-8000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#174637
Contractor CUPERTINO ELECTRIC INC Date 08/31/2016 BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
—MECH_RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: INSTALL TEMPORARY GENERATOR(500 KW)-APPLE VPO1
2. 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.
2. 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. Sq.Ft Floor Area: Valuation:$15000.00
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 20 074
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 pplicant understands and will comply with all non-point
source regul o per the Cup 'no Municipal ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
KSignature ate 5/12/2016 Issued by:PAUL O'SULLIVAN o
Date:05/12/2016 $%LuWW1
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 roofing 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 ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:5/12/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALUROOF 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&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate 0f will maintain compliance with the ertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C e,S tions 25505, nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:5/12/2016 kul
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm 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
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. l understand my plans shall be used as public records.
Licensed
Signature Date 5/12/2016 Professional
CITY OF CUPERTINO i 1
FEE ESTIMATOR—BUILDING DIVISION t
�a
ADDRESS: 19191 Vallco Pkwy DATE: 10/08/2015 REVIEWED BY: PAUL
APN: 316 20 074 BP#: EVALUATION: 1$15,000
yPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 CEAP8
WORK Install Temporary Generator 500'Kw -Apple VP01
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Generators 1 BREMPOWER 1 # ° $179
TOTALS: $179.00Laws
m
u z;
11ech, Clan Check Phimh, Plan(Beck Elec.Plan Check 0.0 hrs $0.00
Aleck.Permittee: Phan i P ivnif "ire: Elec.Permit Fee: IEPERMIT
L
9ecli..Z;i,�p. Other Plumb Insp. Other Elec.Insp, 0.0 hrs $48,00nsp Plumb.Insp.Fee: Elea Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These'fees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan£heckc Fee:
PME Plan Check: $0.00
Permil Fee:
AS`rtppL Insp Fey=
PME Unit Fee: $179.00
PME Permit Fee: $48.00
Construction"coon Tax
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes No $0.0.0
Advanc e }Tanning fees:
Travel Documentation Fee: I TRAVDOC $48.00
Strong Motion Fee: IBSEISMICO $4.20 1' Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
r n SUBI`OTAL :_
$325.201' $0.00 fiCTALr=. $325.20
wr .
- Revised: 1010112015