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11120014CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:I#RESULTS WAY I CONTRACTOR: XL CONSTRUCTION I PERMIT NO: 11120014 OWNER'S NAME: EMBARCADERO CAPITAL PARTNERS 1851 BUCKEYE CT I DATE ISSUED: 12/01/2011 1 OWNER'S PHONE: 4089961010 I MILPITAS, CA 95035 I PHONE NO: (408) 240-6000 1 LICENSED CONTRACTOR,'St DECLARATION License Class Lic. # �`-'� Contractor ((7phi Date I hereby affirm that I am licensed under the provisions o Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 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 permit is issued. Ap 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 whi may acc ag ' st said City in consequence of the granting of this p �t dditiona , th plicant understands and will comply with all non-poso regulat' s pe a Cupertino Municipal Code, Section 9.18. - Signature, ❑ /A OWNER-BUYLDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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. BUILDING PERMIT INFO: BLDG F ELECT F PLUMB I— MECH F_ RESIDENTIAL F_ COMMERCIAL T_ JOB DESCRIPTION: APPLE - BLDG 12 - SHORING UNDERPINNING FOR A NEW 650SQFT LOBBY AT BLDG 12 Sq. Ft Floor Area: I Valuation: $70000 APN Number: 357200400 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Dater/`'��l 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. I 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 e me44 tq Bay Area Air Quality Management District I will maintain cop pliance t th upertino Municipal Code, Chapter 9.12 and the HealthA �jtl'ety Cod cti s 25505, 25533, and 25534. Dater CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Hork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shal I be used as public records. Signature Date Licensed Professional FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 14esults way bldg 12 DATE: REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$70,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: PENTAMATION 1GENCOM PERMIT TYPE: WORK shorinq?underpinninq for a new 650 s.f. lobby. SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the orelininary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (lee Resolution 11-053 L . 7/11Hl FEE QTYIFEE MISC ITEMS Plan Check Fee: $0.00 F 1-1 # $783.00 Foundation Repair IFOUNDREPA Suppl. PC Fee: Q Reg. OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.S Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: _T7 $0.00 f�/rriir�r.tirrrtr� e i Fez Q 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 ?;~ervrl i7ocl��r nr rti:�;r f: Strong Motion Fee: IBSEISMICO $14.70 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $3.00 SUBTOTALS:1 $17.70 $783.00 TOTAL FEE: $800.70 Revised: 10101 /2011 CUPERTINO IAA 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 ❑ NEW CONSTRUCTION ❑ ADDITION © ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECrADDRESS 1hResults Way Building 12 APNn OWNERNAME Apple Inc PHONE 404Q/l1i �........ STREET ADDRESS 1 Infinite Loop CITY, STATE, ZIP Cupertino, CA 95014 FAX CONTACT NAME Marco Innocenti PHONE 408 .240. 6000 F-MALL minnocenti®xlconst.com STREETADDRESS 851 Buckeye Court CITY,STATE, ZIP Milpitas, CA 95035 FAX 408 . 240 . 6001 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT M CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Marco Innocenti LICENSE NUMBER 6 4 7 4 8 0 LICENSE TYPE B BUS. LIC # 21836 COMPANYNAME XL Construction E-MAIL minnocenti®xlconst.com FAX 408.240.6001 STREETADDRESS 851 Buckeye Court CITY, STATE, ZIP Milpitas, CA 95035 PHONE408.240.6000 ARCHIT-ECTIENGINEER NAME David S ab a lva ro LICENSE NUMBER C - 015 9 2 5 BUS. LIC # COMPANYNAME Studios Arch E-MAIIcrossman@studiosarch. COM FAX 415 . 398 . 3829 STREETADDRESs405 Howard St Suite 588 c�•sTPFrancisco, CA 94105 an PHONE415.398.7575 DESCRIPTION OF WORK Scope of work consists of shoring/underpinning for a new 650sf lobby at Building 12. This permit will be pulled for the shoring/underpinni previously included in Building Permit #11110047. EXISTING USE Business Group B PROPOSED USE CONSTR. Business Group B III TYPE FR # STORIES 1 USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG AREA 31, 077 NEW A O, AREA 0 7 7 DEMO AREA 0 TOTAL 3 1 O 7 7 NET AREA ���,�i[l//i BATHROOM N/A KITCHEN /A OTHER N/A REMODEL AREA REMODEL AREAN REMODEL AREA PORNAA DEN/AA RCH AREA TOTAL DNA GAIN�AA: ❑DETACH ATTACH #DWELLING UNITS-N /A IS A SECOND UNITYES BEING ADDED. NOS ADDIT ON'SECONDORY ENO ® PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # MNO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME! ENO RECEIVED BY: TOTAL VALUATION: $ 7 O 0 0 0 By my signature below, I certify to each of a fo wing: perty o r or authorized agent to act on the property owner's behalf. I have read this application and the information I have pro d s correct. he Des Tption of Workand verify it is accurate. I agree to comply with all applicable local 1haved ordinances and state laws relating to bui ' g nstruction. repr ives of Cupertino to enter the above-identifie property for inspection purposes. Signature of Applicant/Agent: Date: QLII SUPPLEMENTA ATION7dolition PLAN c-HFCK TYPE ROUTING SLIP LOVER DING _ New SFD or Multifamily dw llings: Apply for permit for existing building(s). Demolition permit is required p to issuance of building -THE -COUNTER PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD El PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR El SANITARY SEWER DISTRICT' submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BIdgApp_2011.doc revised 06/21/11