12090199CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10441 BANDLEY DR
CONTRACTOR: WESTERN ALLIED CORP
PERMIT NO: 12090199
OWNER'S NAME: LV CUPERTINO LLC
1 180 O'BRIEN DR
DATE ISSUED: 11/15/2012
OWNER'S PHONE: 4089551416
MENLO PARK, CA 94025
PHONE NO: (650)326-0750
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENT➢AIL 0 COMMERCIALE]
License Class Gro, G aro 3 Lic. # Z q Z
APPLE - REPLACE 7 ROOFTOP MECHANICAL UNIT'S
!Z1
Contractor AW X GLt�4 Date ��' �S _12—
Ihereby affirm that 1 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
Sq. Ft Floor Area: Valuation: $140000
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
APN Number: 32633079.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY OM LAST CALLED INSPECTION,
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
Jr
Issued by: -Date: Eta
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date -/Z
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 mttterials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
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
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)
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. ➢ 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(x) 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
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, kr 5534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agen -. ��'- Date:
pen-nit 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
CONSTRUCTION LENDING AGENCY
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
CUPERTINO
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
10300 TORRE AVENUE , CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 ^ buildinclacupertino.org
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USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: 4COMMERCIAL
PROJECT IN WD.DLAND ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN ❑ YES
FLOOD ZONE O
IS THE BLDG AN ❑ YES
EICHLER HOME? ;R -_N0
DESCRIPTION OF WORK `
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TOTAL VALUATION: O
RECEIVED BY:
By my signature below, I certify to eaA of the following: 1 am the property owner or authorized agent to act on the property o Amer's behalf. T 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL
INFORMATION REQUIRED
OFFICE USE ONLY
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❑ O n R -THF -COUNTER
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❑ STANDARD
❑ LARGE
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
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APPLIANCE / EQUIP TYPE
FEE ESTIMATOR
%l_A ll a kLy r LLJY 1P�11� ll lll V LY
- BUILDING INWSIDN
QTY
ADDRESS: 10441 Bandley
DATE: 09/24/2092 REVIEWED BY: jsg
F'lec. Permit Fee:
APN:
1BP#: /-a i Z 7 L7
`VALUATION: $140,000
*PERMIT TYPE: Mechanical Permit
#
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
Furnace, Forced -Air
1MFR=<100
PENTAMATIION FURN/AC
USE:
#
$931
$45.00
PERMIT TYPE:
WORK
Replace 7 rooftop units.
SCOPE
Administrative Fee: ]ADMIN
$42.00
APPLIANCE / EQUIP TYPE
]FEE IID
Plwnb. Plua Check
QTY
UNITS
BP ]FEES
F'lec. Permit Fee:
A/C Units (>10K cfm)
Other Plumb Insp. C
Other Elec, bzsp.
7
#
$931
Furnace, Forced -Air
1MFR=<100
7
#
$931
$45.00
Consti-tiction .Tax:
Administrative Fee: ]ADMIN
$42.00
Work Without Permit? 0 Yes E) No
$0.00
,Idvunred Plornning Fees:
Travel Documentation Fee: 1TRAVDOC
TOTALS:
Strong Motion Fee: 1BSEISMICO
$29.40
Select an Administrative Item
$1,862.00
$6.00
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 oreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
Mech. Plan Check QO hrs $0.00
Plwnb. Plua Check
Elee. Plan Check
Mech. Permit Fee: IMPERMIT
Plumb. Permit Fee:
F'lec. Permit Fee:
LOther Mech. Insp. 0.0 hrs $45.00
Other Plumb Insp. C
Other Elec, bzsp.
h. Insp. Frxa:
Plurub. hrsp. l ee:
Elcc. Insp. Fee:
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 oreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
]FEE
QTY/IFEE
MISC ITEMS
Plan Cheek Fee:
Sul PC Fe e
PME Plan Check:
$0.00
Perinit Fee:
Suppl. Insp Fee C
PME Unit Fee:
$1,862.00
PME Permit Fee:
$45.00
Consti-tiction .Tax:
Administrative Fee: ]ADMIN
$42.00
Work Without Permit? 0 Yes E) No
$0.00
,Idvunred Plornning Fees:
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: 1BSEISMICO
$29.40
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$6.00
SUBTOTALS:
$2,029.40
$0.00
TOTAL ]FEE:
$2,029.40
Revised: 07/01/2012