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14090088CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: I INFINITE LOOP CONTRACTOR: ICOM MECHANICAL INC PERNIIT NO: 14090088 ONA'NER'S NAME: APPLE COMPUTER INC 477 BURKE ST DATE ISSUED: 09/15/2014 OWNER'S PHONE: 4089961010 SAN JOSE, CA 95112 PHONE NO: (408)792-2292 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL /101 P2NDL CIA -40 -C& -40-C& 06 Lic.# FLOOR; INSTAL A/C UNIT IN LED ROOM Contractor ( (,a. M AC.--r—d- [tiC Date I hereby 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: $30000 performance of the work for which this permit is issued. 1 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: 31602105.00 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 WITHIN D YS 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 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 p it. Addit e applicant understands and will comply Issued by: Date: with all non --p n ource ulations er the Cupertino Municipal Code, Section 9.18. r RE -ROOFS: Signature Date���4 � 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 ne%v materials 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 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 wJitlfthe Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Seehon 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's equipmen devices which emit hazardous material. Additionally, s/,v. Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as definay A Air uality Management District I performance of the work for which this permit is issued. will maintain complianceupe ino M iicipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code550 25 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized age Da 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, I CONSTRUCTION LEN'DIN'G 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 1 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 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 1 inflinte loop DATE: 10/15/2014 REVIEWED BY: Mendez UNITS ] APN: 7BP#: *VALUATION: 1$30,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial BuildingPENTAMATION USE: # PERMIT TYPE: FURN/AC WORK I —01v) lil sia & A-11, 11 SCOPEzel S'vpp/ APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES A/C Units (<=10K cfm) A 1BCAIRHA Lj 1 # $143 Absorption Unit 1 MCRAA S'vpp/ 1 # -12— Ob PME Unit Fee: PME Permit Fee; $48.00 Administrative Fee: JADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO NOTE: This estimate does not include fees due to other Departments (4e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addnl info. FEE ITEMS (Fee Resolution 11-053 Eff 711113) Mech. Plan Check 0.0 hrs $0.00 QTY/FEE MISC ITEMS Mech. Permit Fee: IMPERMIT F Other Mech. Insp.Ej�hrs$48.00 El Lj PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (4e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addnl info. FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 Pel'o'lit I cg"" S'vpp/ PME Unit Fee: PME Permit Fee; $48.00 Administrative Fee: JADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 A Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $8.40 Select an Administrative Item BW Stds Commission Fee:. IBCBSC $2.00 SUBTOTALS: )1 $0,00 TOTAL FEE,7,3&&, Revised: 08/20/2014