10080105CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10355 N DE ANZA BLVD
CONTRACTOR: ICOM MECHANICAL INC
PERMIT NO: 10080105
OWNER'S NAME: APPLE INC
477 BURKE ST
DATE ISSUED: 10/12/2010
OWNER'S PHONE: 4089744876
SAN JOSE, CA 95112
PHONE NO: (408)792-2292
❑ LICENSED CONTRACTOR'S DECLARATION
f— r r
License Classv�� Lie. # G.(
(P Z.2'
BUILDING PERMIT INFO: BLDG ELECT PLUMB
Cj
COMMERCIAL
Contractor i co V�l M Lct, • Date 12 .
MECH RESIDENTIAL
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: I ST FLOOR - INSTALL AIR HANDLING UNIT IN LAB 165.
(commencing with Section 7000) of Division 3 of the Business & Professions
TIE INTO EXISTING CONDENSER WATER PIPING ON ROOF
Code and that my license is in full force and effect.
1 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: $87000
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 thys�
permit is issued. �nwv
APN Number: 32633113.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
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.
Issued by: Date: /-,o "n l9
Signature Date
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
1 have and will maintain a Certificate of Consent to self -insure for Worker's
1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should 1 use equipment or devices which emit hazardous air
permit is issued.
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
I certify that in the performance of the work for which this permit is issued, I shall
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or ad gent: r e
O
become subject to the Worker's Compensation provisions of the Labor Code, l must
Date: t r�
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance c r work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
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
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
ICI FEE ESTIMATOR - BUILDING DIVISION
61
ADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
`VALUATION: 1$87,000
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
TOT.11;
FLOOR .AREA.
APPLICATION 1CMAP2
TYPE:
WORK
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
BP FEES
Air -Handling (<=10K cfm)
1.BCAIRHA
1
$126
TOTALS:
$126.00
Mech. Plan Check 2.0 hrs $252.00
IMECPLNC I Mech. Permit Fee: IMPERMIT
Other Mech. Insp. 1.0 hrs $42.00
Mech. Insp. Fee: IMECHINSP $126.00
Plumb, Plan Check
Plumb. Permit Fee:
Ji;s; I'I���rrl: ?
l'!i. b„'p. I:..,_
Elec. Plan Check
Me. Permit Fee,
Other Elec. Insp_
NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff, 7111 0)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$252.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$126.00
PME Permit Fee:
$168.00
Construction Tax
Acoustical Review, Fee:
Work Without Permit? Q Yes No
$0.00
Plannin, l "e .,
i
Travel Doc uinentation Fees:
Strong Alotion Fee.:
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$550.00
$0.00 TOTAL FEE:
$550.00
Revised: 8/12/2010