15100067CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23000 HOMESTEAD RD
CONTRACTOR: WESTERN ALLIED CORP
PERMIT NO: 15100067
OWNER'S NAME: JAYNE HAM YEH
1180 O'BRIEN DR
DATE ISSUED: 10/08/2015
OWNER'S PHONE: 5102978067
MENLO PARK, CA 94025
PHONE NO: (650)326-0750
AD LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
(Ss1=
License ClassG;1�2� Lie. # �`ZfCaj Z
WELLS FARGO - REPLACE 3 (E) ROOF TOP A/C UNITS
Contractor. Lv A- ,s..4 *'p Date ti.=
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 fullforce and effect.
Sq. Ft Floor Area:
Valuation: $19024
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
APN Number: 32601026.00
Occupancy Type:
performance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
PERMIT EXPIRES IF WORK IS NOT STARTED
permit is issued.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
180 DAYS FROM LAST CALLED INSPECTION.
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
Issue _ e:
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
- OOFS:
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
All roofs shall be inspected p ' y roofing material being installed. If a roof is
installed without first obtal g an inspection, I agree to remove all new materials for
Signature ✓ Date La' tiS
inspection.
Signature of Applicant: Date:
OWNER -BUILDER DECLARATION
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
HAZARDOUS MATERIALS DISCLOSURE
compensation, will do the work, and the structure is not intended or offered for
I have read the hazardous materials requirements under Chapter 6.95 of the
sale (Sec.7044, Business & Professions Code)
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
2. i, as owner of the property, am exclusively contracting with licensed contractors to
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
construct the project (Sec.7044, Business & Professions Code).
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
I hereby affirm under penalty of perjury one of the following three declarations:
contaminants as defined by the Bay Area Air Quality Management District I will
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation, as provided for by Section 3700 of the Labor Code, for the
Health & Safety Code, Sections 25505, 25533, and 25534.
performance of the work for which this permit is issued.
Owner or a ized agent:
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Date I� S
Section 3700 of the Labor Code, for the performance of the work for which this
--
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I shall
CONSTRUCTION LENDING AGENCY
,not employ any person in any manner so as to become subject to the Worker's
I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If, after making this certificate of exemption, I
for which this permit is issued (Sec. 3097, Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code, I
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
Lender's Address
revoked,
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I understand my plans shall be used as public records.
correct. I agree to comply with all city and county ordinances and state laws relating
Licensed Professional
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.
Signature Date
GEN . ERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
11110 TORRE AVENUE - CUPERTINO, CA 950143255
(408) 7774228 - FAX (408) 777-3333 - bulidinq@cupertirioorg
CUPERTINO M.ISC
MPLUMBING I 7X AIECHANTCAL MTS( -PTT A KPOT PZ
PROJECTADDPEss 23000 Homestead Road
APN A 3zC- 0/
OWNER NAME8-a fge-BaAk=GRG bfizdnd yea
PHONE 510-297-8067
LE-MAII
gale. alexandergwellsfargo.com'
STREET ADDR. '3 4
I
-CITY, S E, ZIP
E-01
CONTACT NAME Jeremy Goodland
PHONE 650-326-0750
E-MAIL jgoodlandCa)westernallied.com
STREET ADDRESS 1180 O'Brien Drive
CITY, STATE, ZIP Menlo Park, CA 94025
FAX
13 OWNER 13 OWNER -BUILDER 13 OWNERAGENT 19 CONTRACTOR 13 CONTRACTOR AGENT E3 ARCHITECT E3 ENGINEER 13 DEVELOPER 0 TENANT
CONTRACTOR NAME Western Allied Me;;;;7
LICENSENUMBER 826782
LICENSE TYPE C20, C36
BUS. LIC # 480
COMPANY NAME Western Allied Mechanical
E-MAIL jgoodlandgwesternallied.com
FAX
STREET ADDRESS 1180 O'Brien Drive
CITY, STATE, ZIP Menlo Park, CA 94025
PHONE 650-326-0750
ARCHITECT/ENGINEER NAME Western Allied
LICENSE NUMBER 826782
BUS. LIC # 480
COMPANY NAME Western Allied Mechanical
E-MAIL A odland9westernallied.com
FAX
STREET ADDRESS 1180 O'Brien Drive
CITY, STATE, ZIP Menlo Park, CA 94025
PHONE 650-326-0750
USE OF [I SFD r DUPLEX 13 MULTI -FAMILY
BUILDING: ®COMMERCIAL 77
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN 0 YES
FLOOD ZONE NO
FL
70"
I$THE BLDG AN ❑ YES
SICHLER HOME? NO
DESCRIPTION OF WORK - Replace (3) small rooftop packaged air conditioning units with new units of equivalent capacity.
WeL4,3'
TOTAL VALUATION: $19,024
MRECFrvm BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on'T'e—property owner's behalf. I have read this
application and the information 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
ordinances and state laws relating to buildin co o I authorize re entatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Pate: A
SUPPLEMENTAL INFORMATION REQUIRED
omcE USE ONLY
;OVER. -THE -COUNTER
,EXPRFSS
STANDARD
44
El LARGE
MEPMiscApp_,2011.doc revised 06121111
�--- CITY OF CUPERTINO
FEE ESTIMATOR - R1j11,D1NV- nTVTCTnN
M ADDRESS: 23000 HOMESTEAD RD
FEE ID
DATE: 10/08/2015
REVIEWED BY: MELISSA
APN: 326 01 026
BP#:
-
A/C Units (<=10K cfm)
*VALUATION: 1$19,024-�
'PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE:
Alteration / Addition / Repair
PRIUSE: Commercial Building
-
Permit
e mit Fee:.SZ
PENTAMATION
PERMIT TYPE: FURN/A
WORK
WELLS FARGO - REPLACE 3 E ROOF TOP A/C UNITS
SCOPE
PME Unit Fee:
$429.00
PME Permit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
I'!rrrrrh. l'r�rtr C''t, e7c
QTY
UNITS
BP FEES
Islec. "en r Fee:
A/C Units (<=10K cfm)
1BCAIRHA
01he• Elelc. LISP,
3
#
$429
Permit
e mit Fee:.SZ
ppl, 1nsp I. -''j ;
PME Unit Fee:
$429.00
PME Permit Fee:
$48.00
(."onstruct'ion 1LY,Y:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
A
Travel Documentation Fee: 1TRAVDOC
$429.00
Stroma Motion Fee: IBSEISMICO
NUI E: I his estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc. ). These fees are ha.ced on the nroliminaru infnrmatinn availahlo and aro mrhy nn pedmato_ r'nntart tho Want fnr addn'I infn_
FEE ITEMS (Fee Resolution 11-053 Eff.' 711113)
Mech. Plan CheckL
0.0 hrs $0.00
I'!rrrrrh. l'r�rtr C''t, e7c
ec I""(2n (.'hec,`c
Mech. Permit Fee: IMPERiMIT
/?lLi t/7. /7?i r T'e:;
Islec. "en r Fee:
Other Mech. Insp. 10-01hrs $48.00
otlkr P-hUrnl) irt,sn.
01he• Elelc. LISP,
44ech. It2. 3. /`ef::
Plw ib. /iii,/). /pec::
Llec. Ii sp, Fee:
NUI E: I his estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc. ). These fees are ha.ced on the nroliminaru infnrmatinn availahlo and aro mrhy nn pedmato_ r'nntart tho Want fnr addn'I infn_
FEE ITEMS (Fee Resolution 11-053 Eff.' 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check k 1 ee
Scc}:pL .N.' 1-ee
PME. Plan Check:
$0.00
Permit
e mit Fee:.SZ
ppl, 1nsp I. -''j ;
PME Unit Fee:
$429.00
PME Permit Fee:
$48.00
(."onstruct'ion 1LY,Y:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
)d: dance d PZLt7?1z;Ml Fees:
A
Travel Documentation Fee: 1TRAVDOC
$48.00.
Stroma Motion Fee: IBSEISMICO
$5.33
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
Srt7BTOTAL.;
$576.331$0.00
.
TOTAL FEE;
$576.33
Revised: 10/01/2015