11040133CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 4 INFINITE LOOP I CONTRACTOR: ICOM MECHANICAL INC I PERMIT NO: 11040133
OWNER'S NAME: APPLE
C
R'S PHONE: 4089744876
❑ LICENSED CONTRACTOR'S DECLARATION
Liccnse Clas. Lel Com% Lic. # "ZZ_
Z--
Contractor / 4>4 tiCt^ZD�i�Jt CJ—� Date Y• / 7r i f
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 declarations:
1 have and %� ill 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 mll maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
pennit is issued
APPLICANT CERTIFICATION
I certit} that I have read this application and state that the above information is
correct. 1 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 ;ind keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Vantina of this porn it. Additionally applicant understands and will comply
with all non-poin urce r p the Cupertino Municipal Code, Section
9.18.
e
Signature Date
OWNER -BUILDER DECLARATION
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 prgject (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 pertornance of the work for which this permit is issued, I shall
not emplo\ 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 complN 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
z , of this permit. Additionally, the applicant understands and will comply
s. nun -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature__ Date
477 BURKE ST
SAN .LOSE, CA 95112
DATE ISSUED: 08/17/2011
PHONE NO: (408)792-2292
BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB
MECH I— RESIDENTIAL f— 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: 31602108.00 1 Occupancy "Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA S FROM L 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 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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) 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 thtfupertino Municipal Code, Chapter 9.12 and the
Health &S ety C on 25,505, 25533, and 25534.
Owner a ��/ /—
—Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of �,wrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professiona
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 4 INFINITE LOOP
OWNER'S NAME: APPLE
OWNER'S PHONE: 4089744876
❑ LICENSED CONTRACTOR'S DECLARATION
License Clas o/4111 Lie. # i1,%2
Contractor/ `-CN /UC^`r&4 %( 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 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 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 per 't. Additionally^ applicant understands and will comply
with all non- poin urce r Vp
the Cupertino Municipal Code, Section
9.18.
e
Signature Date
❑ 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.
CONTRACTOR: ICOM MECHANICAL INC PERMIT NO: 11040133
477 BURKE ST DATE ISSUED: 08/17/2011
SAN JOSE, CA 95112
PHONE NO: (408)792-2292
BUILDING PERMIT INFO: BLDG J_ ELECT r PLUMB F
MECH ' RESIDENTIAL 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: $14250
APN Number: 31602108.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA S FROM L CALLED INSPECTION.
Issued by: �� e / Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an .inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with th upertino Municipal Code, Chapter 9.12 and the
Health & Safety C_qde-,-S—q41on$ 25505, 25533, and 25534.
Owner t fd e 0 /r I
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of -'wrk'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.
Date
Licensed Professional
__ __ CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
19 ADDRESS: 4 infinite loop
DATE: 04/19/2011
REVIEWED BY: bob s.
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 F1.0 hrs $126.00
1'basrr. t'_0 " <";r<:r7
Elec. Plan Check 1.0 1 hrs $126.00
IMECPLNC Emech. Permit Fee: 1MPERMIT
Fee
IELCPLNC Elec. Permit Fee: 1EPERMIT
Other Mech. Insp. 0.0 hrs $42.00
c 1:,'<c trr;,r„ ;` ; ;.
Other Elea Insp. 0.0 hrs $42.00
NnTF. These fees are based on the nrelindnary information available and are onlv an estimate. Contact the Dept for addn'i into.
FEE ITEMS (Fee Resolution 09-051 Elf. 71-111(�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$63.00
Mechanical
iBAPPLOT I Other Appliance/Equip
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$252.00
0 Electrical
$42.00 imEMCOMAP Appliances
Permit Fee:
$0.00
Suppl. Insp. FeeG Reg. 0 OT
0.0
hrs
$0.00
0 Electrical
$158.00 IBREMPOWER Other Power Devices
PME Unit Fee:
$0.00
PME Permit Fee:
$84.00
Tax
Acoustical Fee: 0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Plaiming Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Travel Documentation Fee: ITRAVDOC
$42.00
Strong Motion Fee: IBSEISMICO
$2.99
0.5 hrs
$39.00
Admin./Clerical Fee
IADMIN
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$381.99
$302.00
TOTAL FEE:
$683.99
Revised: 01 /15/2011