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15030162CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10440 BUBB RD CONTRACTOR: ACCO ENGINEERED PERMIT NO: 15030162 SYSTEMS OWNER'S NAME: APPLE INC 6265 SAN FERNANDO RD DATE ISSUED: 03/26/2015 OWNER'S PHONE: 4089749575 GLENDALE, CA 91201 PHONE NO: (818)244 -6571 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL APPLE- REPLACE A/C UNIT LIKE FOR LIKE /l License Class G " Zc�� Lic. # � Z.� 6;, " 1 Contractor A(LC) �t � k� 7Date 3 Z � 5 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 Sq. Ft Floor Area: Valuation: $17960 performance of the work for which this permit is issued. 1 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: 35720036.00 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. 1 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 FR ST 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 permit. Additionally, the applicant understands and will comply Issued by: IDate: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. c Z 6 IS RE- ROOFS: Signature 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. 13 OWNER-BUILDER DECLARATION Signature of Applicant: Date: ➢ 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 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, 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 I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this G C permit is issued. Owner or authorized agent: 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. 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 CUPERTINO GENERAL PERMIT APPUCATI ®N �1v MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION D\ 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 �� MISC (408) 777 -3228 ^ FAX (408) 777 -3333 ^ building(cDcupertino.org ` V / I I PLUMBING � MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS I d "1 , ! c 1A to 0lo lg-oa U( p APN # -�7 , � CY OWNERNAME Aq 1� ��• I PHONE - ' q � 1� g5 7 5 E-MAIL STREET ADDRESS 1 I a k w I + e, L00 g CITY, STATE, ZIP t,, l wo CA C15O `ma-1 y LAIZ FAX CONTACT NAME -'7 C gal V °iv' � PHONE 5��'��j6 ' $2'i 1 E-MAIL L VA tU 6. dC(,oe3. co 8- STREET ADDRESS IM Rl AV& CITY, STATE, ZIP 5&,,«LeA -Dore �6} �IH511 FAX 510 - 347-131,1 ❑ OWNER ❑ OWNER- BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME f�C� 5 LICENSE NUMBER LICENSE TYPE (_11D BUS. LIC # g� i,a.�p�r� sk 110(0A & COMPANY NAME CO , 1a � ti-C— E -MAIL FAX 510 -75%4-1 • 131[3 STREET ADDRESS I13� �la�t�,w eve• CITY, STATE, ZIP Ste• inrw�6►do CA 4145" PHONE 51() L,-300 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANYNAME $ t;ca toad S �-��, E -MAIL '5(,k4IANA ��.n C4 CCOe'�.Gav+ ,�! FAX S I�!'•S� /��t 3 STREET ADDRESS 113-5 tit �� V� CITY, STATE, ZIP 5A, CA T-r PHONE USE OF ❑ SFD o, DUPLEX ❑ MULTI- FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: GICOMMERCLAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? YNO DESCRIPTTON OF WORK IAC<, t 9 -7) 1 2-0 1 i6 (A,%A, t LI t G IAV'i 1 i i TOTAL VALUATION: ',� 1-7 1 41(.0 RECEIVED BY. /�- By my signature below, I certify to each of the following: I 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 provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: 2'13 I� SU LEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER - THE- COUNUR o. D EXPRESS U x ❑ STANDARD U LARGE m ❑ xmok MEPMiscApp_2011.doc revised 06121111 lk CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10440 bubb rd 1'ltunh. Man Check DATE: 03/26/2015 REVIEWED BY: Mendez BP FEES APN: BP #: 503DI00- *VALUATION: 1$17,960 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Permit Irene: PENTAMATION FIJRN /AC PERMIT TYPE: replace a/c unit like for like Eapple- PME Unit Fee: $143.00 APPLIANCE / EQUIP TYPE FEE ID 1'ltunh. Man Check QTY UNITS BP FEES is "le.e. PerinirPee: A/C Units ( >10K cfm) (.Mier- Plumb Insp Ocher Islet. Insp. Li 1 # $143 Permit Irene: suppl. Insp Pee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Construction Tax: Ll Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 Adwinced Planning Fees: TOTALS: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $143.00 Select an Administrative Item NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These fees are based an the nreliminarv, information available and are onlv an estimate Contact the DeDt for addn'l info. YEE ITEMS (Fee Resolution 11 -053 Eff 711113) Mech. Plan Check 0,0 1 hrs $0.00 1'ltunh. Man Check Elec:. Plan Check Meeh. Permit Fee: IMPERMIT Plumb. Permit is "le.e. PerinirPee: Other Mech. Insp. 0.0 hrs $48.00 (.Mier- Plumb Insp Ocher Islet. Insp. Li Insp. Fee: P/rsntb. hup. her: E'lec.. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These fees are based an the nreliminarv, information available and are onlv an estimate Contact the DeDt for addn'l info. YEE ITEMS (Fee Resolution 11 -053 Eff 711113) FEE QTY/FEE MISC ITEMS Plr;In Check Fee: ,Suppl. PC Fee PME Plan Check: $0.00 Permit Irene: suppl. Insp Pee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Construction Tax: Ll Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 Adwinced Planning Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $5.03 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $290.03 $0.00 TOTAL FEE: $290.03 Revised: 02/14/2015