13080165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18880 HOMESTEAD RD CONTRACTOR:ACCO ENGINEERED PERMIT NO: 13080165
SYSTEMS
OWNER'S NAME: CUPERTINO OFFICE PARTNERS LLC 6265 SAN FERNANDO RD DATE ISSUED: 11/12/2013
OWNER'S PHONE: 4085679900 GLENDALE,CA 91201 PHONE NO:(818)244-657I
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License ClassC4 Lic.# �6�q REMOVE/REPLACE(2)ROOFTOP AIR COOLED
CHILLERS AND
Contractor "0 eaeJ, Date 1111-2,113 (3)CHW PUMPS; INSTALL NEW CHW DP SENSOR.
I hereby affirm that I am licensed unde the pro vidns of Chapter 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. Sq.Ft Floor Area: Valuation:$358000
1 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 APN Number:31609037.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 1 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ///2/
granting of this permit. Additionally,the appli t understands and will comply Issued by: Date:`
with all non-point source regulation per the u ertino Municipal Code,Section
9.18.
f ? RE-ROOFS:
Signatureate l 2 /J 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.I2 and the
declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area&.d53
agement District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino oil ,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sc ons 25505,`2
Section 3700 of the Labor Code,for the performance of the work for which this �2
permit is issued. Owner or authorized age Date:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
PROJECT DATA - COMMERCIAL—
COMMUNITY
OIVMERCIALCOMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTI NO (408) 777-3228• FAX(408) 777-3333 • building aQcupertino.org
PROJECT ADDRESS � t �� ^� APN#
OWNER NAME � PHONE �o �� -� ® E-MAIL
STREET ADDRESS CITY, STATE,ZIPS FAX
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CONTACT NAME PHONE E-MAIL
ka- (4! S1 s7-6 dem1e:?--@a le.cam
STREET ADDRESS CITY,STATE, ZIP FAX
119
D O N. � e. -rtoLf
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❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCF cT ❑ ENGINEER ❑ DEVELOPER tIntNANT
TENANT CONTACT NAME PHONE E MA L
b� cc 2 415 V.S-
BUSINESS NAME
(� ��, r �he FAX
BUILDING OR TENANT SPACE DIMENSIONS S'n .Sr .2' °-e-S
.DESCRIPTION OF WORK: 40
.
ee
EXISTING USE(S): PROPOSED USE(S):
OCCUPANCY(S): � OCCUPANT TYPE OF Q
LOAD: CONSTRUCTION
AREA OF FLOOR(S) HAZARDOUS
REMODEL SPACE: IV �" OF REMODEL SPACE: LD MATERIALS? Y N
FIREy N WUI Y N FLOOD Yq. siESMIc y N
SPRINKLERS: AREA: AREA: AREA:
f
1 e)c IS Kit)- NUMBER OF CHILDREN<2 YRS OLD:
LEARNING CENTERS AND 24
NUMBER OF STUDENTS>=2 YRS OLD UP TO 12TH GRADE: 0
EDUCATIONAL OPERATIONS: HOURS CARE? Y 0 NUMBER OF ADULT CLIENTS:
slQ
N1 NUMBER OF EMPLOYEES:)(. O TOTAL OCCUPANTS:
Governing Codes: 2010 California Building Code (based on the 2009 International Building Code)
2010 California Residential Code(based on the 2009 International Residential Code)
2010 California Plumbing Code (based on the 2009 Uniform Plumbing Code)
2010 California Mechanical Code(based on the 2009 Uniform Mechanical Code)
2010 California Electrical Code (based on the 2009 International Electrical Code)
2010 California Energy Code
2010 California Green Building Standards Code
Cupertino Municipal Code
ProjectData-CommerciaLdoc revised 12/01/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 18880 HOMESTEAD RD DATE: 08/22/2013 REVIEWED BY: MELISSA
APN: 316 09 037 BP#: � �d� 'VALUATION: 1$358,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: FURN/A
WORK REMOVE & REPLACE 2 ROOFTOP AIR COOLED CHILLERS & 3 CHILLED WATER PUMPS. ADD
SCOPE (N) & FREQUENCY DRIVES
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Cooling System 1MCRAA 1 # $139
TOTALS: $139.00
Mech.Plan Check0,0 hrs $0.00 Phunb. P/cm Check E/ec..P/un Cherk
Mech.Permit Fee: IMPERMIT Phamh. Permit Free: lilec'. Permit Fee:
Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Offier Elce.Insp. ET
Alech.Insp.Fee: Plumb. Inst. Fee: Elec.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.). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn'l info,
FEE ITEMS(Fee Resolution 11-053 E(f. 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check
S'arppl. .PC Fee
PME Plan Check: $0.00
Penn it.Fee:
Supp/.Insp Fee
PME Unit Fee: $139.00
PME Permit Fee: $47.00
Constr uction I nr: 1-T
Administrative Fee: 1ADMIN $44.00
Work Without Permit? Yes E) No $0.00
Advanced Planning,h'ees:
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion Fee: 1BSEISMICO $75.18 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $15.00
SUBTOTALS: $367.18 $0.00 TOTAL FEE: $367.18
Revised: 07/01/2013