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14070063 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22100 STEVENS CREEK BLVD CONTRACTORr+BH---f6BE PERMIT NO:14070063 DEED OWNER'S NAME: CITY OF CUPERTINO(TANK HOUSE) L DATE ISSUED:07/15/2014 OWNER'S PHONE: 4087773228 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL XA/C REPLACEMENT,ROOF TOP,WEIGHT IS EQUAL OR License Classes�aP C t ic. Q►Jt u 1 ci tt 11 LESS Contractor Pf 1 n e Me_c*L-`,t-aA Date 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$19561 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 APN Number:35710007 01 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 180 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 DAY R LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, ry costs,and expenses which may accrue against said City in consequence of the Issued by: Date: <a Afy 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. �+ RE-ROOFS: Signature Date ? V"l 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: �/6 Date.? /Y 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 GENERAL PERMIT APPLICATION MEP COPVIMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION! 63 10300 TORRE AVENUE•CUPERTINO, CA 85014-3255 (�' 408 777-3228• FAX(4,08)777-3333•building(a.cuDerinO.org ' `�� UI�'�Ri C[,C4 m I ❑PLUDBFATG ❑-im HAI,TIC-kL ❑ELECTRICA-L ❑AUSCELLAhrBOUS PROTECT ADDRESS () o E- P•- w I Ni�.II. STR`Fl f TJDP ES7 I CrrY, STATE,ZIP. I FAX CON ACT N_4ha I PHONE E-14KIL STREF ADDRESS CITY,STAT-E, ZIP FAX ❑ owm-m '❑ OW=,-BLrmm ❑ OA7�r'R. ACEATT ❑ COTTRACTOR ❑C01\7?-RCT0RAGE?rT ❑ A c-mr,-ECT ❑LNGI�r— ❑ D1EL0?ER ❑TEN.ix'T CON-MACTORNAW-- j�/�„y�� I LICMIISF-NuaEP1 I LIMPNSE TYPE I BUS.LIC'I COIJ�ANY NAI✓E / / ��K I E41LAI, I FAX STREET ADDRESS I CITY,STATE,ZIP PHONE ARCHITZ-CT/E''GR\EERN?ily I LICENSENUhm-ER I BUS.LIC' COI/PANYIN4IJE E1JAII I FAX STREET ADDRESS CrrY,STATE,ZIP PHON USE OF ❑SFD or DUPLEX ❑ MULTI-FAM LY PROSECT LN WILDLAND ❑ YES PROTECT IN ❑YES I IS TBE BLDG AN ❑YES BL-II- N.G: ❑COYmmcLSI. I 'URBANN== ACE AREA ❑ NO ( FLOOD ZONE ❑NO EICTILM HOilm? ❑ NO DESCRIPTION OF WORK OC .r ,A-oe «r J 44E L T OTAL V LUATION: I� c � — By ny signature below,I cert'" o each of the following: I am the property o;;izer or authorized a_ent to acto :e property ov„Ier's behalf. I have readthis application and the information I have :a provided is corct. I have read the Description of Work and verify it is ccgate. I agree to comply with all applicable local ordinances and s°ate Lws relatin to b nsiluctiom I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Si--natureof pplicant/kaent: Date: T IS SUPPLEI I;IE.N AL LNTFORI aTION REQTJ=D l� 0 � `COTa3ER - �30 :. SO 1✓EPk7scApp_2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22100 Stevens Creek Blvd. DATE: 07/15/2014 REVIEWED BY: LarryS APN: BP#: *VALUATION: 1$19,561 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY Commercial Building PENTAMATION FURN/AC USE: PERMIT TYPE: WORK 10 ton G/E Trane A/C unit and economizer. Weight is equal or less than existing unit. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (>1 OK cfm) 1 # $143 d TOTALS: $143.00 Mech. Plan Check F0.0 I hrs $0.00 Flurrrlx.I*Iz„r Ciwul, Mech.Permit Fee: IMPERMIT l'irat7a13. of aril('v' Other Mech.Insp. 0.0 hrs $48.00 Other Plurv,17 h7sp, 0r . r_kA., PIut3af3.J77sp.Fere: NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees 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 Eff. 7/1/13, FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $143.00 xPME Permit Fee: - -$48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? jb Yes (E) No $0.00 Ac9 zt€ig € Travel Documentation Fee: ITPA VDoC $48.00 Strong Motion Fee: IBSEISMICO $5.48 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ,.: $2$290.48 $0.00 ” TQ�AL,FEE: ,.. 90.48 Revised: 07/1012014