12070257CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20230 STEVENS CREEK BLVD
CONTRACTOR: DPR CONSTRUCTION, A
PERMIT NO: 12070257
GENERAL
OWNER'S NAME: TORRE AVENUE PROPERTIES
1450 VETERANS BLVD
DATE ISSUED: 12/11/2012
OWNER'S PHONE: 4087384444
REDWOOD CITY, CA 94063
PHONE NO: (650)474-1450
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS
❑ LICENSED CONTRACTOR'S DECLARATION
L' ense Class Lic. #
INSTALL RATED EXHAUST DUCT AND CHASE, WITH
ROOF
Contractor fj ate t -
MOUNTED CONDENSOR
I eby 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: $46408
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
APN Number: 36902031.00
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 DAY 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
Issued by: Date: Zlll /
granting of this permit. Additionally, the applicant understands and will comply
with all no p int sour egulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Si�ure Date
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-B LDE 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)
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, 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
the Health & Safety Code, Secti ns` 25505, 55 nd 25534.
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
Owner or authorized agen Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
1i
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDnGAENCY
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
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20230 stvns crk blvd
DATE: 07/31/2012
REVIEWED BY: bob s.
APN:
BP#:
*VALUATION: 1$46,408
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
PENTAMATION
PERMIT TYPE: FURN/A
WORK
install rated exhaust duct and chase with roof mounted condensor.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Air -Handling (<=10K cfm)
1BCAIRHA
1
#
$133
Hood, Mech. Exhaust
1MCHOOD
1
#
$133
TOTALS:
$266.00
Mech. Plan Check 4.0 hrs $532.00
Plumb, t'loo Check
Flec. flan Chcek
IMECPLNC Mech. Permit Fee: IMPER T
Flr�rrxh. Ye,�r,ir 1 ��e:
! lec. Per�rri� I'ee:
Other Mech. Insp. 0.0 hrs L $45.00
oilier Phanh Msp.
Other Elec. Insp.
Hc(h. tnay). Fcc:
P/r/mh. Insp, Fee:
Elec. Insp. Fee:
NOTE: This estimate floes not include fees rlue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School
District. etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Devt for addn'I into.
FEE ITEMS (Fee Resolution 11-053 Eff 711/11�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
PC, Fcc
PME Plan Check:
$532.00
Pe rynit Fcc:
supp/, 111sp Fee
PME Unit Fee:
$266.00
PME Permit Fee:
$45.00
C'on'mwclioll Tax:
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
ri(lt'CR)CE'Cl Plat 71177g Fces:
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICO
$9.75
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$941.75
$0.00 TOTAL FEE:
1 $941.75
Revised: 07/01 /2012