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11110116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10600 N TANTAU AVE CONTRACTOR:XL CONSTRUCTION PERMIT NO: 11110 116 OWNER'S NAME: 10590 TANTAU INVS LLC 851 BUCKEYE CT DATE ISSUED: 12/15/2011 OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)240-6000 ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Li..a �;_q-7 4P r r r 11 MECH RESIDENTIAL COMMERCIAL Contractor " �L C o n s T('L...a.o yl Date a 2 lg l l 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APPLE-ADD TWO(2)NEW CHAMBERS AND RELOCATE (commencing with Section 7000)of Division 3 of the Business&Professions TO Code and that my license is in full force and effect. EXISTING CHAMBERS AT COMMERCIAL BUILDING**CHAMBER EQUIPMENT IS PRE-MANUFACTURED(2240SQFT) I hereby affirm under penalty of perjury one of the following two declarations: 1 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. Sq.Ft Floor Area: Valuation:$150000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31618035.10600 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. �J Signature Date Z �S Issued Date! C` 5/ ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without firs(obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Ow or ized gent: Date: / 1 20, �Z s APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE'CUPERTINO, CA 95014-3255 (, (408)777-3228' FAX(408)777-3333'buildingCa)cupertino.org CUPERI'INO PROJECT AD CONSTRUCTION ❑ ADDITION }{❑ ALTERATION/TI ❑ REVISION/DEFER RED ORIGINAL PERMIT# ill 0 OWNER NAME Apple c 4 0 8 . 9 9 6 .1010 E-MAIL STREET ADDRESS 1 Iup e , CA 9 5 014 FAX CONTACT NAME Jerod Creese PHONE 408 .240 .6000 E-MAII Icreese@xlconst.com STREErADDRESS 851 Buckeye Court CITY,STATE,ZIP Milpitas, CA 95035 FAX 408 .240 .6001 ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME J e rod C r e e s e LICENSE NUMBER 647480 LICENSE TYPE B BUS.LIC# 21836 COMPANYNAME XL Construction E-MAIL jcreese@xlconst.com FAX 408 .240 . 6001 STREETADDRESs 851 Buckeye Court CrrY,STATE,ZIPMilpitas, CA 95035 PHONE408 .240 . 6000 ARCHITECT/ENGINEER NAME David Sabalvaro LICENSE NUMBER C-015925 BUS.LIC# COMPANYNAME Studios Arch E-MAIL FAX 415 .398 .3829 STREET ADDREss 4 0 5 Howard St Suite 588 CITY,STE,ZIP PHONE 415 . 398 . 7575 gan Francisco, CA 94105 DESC ON OF WORK11 I -It A.o, O� M� OGQT � 1 U JO -N �OCA m n&,A) t Marv, re,l oca ►S re,—Mgh\A cj\.Ar EXISTINGE PROPOSED USE CON E #STORIES USE \•/TYPEOC�JCC. SQ�.FT. 1VALUATION�(S) EG^ NEW FLOOR DEMO TOTAL AREA AREA21 NET AREA(IG BATHROOM N/A KITCHEN OTHER D REMODELAREA REMODELAREAN/A REMODELAREA N/A PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAG AREA: DETACH N/A N A N/A N/FA [:I ATTACH #DWELLING UNTTSN IS A SECOND YES /A BEING ADDED. rf ®NO ADDITION' �O PRE-APPLICATION Q YES IF YES,PROVIDE COPY OF IS THE BLDG ANQ YES RECEIVED BY: /+ TOTAL V 150 _Sj�4oTIO PLANNINGAPPL# NO PLANNING APPROVAL LETTER EICHLER HOME! YC 5 WI NO J -Bymy-§ignature below certify'to eaach of the-following: I am the property owner or authorized agent to act on-the-property owner's-behal£-1havereadthis application and the information I have provided is correct. I have read the Description.of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating t Z in nstruction. I author epresentatives of Cupertino to enter the above-i ntifie property for inspection purposes. Signature of Applicant/Ag( Date: SUPPLEMENTAL tFORMATIbN UIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. �❑ EXP�� I� PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure SLS TANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. El �� LARGE I� FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ElMAJoR ❑ SANITARY SEWERDISTRICr submittal of Building Permit application. ❑ ENVntONMENTAL HEALTH BldgApp_201 Ldoc revised 06/21/11