141001416 RESULTS WAY
14100141
F/P
BVK PERIMETER SQUARE RETAIL
LLC ET
SCANNED BOX #596
I CITY OF CUPERTINO BUILDING PERMIT I
1 BUILDING ADDRESS: 6 RESULTS WAY I CONTRACTOR: UNfTED MECHANICAL I PERMIT NO: 14100141
OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET 12161 OAKLAND RD 1 DATE ISSUED: 10/23/2014 1
OWNER'S PHONE: 6502084081 1 SAN JOSE, CA 95131 J PHONE NO: (408)232-9000 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class C-20 Lic.4 �1((ZP33J
Contractor 0; if oA Date 10 Z3
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.
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 theor Code, for the performance of the work for which this
_Lgb
Permit is issued. w
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- . t source regul ions the Cupertino Municipal Code, Section
9.18.
Signature Date 0 Z
❑ 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)
1, 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 aCertificate 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, l
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.
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 0
APPLE- REPLACE (E) BOILER ON ROOFTOP; INSTALL
HOT
WATER COILS AND PIPING
Sq. Ft Floor Area: I Valuation: $200260
APN Number: 35720041.6 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FRON"LLED INSPECTION.
Issued by:
Date: 16 •2-1 Al
RE -ROOFS:
All roofs shall be inspected prior to any rooting 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 1 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 M nici Code, Chapter 9.12 and
the Health & Safety Code, Sect• s 255 5, 255
Owner or authorized agent: Date: I� Z
CONSTRUCTION LENDING AGENCY
1 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
1 understand my plans shall be used as public records.
Licensed Profess
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE ' CUPERTINO, CA 95014-3255 �\
(408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.org \
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION! TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS /
APN # O _ O
OWNERNAME APPj'
PHONE J&f 40611
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP FAX
CONTACT NAME I yr' _ ' '
PHON '-ry[J�
E-MAIL
�C Li/IL lJ t r2eV� `
[�/(J Ci�
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
^
CONTRACTOR NAME f �_ ,` `�/'
LICENSE NUMBERSZ 33
LICENSE TYPE
BUS. LIC #
COMPANY NAME
he
E-MAIL
FAX
L) C-
STREET ADDRESS !-'—"LICENSE
CITY, STATE, ZIP
!
1 `
J
PHONEARCHITECT/ENGINEER
NAME
NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
^
DESCRIPTION OF
r K V No (
-144 41- A W co
S 1
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA" DETACH
[] ATTACH
I
# DWELLING UNITS:
IS ASECOND UNIT ❑YES
SECONDSTORY []YES
BEING ADDED? ONO
ADDITION? ❑NO
-
PRE -APPLICATION [-]YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED. BY:
TOTAL VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? []NO
i
OO 0
By my signature below, I certify to eacb of the following: I am the property owner or authorized t to act on the roe wner's behalf. I have read this
application and the information I hav ovid d is corn t. I e read the Description of Work an verityi is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ldin onstruc on. thorize representatives of Cupertino to enter the above-identi led property for inspection purposes.
Signature ofApplicant/Agent: Date: �0 z
SUPPLEMENTAL INF ATION REQUIRED RE
Q
"
PLAN CHECK TYPE
ROUTING SLIP
ovER TxE coulvTER
sLTILDJNG PLAN xEviEw"
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of buildin
Y
permit for new building.
❑"'EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑" sTANDARD ",
❑ 1`17BLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑
LARGE
FIRE DEFT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
MAJOR
❑" SANITARY SEwERDISTRICT
Submittal of Building Permit application.
❑' ENVIRONMENTAL HEALTR
B1dgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 6 results way
DATE: 10/23/2014
REVIEWED BY: mendez
APN:
BP#: �W
`VALUATION: 1$200,260
,,PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE:
Alteration /Addition /Repair
PRIMARY
USE:
Commercial Building
PENTAMATION 1 CM134
PERMIT TYPE:
WORK a
le- re lace a boiler on rooftop;
install hot water coils and
piping
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Boiler/Comp. <=3hp
1BBOILER(1)
3
#
$321
Absorption Unit
1MCRAA
1
#
$143
TOTALS:
$464.00
Mech. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: IMPERMIT
Other Mech. Insp. 0.0 hrs $48.00
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 preliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$464.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICO
$56.07
Select an Administrative Item
81ci& Stds Commission Fee: IBCBSC
$9.00
SUBTOTALS:
1 $670.07
$0.00 TOTAL FEE:
$670.07
Revised: 08/20/2014