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13070097CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10455 TORRE AVE CONTRACTOR: AIR AND PLUMBING PERMIT NO: 13070097 SYSTEMS OWNER'S NAME: 10455 TORRE AVENUE VENTURE 285 SOBRANTE WAY STE P DATE ISSUED: 07/15/2013 OWNER'S PHONE: 4082525211 SUNNYVALE, CA 94086 PHONE NO: (408) 733-2000 JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALL ❑ LICENSED CONTRACTOR'S DECLARATION License Class Li.. # ©tlZ Li 6 REMOVE AND REPLACE (1) A/C UNIT ON SIDE OF Contracto `/P LJ%/t9 Sate ? S BUILDING I hereby affirm that I am licensed under the provisions 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 Sq. Ft Floor Area: Valuation: $2800 performance of the work for which this permit is issued. 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: 36940009.00 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 0 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 DA OM 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 _ G 3 Date: granting granting of this permit. Additionally, the applicant understands and will comply Issued by: with all non -point source reguja09&feQhe Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signat Date 7 X 3 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I 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 Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2 2553= 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 0 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 CONSTRUCTION LENDING AGENCY 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 8 GENERAL PERMIT APPLICATION MER... COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION (° p ^ IIJJ '10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 q� (408) 771-3228 • FAX (408) 777-3333 • building (a-cul) rtino.org V L misc COPIER?INO \� ❑PLUMBING ' . ' . ❑ MECHANICAL ❑ ELECTRICAL / ,/i , [�❑ MISCELLANEOUS PROJECT APN # l-1 �-� OQ . OWNER NAME /'PHO c ua �GJ ��✓f27/r E-MAIL 41 .FAX � CITY, STATE, ZIP FAX STREET AD 7 Pv—tYj,VP� `L 55 ��r �fii9l-cam CONTACT NAME I' PHONE E-MAIL STREET ADDRESS . CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUIIAER:: ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT _ CONTRACTOR NAME f� / LICENSE NUMBER 2 �6 LICENSE TYPE // L` o BUS. LIC # COMPANY NAME E-MAIL �Q�WY/ v FAX STREET ADDRESS CITY, STATE, ZIP �` �� ` of 1� Vl V J PHO ARCHrrECTIENGINEERINAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESSf " j CITY, STATE, ZIP PHONE USE . OF 1 i . El SFD of DUPLEX ❑ ' MULTI.FAMII,Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN YES BUILDINCr ❑.COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? - ❑ NO DESCRIPTION OF IYORi IIi'iI I i li ,III ii. i I.j!iI ' i TOTAL V By my signature below, I cemfy fo each of the following: I am the property owner or authorized agent to a o e property owner's behalf I have read this application and t{Ie mfomation.I, Have provided is correct I have re Eie f Work and verify it i curate. I agree to comply with all applicable local orduiances and: state.laws relatmg;to building construction. I au ize re ntatives _f Cupertino to enter the above-identified property for inspection purposes. `I,' Signature ofApplicant/Agent it ' I Date: SUPPLEMENTAL INFORMATION REQUIRED = t I: I I I I a illi I it � G I ,. MEPMiscApp 2011.doc revised 06/21/11 ijwl CITY OF CUPERTINO FRR ESTIMATOR - BUILDING DIVISION Mech. Plan Check 10.0 1 hrs $0.00 Phimb. Plun Check Elee. Plan (,heck Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. 0.0 hrs $47.00 Other Plumb Inch.Li Other Elec. Insp. lilech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These ees are based on the prelimina information available and are only an estimate. Contact the Dept -for addn7 info. 1.0455 TORRE AVE DATE: 07/15/2013 REVIEWED BY: Mendez. ,W'ADDRESS: APN: BP#: *VALUATION: 1$2,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building $0.00 PENTAMATION PERMIT TYPE: FURN/A WORK REMOVE AND REPLACE 1 A/C UNIT SCOPE $0.00 Mech. Plan Check 10.0 1 hrs $0.00 Phimb. Plun Check Elee. Plan (,heck Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. 0.0 hrs $47.00 Other Plumb Inch.Li Other Elec. Insp. lilech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These ees are based on the prelimina information available and are only an estimate. Contact the Dept -for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Mechanical $139.00 IBCAIRHA A/C Units (<=10K cfm) Suppl. PC Fee: (E) Reg. 0 OT F676 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 (. onstruction :Tax: Administrative Fee: IADMIN $44.00 E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential 0 Building or Structure Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISAIICO $0.59 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $139.591 $139.00 ISG $278.59 Revised: 07/01/2013 IC)qs5 llwpl�hkv' eA t 9e COMi�lW1 :�::,AFNT DEPAR' BUILDING -CUPERTiNO This eet of r)!Pns and ions MUST be kept at the to make any co lstrur tiara. it ic'unla%�"Iul lob' U r same, or to djvi, 0 a! from the Building Official.them'i -)rn, without 3.PPrcv -,e-,ifications SHALL NOT 'Ing of this pian �nc; s� -�)proval of 1,6 P y ordinance or Sia:�e Law. cf Fj, provisions of any Cit V-1 a - "Y PERMIT NO. r,UPERTNO wilding DePa�ent JuL CODE COMPLIP't4CE REVIEWED FOR 0.4. v? Reviewed BY: -14'4 5^yi4 PJ -(Yl' PLANS C1-J%ECXND D'y -7 N c , G F R.,