15120073CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15120073
10050 N WOLFE RD CUPERTINO CA 95014 (316 20 086)
BAY AIR SYSTEMS INC
1300 GALAXY WAY # 9
OWNER'S NAME: I&G DIRECT REAL ESTATE 27 LP
DATE ISSUED: 02/18/2016
OWNER'S PHONE: 408-982-8433
PHONE NO: 925-356-3000
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-4. C-10 & C-20 Lic. #450929
Contractor BAY AIR SYSTEMS INC Date 02/18/2016
— BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH _ RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
REPLACE WATER COOLED CHILLER, ASSOCIATED PUMPS,
I hereby affirm under penalty of perjury one of the following two declarations:
PIPING, PIPING APPURTENANCES, AND DIGITAL
1. I have and will maintain a certificate of consent to self-insure for Worker's
CONTROL.
Compensation, as provided for by Section 3700 of the Labor Code, for the
✓�j performance of the work for which this permit is issued.
/ 2, I have and will maintain Worker's Compensation Insurance, as provided for
f
by Section 3700 of the Labor Code, for the performance of the work for which
Sq. Ft Floor Area:
Valuation: $200000.00
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
316 20 086
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal
180 DAYS CA INSPECTION.
Code, Section 9.18:
Issued by: MELIS AN .
Signature C Date 02/18/2016
Date: 02/18/2016
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1. 1, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 02/18/2016
contractors to construct the project (Scc.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
this pen-nit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Sections 25505, 25533, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
F
Labor Code, I must forthwith comply with such provisions or this permit shall
r
Owner or authorized agent
be deemedrevoked.
Date: 02/18/2016
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
I understand my plans shall be used as public records.
understands and will comply with all non-point source regulations per the
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 02/18/2016
CUPERT[NO
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GENERAL PERMIT APPLICATION M E rP
COME,/UNITY DEVELOPMENT DEPARTMENT • BUILDING, DIVISION
10300TORRE AVENUE • CUPERTINO, CA 9501'-3255
(408) 777-3228 • FAX (=.08) 777-3333 bujIdlno(a CUDerilno.orq
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By my signaal-e belo w, I ce: _iry to each of the following: I an L e aroperty ov, ner or au`uorized agent to act on the property o wner's half I have read this
application and he irifor ation I Have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
c dinm ceS zna St to la;vs relit ng to bu11d'gons tion. I a+�horize representatives of Cuue ino to enter the above -id atified propel t} for Tspecd a purposes.
S12matue ofApplicau /Agent: =/ Date: /G1fj
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111EPA/isc'vp_2011200 remised 06/21/11
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WIL
CITY OF CUPERTINO
F"_7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10050 N Wolfe Rd
FEE ID
DATE: 12/08/2015
REVIEWED BY; Phuong
APN: 316-20-086.10050
BP#:
BP FEES
VALUATION; $200,000
'--PERMIT TYPE; Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Mech. Permit Fee:
_ -
PENTAMATION
PERMIT TYPE: FURN/AC
WORK
Re lace water cooled chiller, associated pumps, piping,piping appurtenances, and digital control.
SCOPE
. Insp.
Other MechEl
APPLIANCE ! EQUIP TYPE
FEE ID
$286.00
P11M b z inn ",'heck
QTY
UNITS
BP FEES
Cooling System
1MCRAA
IMECPLNC
Mech. Permit Fee:
1
#
$143
Mech, Plan Check 12.0
1 hrs
$286.00
P11M b z inn ",'heck
plan Fee:
Lj
IMECPLNC
Mech. Permit Fee:
1MPERNIIT
ern
� C'€r�fia
. Insp.
Other MechEl
0.0
hrs
$48.00
odd',- Ph -i, fr:u;.
PME Permit Fee:
$48,00
I sr%.e.,
Administrative Fee: 1ADMIN
Ahe,u,h. Insi, 1�
Work Without Permit? Q Yes Q No
$0.00
r r
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distract, etc.). These.fees are based ontltepreliminary information available and are only all estimate. Contact the Dept.ror aaan't mjo.
FEE ITEMS (Fee Resolution 1.1-0531'f. ?`li:t3)
FEE
QTY/FEE
MISC ITEMS
plan Fee:
Lj
PME Plan Check:
$286.00
ern
� C'€r�fia
PME Unit Fee:
$143.00
PME Permit Fee:
$48,00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? Q Yes Q No
$0.00
r r
Travel Documentation Pee: 1TRAvDoC
$48.00
Stroa. Motion Fere: IBSEISMICO
$56,00
Select an Administrative Item
Bldg Std.s Commission Fee: IBCBSC
$8.00
SUBTTLS;
$634.00
$0.00 TO'tAI .FEE _.
$634,00
Revised: 10/01t2C