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11060199CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10455 TORRE AVE OWNER'S NAME: 10455 TORRE AVENUE VENTURE R'S PHONE: 4082525211 ❑ LICENSED CONTRACTOR'S DEECLARJATIIOOjN License Class Z0 Li . # G6 Contractor � �Iicensed Date � � I hereby affirm th t I am un r the provisions Chapter (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 declara 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. Additionally, the applicant understands and will comply with all non -point source re he Cupertino Municipal Code, Section 9.18. Signature Date ' L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). CONTRACTOR: AIR AND PLUMBING PERMIT NO: 11060199 SYSTEMS 285 SOBRANTE WAY STE P DATE ISSUED: 06/23/2011 SUNNYVALE, CA 94086 PHONE NO: (408) 733-2000 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 it ' -inify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the gr—ong of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG ELECT PLUMB r— MECH RESIDENTIAL r COMMERCIAL JOB DESCRIPTION: REPLACE AIR CONDITION UNIT SIDE YARD OF BUILDING **SEE NOTE** Sq. Ft Floor Area: I Valuation: $2200 APN Number: 36940009.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: �`1� 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(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. Oj_---�.wn�s entltr6i✓i a � Date: C/ 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professional 5 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36940009.00 DATE ISSUED.......: 06/23/2011 RECEIPT #.........: BS000013870 REFERENCE ID # ...: 11060199 SITE ADDRESS .....: 10455 TORRE AVE SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER 10455 TORRE AVENUE VENTURE ADDRESS ..........: 10455 TORRE AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: SERHIY BUKIN CONTRACTOR .......: AIR AND PLUMBING SYSTEMS LIC # 31732 COMPANY ..........: AIR AND PLUMBING SYSTEMS ADDRESS ..........: 285 SOBRANTE WAY STE P CITY/STATE/ZIP ...: SUNNYVALE, CA 94086 TELEPHONE ........: (408) 733-2000 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCAIRHAN ------------- UNITS ---------- 1.00 ---------- 126.00 ---------- 0.00 ---------- 126.00 ---------- 0.00 1BCBSC VALUATION 2,200.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 2,200.00 0.50 0.00 0.50 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 TOTAL PERMIT ---------- 211.50 ---------- 0.00 ---------- 211.50 ---------- 0.00 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING F'. CITY OF CUPERTINO 1VU1V UCr"1%4 A 9r"ID — RITIT ,"'INC DIVICION APPLIANCE / EQUIP TYPE ADDRESS: 10455 torre ave. DATE: 06/23/2011 REVIEWED BY: bobs. 091 APN: BP#: `EVALUATION: $2,200 y° PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY —F Commercial Building # I PENTAMATION FURN/AC PERMIT TYPE: USE: WORK replace a/c unit at existing side yard location PME Unit Fee: SCOPE PME Permit Fee: APPLIANCE / EQUIP TYPE FEE ID - - ---- QTY/FEE QTY UNITS BP FEES A/C Units (<=10K cfm) 1BCAIRHA 1 # $126 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $126.00 Strom Motion l=ee: IBSEISMICO Mech. Plan Check 10.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech.Insp. 1 0.0 1 hrs $42.001 --.j --- .....1.. ,,,, .,n{7as.,./n i'n rdnnf f/fo Wont Fnr nddN '/ lit n_ IVVl In. !/[GJC =3 "IV uo cu we use FEE ITEMS (Fee Resolution 09-051 F't'. ';'/.-10) FEE - - ---- QTY/FEE --- --- MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion l=ee: IBSEISMICO $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.501 $0.00 TOTAL FEE: 1 $211.50 -ti Revised: 04/2 9t'1_D''11 J I CUPERTINO C:QNTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: © PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTO'i` : R K BUSINESS LICENSE # ADDRESS: ;� c2 ✓Lli� CITY/ZIPCODE: J-24 b-L-1.-641 vu■ ..,uuiLipat vuue requires all Dusmesses worKmg in the city to have a City of Cupertino busins license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Dat Please check applicable subcontractors and complete the following information: 6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date a CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building c1cupertino.org MBING MECHANICAL PROJECT ADDRESS OWNER NAME ,STREET ADDRESS G CONTACT NAME -STREET ADDRESS V ❑ OWNER 11 OWNER -BUILDER ❑ OWNER AGENT C� ONTRACTOR 13 CONTRACTOR AGENT 11ARCHITECT 11ENGINEER11DEVELOPER 11 TENANT //06 0/&79 MEP MISC ELECTRICAL 2 L MISCELLANEOU^S APN# ( �) 4-10 6/y 6 7PHoNE2 _5 J -)f/ E-MAIL r CITY, STATE, ZIP FAX 7 PHONE E-MAIL CITY, STATE, ZIP I FAX CONTRACTOR NAME { `{ y(/ ' ,��,...... COMPANY NAME ' E-MAIL FAX STREET ADDRESS C :y _ y✓�d,t ��/3 ! :! CITY, STATE, ZIP �/j.`: t t �: C i (,-. f f PHONE �;� Y (/ / ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE, USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAN'D ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICH�LLER HOME? ❑ NO BUILDING: E45QMMERCIAL DESCRIPTION OF WORK ,c j /�y j �+ CJ�? (' i�� L 1 A TOTAL VALUATION: RECEIVED BY. By my signature b, ow, 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 iriformation I have provided is correct of Work and verify it is accurate. I agree to c mply with all applicable local ordinances and state'7aws relating to building con ction. I a f Cu ertino to enter the above -identified p perry fo-�r insp -tion p (poses. 2 2Z Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED , OI/FFICE USE ONLY LT OVER-THE-COUNTER c F' ❑ EXPRESS Y U i� ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06121111