12050159 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20410TOWN CENTER LN CONTRACTOR:PARAGON MECHANICAL. PERMITNO: 12050159
INC.
OWNER'S NAME: FUND VIII CUPERTINO LLC 2460 DE LA CRUZ BLVD DATE: ISSUED:05/222012
OWNER'S PHONE: 4089730783 SAN'T'A CU.ARA.CA 95050 PHONE NO:(408)727-7303
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LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
r r r
ik
MECH RESIDENTIAL CONIM1IERCIAL
JOBDESCRIPTION:TO CLEAR CODE ENFORCEMENTCASE:REMOVE(2)
ROOFTOP
ing with ticetion 7000)of Division 3 of the Business&Professions A/C UNITS AND REPLACE W I'rli(2)NI7W 25 TON VAV
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
performance of the stork 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 Sq.Ft Floor Area: Valuation:$80000
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is APN Number:36940060.20410 Occupancy Type:
correct. I agree to comply with all city and county ordinances and stale 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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point sou�x regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. ,\ ' ,{ /i • ,
Sighamre — - Lela"DateIssued b ,��i�/'✓ ��ry�/�j Date:
A. / y:
❑ OWNER-BOILDF.R DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first oblaining am inspection.I agree to renhove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner ohhe property,am exclusively contracting with licensed contractors to Signal ore of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVF.RINGSTO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA%ARDOUS MATERIALS DISCLOSURE:
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ohhe work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safely Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should 1 store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will
not employ any person in anymanner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws ofCafifomia. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code.I must N
IonMvillt comply with such provisions or this permit shall be deemed revoked. °jr ur anth i
y�z�d a en �
nth Date: - l
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I cenify that I have read this application and stale that the above information is
cored. I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ G)
upon the above mentioned properly for inspection purposes.(We)agree to save Lender's Name
indemuhify and keep harmless the City of Cupertino against l iabil hies,judgments, -
costS,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCIIIT'F.CT'S DECLARATION
9-18-
1 understand my plans shall be used as public records-
Signature Dale
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20410 Town Center Lane DATE: 05/22/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: 1$80,000
*PERMIT TYPE: Mechanical Permit=PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: *URN/A
WORK To Clear Code Enforcement Case: Remove 2 roof to A/C units and replace with 2 new 25 ton
SCOPE VAV.
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BCAIRHA 2 # $260
TOTALS: $260.00
Mech. Plan Check 0.0 hrs $0.00 Phm,A, P/on ChacF I luc. PGm Chrck�
Mech. Permit Fee: IMPERMIT l,hunh. Permit F.c: !iltr. I'drmir Pee:
Other Mech. Insp. 0.0 hrs $44.00 other Plumb Imp. U/her li/cc.In..P. ED
h"p. 15r: Plun,h. hop. Fen: /ilex. brep. i',c:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact lite Dept for addn7 info.
FEE ITEMS (/Fee Resolution 11-053 Ff. 7/1.111) FEE QTY/FEE MISC ITEMS
/'(cera ChCck Pe('.-
Serppl. PC Fof
PME Plan Check: $0.00
Petinil Fce:
.Supp/. Ga-p I.o:
PME Unit Fee: $260.00
PME Permit Fee: $44.00
('Nino 11(lion 7"11:
Administrative Fee: IADMIN $41.00
Work Without Permit? 0 Yes O No $304.00
'I dl-am ed P1,urnin,g Fees:
Travel Documentation Fee: 1TRAVDOC $44.00
Strone Motion Pee: IBSEISMICO $16.80 Select an Administrative Item
131de,Stds Commission Fee: 1BCBSC $4.00
ij SUBTOTALS: $713.80 $0.001 TOTAL FEEL: $713.80
Revised: 04/0112012
U / 7
GENERAL,PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I
SC
CUPERTINO (408)777-3228• FAX(408)777-3333•building0cuoertino.orG
PLUMBING MECHANICAL FIELECMCAL MISCELLANEOUS
PROJECTADDRESS ��//a 1. Our A/ CSN IC-JL / ^ '(� APN# �J C�_ _ v60 �(D I
OWNERNAME '` food MONT 7 l i`I C yUV� 9� 3— C-13I ` E-MAILUvJ .
STREET ADDRESS \/ _I CITY. STATE.ZIP s FAX
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CONTACT NAME -
/0 OJLA-1' C 2 a PHONE rl, E-MAIL
STREETADDRESS Crry,STATE, ZIP FAX
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❑OwNER ❑ OWNER-BUDDER ❑ OWNER AGENT ❑ CONTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVEJDPER ❑ TENANT
CONTRACTOR NAME �nJ // y LICENSE NUMBE0. LICENSE TYPE BUS.LIC N
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COMPANY NAME E-MAIL .4q iL.^ (� FAX
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STREET ADDRESS P2 y�D peAa G%L�r_ cm.Sn-��A C� n-R Cq PxonT:-yid=7a7'73a
ARCHITECT/FNGAIEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ FD.DUPI.EX ❑ MULTI-FAMILY PROJECT N wUDIwND ❑ YES PROJECT IN ❑YES ISTHEBLDGAN ❑ YFS
BUTLEHNG: gcoM RcW URBAN Q.'TERFACEAAEA ❑ NO F ZONE ❑NO EICTn.FA HOME? (:3 NO
DESCRIPTION OF WORK nn/
TOTAL VALUATION: GD OOU RECEIVED BY:
By my signature below,1 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 1 have provided is correct 1 have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to bui ing.wnnstmcti uthoriu sentatives of Cupertino to enter the above-idcn4fied properry for inspection pulposes.
Signature of Applicant/Agent:. tMt Date: 2 a
/SUPPLEMENTALWORMATION REQUIRED OFFICE USE ONLY
ON ER-THE-COUNTER
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❑ STANDARD
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❑ MAJOR
AEP,ITscApp_2011.doc revised 06/21/11