11040132CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 3 INFINITE LOOP I CONTRACTOR: ICOM MECHANICAL INC I PERMIT NO: 11040132
OWNER'S NAME: APPLE
O
477 BURKE ST
DATE ISSUF.D:08/17/2011
2'S PHONE: 408974876 —1 SAN JOSE, CA 95112 I PHONE NO: (408)792-2292
❑ LICENSED CONTRAC(/TOyR'S DECLARATION
License ClassCZO Lic. # !DO 4'
Contractor
1 hereby affirm that 1 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.
hereby affirm under penalty of perjury one of the following two declaranot , i
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.
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. Additional y th pplicant understands and will comply
with all non -point s ce re ati er e Cupertino Municipal Code, Section
9.18.
2.
Signature_ Date -s<
L OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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).
1 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 a<aree 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,
and expenses which may accrue against said City in consequence of the
ng of this permit. Additionally, the applicant understands and will comply
narttn all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
BUILDING PERMIT INFO: BLDG F ELECT f— PLUMB
MECH r— RESIDENTIAL r— COMMERCIAL
JOB DESCRIPTION: BASEMENT - REPLACE EXISTNG DOMESTIC COOLING
WATER
SKID(DCW) WITH NEW MORE EFFICIENT MODEL(COLD WATER
BOOSTER SKID BREAK TANK)
Sq. Ft Floor Area: I Valuation: $14250
APN Number: 31602107.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY FROM LAS CALLED INSPECTION.
Issued by: �/ ) * / Date:
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 App]
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. 1 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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain co pliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health fe a io s 25505, 25533, and 25534.
Ow o 'cif t: a /
> Date:
CONSTRUCTION LENDING AGENCY
I hereby aftirnl that there is a construction lending agency for the performance of "uxk'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
_ CITY OF CUPERTINO
WWI FEE ESTIMATOR - BUILDING DIVISION
61'
ADDRESS: 3 infinite loop
DATE: 04/19/2011
REVIEWED BY: bobs.
APN:
BP#:
`VALUATION: 1$14,250
PERMIT TYPE: Building Permit
PLAN CHECK. TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 1CMAP1
PERMIT TYPE:
WORK
remove and replace domestic cold water booster skid break tank.
SCOPE
Mech. Plan Check F0 hrs $126.00
Elec. Plan Check 1.0 hrs $126.00
IMECPLNC Mech. Permit Fee: IMPERMIT
IELCPLNC FElec. Permit Fee: IEPERMIT
Other Mech. Insp. 0.0 hrs $42.00Li
Other Elec. Insp. 0.0 hrs $42.00
NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 09-051
[10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$63.00
Mechanical
IBAPPLOT I Other Appliance/Equip
Suppl. PC Fee: E) Reg. ® OT
0.0
1 hrs
$0.00
PME Plan Check:
$252.00
0
$42.00
Electrical
IBREMCOMAP Appliances-
Permit Fee:
$0.00
Suppl. Insp. Fee4�) Reg. O OT
0.0
hrs
$0.00
0 Electrical
$158.00 IBREMPOwER Other Power Devices
PME Unit Fee:
$0.00
PME Permit Fee:
$84.00
Acoustical Fee: O Yes 0 No
$0.00
0
e)
Work Without Permit? o Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
i
Travel Documentation Fee: ITRAVDOC
$42.00
Strong Motion Fee: IBSEISMICO
$2.99
0.5 J hrs
$39.00
Admin./Clerical Fee
IADMIN
Bldg Stds Commission Fee: 18CBSC
$1.00
SUBTOTALS:
$381.991
$302.00
'TOTAL FEE:
$683.99
Revised: 01 /15/2011