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13100186 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20740 VALLEY GREEN DR CONTRACTOR:ICOM MECHANICAL INC PERMIT NO: 13100186 OWNER'S NAME: CUPERTINO S130 LLC 477 BURKE ST DATE ISSUED: 11/19/2013 OWNER'S PHONE: 4089748865 SAN JOSE,CA 95112 PHONE NO:(408)792-2292 TFI- LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ 2' �QQ 't APPLE-REPLACE(E)(3)ROOFTOP COOLING UNITS,(5) License Class �8 Cp 1L ic.# 7 �6 ZZ- REPLACE SERVER ROOM COOLING UNITS,(2)INSTALL RELIEF FANS Contractor r c�M �s+" !�/171rI chute �� . O�. REV#I-REMOVE&REPLACE AN ADDITIONAL ROOFTOP UNIT,SAME I hereby affirm that I am licensed under the provisions of Chapter 9 LOCATION&SIZE-ISSUED 1/17/14 (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:$500000 Pave and will maintain Worker's Compensation Insurance,as provided for by (Sedion 3700 of the Labor Code,for the performance of the work for which this APN Number:32610047.20740 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 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 FR AS ED INSPECTION. indemnify and keep h less the City of Cupertino against liabilities,judgments, costs,and expenses ch ma amst said City in consequence of the granting of this p Rionally, a applicant understands and will comply Issu Date: with all non-poi urc regulatio per the Cupertino Municipal Code,Section 9.18. �'y 0(r RE-ROOFS: Signatur Dat 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 1,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 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,shoulZt ment ices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined bit Qu ity Management District 1 performance of the work for which this permit is issued. will maintain compliance with o Mu I Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec53 ,and 5534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date..A/z/ty 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,l must 1 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 1 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 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20740 valley green dr DATE: 01/17/2014 REVIEWED BY: melissa APN: BP#: 13100186 "VALUATION: Iso FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION FURN/AC USE: PERMIT TYPE: WORK REV# 1 - REMOVE & REPLACE AN ADDITIONAL ROOFTOP UNIT SAME LOCATION & SIZE - SCOPE ISSUED 1/17/14 Mech.PI �Permit �Fee: Mech. PER Oth'Mech. Insp. 0.0 hr `` $47.00 .>o� �, °; '�hurl gyp, NOTE: Festimate does not inclu a ees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School Distr' etc . Thesefees are based on the prelimina information available and are e.Contact the Dept for addn 7 info. FEE ITEMS Wee Resolution 11-053 EJf' 711/13,) FEE Y/FEE MISC I Plan Check Fee: 0.00 1 # Mechanical Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $139.00 IBCAIRHA A/C Units(<=10 cfm) PME Plan Check: 0.00 Permit Fee: $0.00 Suppl. Insp.Fee.0 Reg. Q OT ro.0 hrs $0.00 PME Unit Fee: $0. PME Permit Fee: $ 00 Cora"�Ir rwtion KLV_ Administrative Fee: IAD $44.00 Work Without Permit Yes No $0.00 Advanced Plannin ee: $0.00 Select a Non-Residential Travel Documentat° n Fee: ITRA VDOC $47.00 '' Building or Structure Strong Motion Fee:, $0° Select an Administrative Item Bldiz Stds Commissi e: 4^$0.00 LfBT UW. 1$138.001 $139.00 TOTAL,f $277.00 Revised: 01/15/2014 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX(408)777-3333•building(c1cupertino.ong ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION J TI Z REVISION/DEFERRED ORIGINAL PERMIT# 3 I �� PROJECT ADDRESS )D1 1 A�a , �`V� APN# OWNERNAME f PH (n . /./7AIL STREET ADDRESS 4•• ( CITY, STATE,ZIP �f` E-MFAX CONTACT NAME PHONE MAIL rr C,KSor�( o$ 79 2 zza 3 e cxser�Q C J Jl C c�wti STREET ADDRESS C , TAT ,Z -, /L G t?S-( ' /7 0 �q Z 4 6 f) 1:1 OWNER 1:1 OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT�❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER -❑ TENANT CONTRACTOR N e LICENSF"y �I SE�y�E BUS.21 COMPANY NAME O _ - �.,� \ ' E-MAIL(t�3 x' 8 [2 gl? STREET ADDRESS /� %Alt(46 � CITY,S E, Ii� , Jil( I� �2 2.2pARCHITECT/ENGINEER NAME "^7 LICENSE NUMBER BUS.LIC# / COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK J J Lc RM 1T U l .96 r:MouCV� �CPc.�c,� 2�' EXISTING USE PROPOSED USE CONSTRTYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: LJDETACH I]ATTACH -FD-WELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YFS IF YES,PROVIDE COPY OF 1S THE BLDG AN ❑YES RECEIVED BY;: TOTAL VALUATION: PLANNING APPL 9 ❑NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO .;�, E By my signature below,I certify to each o folio - g: am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I have p ded co v,read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ing c s ct' I a thorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT INFO TION REQUIRED Piai�rcl�rxxr "u°' r. s' w,.xotirnvcsiie New SFD or Multifamily dwellings: Apply for demolition permit for 2Ia � �� r D AVERTHT<CQUJyTER BiJILDZI GPT,ANREYIEW existing buildings). Demolition permit is required prior to issuance of buildingI permit for new building. - © EXPRES3 � PLANNIIvciPLA1�REi�Vt '�n _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑�sTANDARD fl PUBLIC 1tivb I R�Ylk � F form if any Hazardous Materials are being used as part of this project. a�: ' � _Copy of Planning Approval Letter or Meeting with Planning prior to �� TlA�t7�9EVlE#DI1TIUCT submittal of Building Permit application. O."ENVIRON113EN? TtEALH . ."`@ BIdg,4pp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20740 VALLEY GREEN DR CONTRACTOR:ICOM MECHANICAL INC PERMIT NO: 13100186 OWNER'S NAME: CUPERTINO Sl 30 LLC 477 BURKE ST DATE ISSUED: 11/19/2013 OWNER'S PHONE: 4089748865 SAN JOSE,CA 95112 PHONE NO:(408)792-2292 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class L 2D 636 Lic.# X 0$"6 Z Z APPLE-REPLACE (E)(3)ROOFTOP COOLING UNITS,(5) REPLACE SERVER ROOM COOLING UNITS,(2)INSTALL Contractor / —to/"l Jita-cffjiV ct —Date r--*(3. 01. 1 RELIEF FANS- 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:$500000 I have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:32610047.20740 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMITE IBES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 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 DOM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses w ' ay accrue against said City in consequence of the / granting of this pe t. dditio t e pplicant understands and will comply Issued by: Date: L with all non-point ou a reg ations pe he Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Dater/ All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION 1 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 1,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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 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 eCupeptKo y Area Quality Management District I performance of the work for which this permit is issued. will maintain compliance with nicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se ons 25 05 , nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this (��/(.7 permit is issued. Owner or authorized agent Dat . 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,1 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 1 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. Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \D 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 b� CUPERTINO (408)777-3228• FAX(408)777-3333•building(a)cul2ertino.org \ MISC 0 PLUMBING E&ECHANICAL ELECTRICAL MISCELLANEOUS PROJECT ADDRESS 2_0 APN#Ve �f OWNERNAME G7 �/�/((((�� E-MAIL STREET ADDRESS CITY, STATE,ZIP/ o o FAX CONTACT NAME PHO E MAIL L P�� �t wt•1c- STREET ADDRE5F 21 SS /+ CI=E, P �t��, ❑OWNER ❑ OWNER-BUILDER ❑ OWNER✓\AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N E LICE NSENU RX� I�IC�NS� B �1 ftc COMPANY NAME E-MAIL FA g_ 2-11 STREET ADDRFgo7-) &Al!:� /�� CIT , A E,ZI ' �� r-�/ P N � ARCHITECT/ENGINEER NAME 7 LICENSE NUMBER / BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? W-0 DESCRIPTION OF WORK JZ it'kvlM e4o8-1 X tw rftc-4- Qf L,E AC` �v�►�1-� Ce . TOTAL VALUATION:100 RECEIVED BY: By my signature below,I certify to each of the fol i e property owner or authorized agent to act on the property o er s behalf I have read this application and the information I have provide rrect. I e ad the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin nst io tho ize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPP MENTAL INFORMATION REQUIRED OFFICE USE ONLY w ❑ <R-THE-COUNTER xf EXPRESS ❑ STANDARD U ❑ LARGE P. ❑ MAJOR MEPMiscApp_2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20740 valley green dr DATE: 10/28/2013 REVIEWED BY: mendez APN: BP#: l 'VALUATION: 1$500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION FURN/AC USE: PERMIT TYPE: WORK APPLE- REPLACE E 3 ROOFTOP COOLING UNITS,(5) REPLACE SERVER ROOM COOLING SCOPE UNITS,(2) INSTALL RELIEF FANS- Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check I 0.0 Fhrs $0.00 Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: 1PPERMIT Other Mech.Insp. E hrs $47.00 Other Plumb Insp. 0.0 hrs $47.00 NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff' 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-3-1 # Mechanical Suppl. PC Fee: Q Reg. Q OThrs 0,0 $0.00 $417.00 A/C Units(>I OK cfm) PME Plan Check: $0.00 2 # Mechanical Permit Fee: $0.00 $48.00 1BREMVENF I Ventilation Fan Suppl. Insp. Fee-0 Reg. Q OT 0 0 hrs $0.00 = # Mechanical PME Unit Fee: $0.00 $695.00 1MCRAA Cooling Unit PME Permit Fee: $94.00 = # Plumbing E�t�.;lrrrtts�f�t '�r:. $47.00 1BPVENT Piping, Vent Administrative Fee: IADAfIN $44.00 0 Work Without Permit? Yes (F) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITPA VDOC $47.00 Building or Structure 0 t Strong Motion Fee: IBSEISMICO $105.00 Select an Administrative Item B1dp,Stds Commission Fee: 1BCBSC $20.00 SUBTOTALS: $310.001$1,207.001 TOTAL FEE: 1 $1,517.00 Revised: 10/01/2013