13020141CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR: FUTURE AIR PERMIT NO: 13020141
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 1395 N IOTH ST DATE ISSUED: 02/27/2013
OWNER'S PHONE: 4088730121 SAN JOSE, CA 95112 PHONE NO: (408)971-6616
❑ LICENSED CONTRACTOR'S DECLARATION
License Class C-7 G Lio, # e0 ?
Contractor .uTU 2, Date
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 an d 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.
I have and wilt maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
upon the above mentioned property for inspection purposes. (We) agree to save
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18
Signature �(s�t !ly! Date 2 r2 3
❑ OWNER -BUILDER. DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the. above mentioned property for inspection purposes. (We) agree to save
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIALU
SUITE 150- REDUCT TWO A/C UNITS INSIDE 2 ROOMS
Sq. Ft Floor Area: Valuation: $6400
APN Number: 36901028.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 80 DAYS OF PERMIT ISSUANCE OR
180 DA ROM LAST CALLED INSPECTION.
Issued by: Date` z rz
i
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER, .
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air 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 Health & Safety Code, Sections 25505, 25533, and 25534. .
Owner or authorized agent: (/` Dater .�
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Date
CITY OF CUPERTINO
IL-WU -Vc'rr-N4 A W"ID — RTTTT .11TN1--nlVTCTCIN
ADDRESS: 20400 SCB
DATE: 02/27/2013
REVIEWED BY: MENDEZ '..
APN:
BP#:�,2��L*VALUATION:
$6,400
*PERMIT TYPE: Building Permit
CHECKTYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
PENTAMATION 1CMAP1
PERMIT TYPE: i
WORK
SUITE 150- REDUCT TWO A/C UNITS INSIDE 2 ROOMS
SCOPE
Mech. Plan Check 0.0 hrs $0.00
P111111 Phm Cheek
Elec. Plata Cheek
Mech. Permit Fee: IMPERMIT
Phnnb. Pelmii Fee:
Elee. Permit Free:
rMech. Insp. hrs $45.00
0.0
Other Phrmb Insp.
Other Elec. 1n p.
: Lisp. Fee:
L
Phnnh. hlsp. Fee:
Elec. Lisp, Fee:
NOTE: This estimate does not incluae fees aue to otner vepartnzents (i.e. rttntnn.g, •—..1....... I - •__, __--_
!'nutnnt tbo nont far addn'l info.
Ulstria, era). lnese xes tore ouaet[ v.t ene t ..........0.
FEE ITEMS (Fee Resolution 11-053 E . 7f / F 1/121
... ... .........................
FEE
........• _
QTY/FEE
---- ------------
MISC ITEMS
Plan Check Fee:
$0.00
2 #
$134.00
Mechanical
IBAPPLOT Other Appliance/Equip
Suppl. PC Fee:, Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Con,stt,uction Tax.,
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? 0 Yes Q) No
$0.00
Advanced Planning Fee:
$0.00
�� hours
$133.00
Inspections
ISTINSP Inspection, Hourly
G
0�
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICO
$1.34
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$134.34
$267.00
TOTAL FEE:
$401.34
mevibuu. U Ilu 1/4U I)