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15110139CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10050 N WOLFE RD CONTRACTOR: BAY ATR SYSTEMS INC. OWNER'S NAME: I&G PIRECT REAL ESTATE 27 LP OWNER'S PHONE: 4089828433 LICENSED CONTRACTOR'S DECLARATION License Class t.6 a. 4 �� � C( Contractor 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 o�t��e, for the performance of the work for which this permit is issued d"� [y —`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. Signature f.O --,^® Date 171 OWNER -BUILDER 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) I, 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 1300 GALAXY WAY STE 9 CONCORD, CA PERMIT NO: 15110139 DATE ISSUED: 12/08/2015 PHONE NO: (925) 356-3000 JOB DESCRIPTION: RESIDENTIAL Q COMMERCIAL CUPERTINO FINANCIAL CENTER - REPLACE (E) HOT WATER BOILER IN BASEMENT (SAME LOCATION) Sq. Ft Floor Area: I valuation: $105000 APN Number: 31620086.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: t V1 Date: Ps 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 Applicant: 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. 1 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 defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, an"5534. Owner or authorized agent Date: 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 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. Signature_ Date Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional GENERAL PERMIT APPLICA i (4N COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 T ORRE AVENUE - CUPERTINO, CA 95014-3255 C pER . 0 (408) 777.3228 . FAX (408) 777-3333 • build! nO(G)cuoerino.ara El PLUIgIlvG I 1✓Frue arr(' A T - — u�Lt�riuCAT pR0J-KTADDP`SS V bliISCELL OtOWNER)\AlJlF. p , 1�� I Pi 0 J✓'=II STRE-tTADDPESS i z� CITY, STAl�, L CON7dCT K.i✓.3 -- - p � p f1 -Z�� I P I0.�CI �C�l- 13 I Ft�k�J STREET.nDDPESS �6 C�td� /4er iZ W01 /a I CITY, STATE, Zip €2:3 ori D ounce-3UnnE ❑ OtiTtetn AG - 'T CO?�*Ip 4CTOR ❑ ?. .ACTORAG;wT ❑ ARM—ARM❑ t�7Gi\=-^� ❑ CO?�TRyCT0R1.a11L CO trl 7�AZV.-t�!!!)L Ob?-E:R . j �LIMSE Ml'SER BUS. Llc-�i -1-INMCO1Y•AI-0 a Gwl FAX- Ys-L/'STRETADDRESS CITY, 51k1=,zip C A2CHITECTEGi��ER.4TM %❑" �T�j' r� I LIC�SE?\1t]T!;3ER BUS. LIC c COIJ3 A �*Y :�AIJ,E - I E-MAU - FA, STRP.ET ADDR.^ SS CITY, STATE, Zip USE OF ❑ S D "Dtl?LEX ❑ MMLTIFAIMY 1 PHOI�t BTjMDG: L>`DROrCTNN'WLkNID Ys PRO ❑ ' I ieCTIN Yps ❑ [] COh� �_ tCIAI I JP3A3 L I�'rACE AF2RA 1\10 Floonzo DESCRIPTION IS Fr_E BLDG A11 C7 [] > o I alcz� Rao1 =? El�-s OF WORK ❑ NO Ly (C7 TOTAbVfTU TIO': jospoo, 3y MY siva + e below, I c • :i�� to each of fhe folloh ince: I � he open y � � � �� W � a lcat;o pr o' ner or autbo �._•�eai ct e property owners behalf. I have read this 1�P and isuor�a ion I have Drovided is correct I have read he Description of 1TTork aid ve u rt s accurate. I agree to coinpi a=ih all - } c erances and st_ lag's elatffig fob a c`' ruction. I zLuoaze r> res nt?tives of Cu rt y applicable local e -p pe _no to enter thea ove-'dentif-d property for inspection purposes. Si-5ima'ure of Apphc n /-Agent: } f S date: l / SL-PPLE-\fEIN�TAL -INE OR?,41 TIONT REOULRED i - 1/EPh/isc 4u _�011.doo revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — 1111TIT 'DIN CZ "yV1Q1nT+4T S: SS. ADDRES10050 N WOLFE RD FEE DATE: 11/19/2016 REVIEWED BY: MELISSA P N: 31620086 _FAP P#: $0.00 *VALUATION: 1$105,000 xPERMIT TYPE: Building Permit A PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building -USE. _$0.00 PENTAMATION 1GENCOM PERMIT TYPE: A WORK CUPERTINO FINANCIAL CENTER - REPLACE (E) HOT WATER BOILER IN BASEMENT (SAME SCOPE LOCATION) $0.00 I Mech. Plan Check 1 0.0 1 hrs $0.001 P;`nh, 1-1.1w., ("heck Mech. Permit Fee: IMPERMIT 1'1­1-r'.;;t 1°e Other Mech. Msp. F0.0 hrs fr,,a L We"'h. Insp. fee: Pho�&. Insill Fee; NOTE. This estimate does not includefees due to other Departments (i.e. Planning, Oihe�- 61ee'. frv�p. Works, Fire, Sanitary Sewer District, School DiOriet-ph-A Ca"tart tho Aunt fnr addn'l info. FEE ITEMS 0 -­ee Resolution 1.1-053 fEff, 7,17113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes e) No $0.00 1 hours $143.00 Plan Check, Hourly 1sTPLNCxI - A Suppl. PC Fee: (E) Reg. 0 OT _$0.00 PME Plan Check: $0.00 =#1 $203.00 - Mechanical IBBoILER(75) Boiler/Comp. >50hp, Permit Fee: Hourly Only? 0 Yes (j) No $0.00 Suppl. Insp. Feele Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fed: $48.00 Administrative Fee: 1ADM1N $45.00 0 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $29.40 -3.0 hrs $429.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $5.00 $175.40 z $775.00 $950.40 Revised: 1010112015