The URL can be used to link to this page

15050040 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21220 HOMESTEAD RD CONTRACTOR PERMIT NO: 15050040 OWNER'S NAME: 7-ELEVEN INC DATE ISSUED:05/07/2015 OWNER'S PHONE: 8889283276 PHONE NO: LICENS D CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] 7-11-REPLACE&ROOF TOP A/C UNIT&ASSOCIATED License Class ic.# �� i C, DUCT WORK Contractor 'tj�('rr �/.�,Q`�'� Date r i 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. Sq.Ft Floor Area: Valuation:$11000 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 APN Number:32605086.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITBIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter LED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ed ate: J granting of this permit. Additionally,the applicant understands and will comply with all non-poinelource regulations per the Cupertino Municipal Code,Section 9 18, RE-ROOFS: Signature Date — 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. ❑ OWNER-BUILDER DECLARATION Date: Signature of Applicant: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER y 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with th Cupertino Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. the Health&Safety Code,Sect' ns 25 ,25 3 nd 25534. I have and will maintain Worker's Compensation Insurance,as provided for by ^7 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: _(r 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date lGENERAL PERMIT APPLICATION o MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �O MISC (408) 777-3228• FAX(408)777-3333•building aQcupertino.Ong CUPERTINO ❑PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# Q� OWNER NAME _ PHO �_ ^ E-MAIL STREET ADDRESS ( �� CITY, STATE,ZIP �J, , � �I'14') q�; - FAX CONTACT NAME PHO (/v d,12-535 E-`MAIL q I t� _a STREET ADDRESS / CITY,STATE, I$ nz `` FAX ❑ OWNER ❑ OWNER.BUILDER ❑ OWNER AGENT CONTRACTOR 'Y`❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT iE CONTRACTOR NAME LICENSE NUMBER �� 0 LI�}E �T BUS.LIC# COMPANY NAME ( � MAIL FAX STREET ADDRESS /) CITY,STATE,ZIP PHONE ARCMTECT/ENGINEERNAME (� LICENSE NUMBER BUS.LIC# COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMMY PROJECT INWILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN El YES BUILDING: OMMERCIAL URBAN INTERFACE AREA t NO FLOOD ZONE NO EICHLER HOME? NO I - - �f DESCRIPTION OF WORK I--- ^T f1 e V (J TOTAL VALUATION: By my signature below,I certify to eac pf t following: the property owner or authoriz gent to act on t s behalf. I have read this application and the information I have rovi is Orr ct. ave read the Description of Work and veri is accurate. agree to comply with all applicable focal ordinances and state laws relating to 'ldi on c on authorize representative a mo to enter the above-identified prope inspection purposes. Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED �� OVER THE-COULTER , h. D E},PRESS t8m S x z �'HE +i MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21220 HOMESTEAD RD DATE: 05/07/2015 REVIEWED BY: MELISSA APN: 326 05 086 BP#: *VALUATION: $11,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY Commercial Building PENTAMATION FURN/AC USE: PERMIT TYPE: i WORK 7-11 - REPLACE & ROOF TOP A/C UNIT &ASSOCIATED DUCT WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BCAIRHA 1 # $143 TOTALS: �r ;, •' $143.00 ,r , �.w tib � „,,�, • - +� � i a m �i� v � i i _ t t �I .abs �`_ dk..: ;-� ,�{• 'r,S., a.. ago-+, an�. Mech.Plan Check 0.0 hrs $0.00 Plianb. 11lcrn(:'heck Elec.Plata Checic Mech.Permit Fee: IMPERMIT Ph..;mtr. Per lnir Fee: glee. Peranir Fez: Other Mech.Insp. 0.0 hrs $48.00 Other Plumb Insp. Li ocher FICC.Insrr. ET ,:ittech.Insp.Fere: Phaiib. has). Fee: Elec.Ins/:, NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the preliWina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113) FEE QTY/FEE MISC ITEMS plan Check Fee: :suppl. IAC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Ins"o Fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Construction Ta: : Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes ) No $0.00 Advanced Plunning Fees: Travel Documentation Fee: 1TRAVDOC $48.00 A Strong Motion Fee: 1BSEISMICO $3.08 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTAis = $288.08 $0.00 ` TOTAL>E'EE $288.08 vxm3'�c.....» Revised: 04/01/2015