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14080247 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: ICOM MECHANICAL INC PERMIT NO: 14080247 OWNER'S NAME: MISSION WEST PROPERTIES LP IV 477 BURKE ST DATE ISSUED:08/26/2014 OWNER'S PHONE: 4087835395 SAN,JOSE,CA 95112 PHONE NO:(408)792-2292 ❑ LIC'ENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL APPLE- INSTALL NEW(2)AIR HANDLING UNITS ON License Class Lic.#466�� ROOFTOP; TIE INTO EXISTING HEATING WATER Contractor /Cory Z/�C Date C'qt, tl�;Z4 SUPPLY AND RETURN PIPING FUTURES ON THE ROOF TO I hereby affirm that I am licensed under the provisions of Chapter 9 PROVIDE (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 t�>erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$350000 ve 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:31622017.00 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 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 DAYS FROM 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 granting of this pe in dditio e ap lip-ant understands and will comply Issued by: Date: with all non-point e reg tions pert Cupertino Municipal Code,Section 9.18. 6. RE-ROOFS: Signature Dat e•� All roofs shall be inspected prior to any rooting 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(See.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. 1 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 a ment or d n es which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the a re lit Management District I performance of the work for which this permit is issued. will maintain compliance with th per o Mu ip Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 550 5 33 an 5534. Section 3700 of the Labor Code,for the performance of the work for which this p permit is issued. Owner or authorized agent: Dat •�a 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. l 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 ofthis 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 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 1i 1 ' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 V ICUPERTINO (408)777-3228• FAX (408) 777-3333• buildin cupertino.org !.� U M i [:1 PLUMBING [K MECHANICAL OELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 10500 N De Anza Blvd. APN# 316-22-.017 OWNER NAME Apple, Inc. PHONE (408) 783-5395 E-MAIL demetri gonzalez@apple.com STREET ADDRESS 1 Infinite Loop CITY, STATE,ZIP Cupertino, CA 95014 FAX CONTACT NAME Brett Erickson PHONE 408_792-2292 E-MAIL berickson@icominc.com STREETADDRESS 477 Burke Street CITY,STATE, ZIP San Jose, CA 95112 FAX 408-292-4968 ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBERi1FIJSE T}p 6 B BUS.LIC# Don Isaacson 408622 CC UU Ci 21800 COMPANY NAME ICOM Mechanical, Inc. E-MAIL disaacson@icominc.com FAX 408-292-4968 STREETADDRESS 477 Burke Street CITY,STATE,ZIP San Jose, CA 95112 110N E4 �b ARCHiT-ECffENFsFIJEFR NAME LICENSE NUMBER BUS. COMPANY NAME —F-MAIL FAX STREET ADDRESS CITY,STATE,ZIP USE OF ❑SFD.,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? ❑NO DESCRIPTION OF WORK INSTALL NEW AIR HANDLING UNITS ON THE ROOF TO PROVIDE ADEQUATE LOAD TO EXISTING OFFICE SPACE . PENETRATE THRU ROOF TO TIE INTO THE EXISTING FOURTH FLOOR HOT SIDE SUPPLY AIR DUCTING. TIE INTO THE EXISTING HEATING HOT WATER SUPPLY AND RETURN PIPING FUTURES ON THE ROOF TO PROVIDE WATER TO THE AH UNIT COILS . TOTAL VALUATION: $350,000,00 RECEIVED BY: By my signature below,I certify to eacLtllowigd) yowner or authorized agent to act on t operty owner'sbeha I have read this application and the information I have rrescription of Work and verify it is accura e. h all applicable local ordinances and state laws relating to bucr sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 2014.08.26 SUPPLEMENTAL INFORMATION REQUIRED OFF! sE ONLY „r' W .1 OVER'.-THE-COUNTER a F ❑ EXPRESS U w ❑ STANDARD U LARGE a ❑ MAJOR MEPMiscApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10500 n de ansa blvd DATE: 08/26/2014 REVIEWED BY: Mendez APN: BP#: c�� 'VALUATION: $350,000 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: FURN/A C WORK apple- install new 2 air handling units on rooftop; tie into existing heating water supply and return SCOPE piping futures on the roof to provide water to the ah unit coils APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Air-Handling (>10K cfm) 2 # $286 Cooling System 1MCRAA 1 # $139 TOTALS: $425.00 Mech. Plan Check 0.0 1 hrs $0.00 Mech.Permit Fee: IMPF_RMIT Other Mech. Insp. 0.0 hr�$48 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 preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Ell' 7, 1,1.3) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $425.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes Q No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICO $98.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $14.00 SUBTOTALS: $678.00 $0.00 TOTAL FEE: $678.00 Revised: 07/10/2014