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11120053CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10050 N WOLFE RD CONTRACTOR: AIR MAZE SERVICES INC PERMIT NO: 11120053 OWNER'S NAME: CUPERTINO FINANCIAL CTR PARTS LLC 933 KIFER RD STE A DATE ISSUED: 01/18/2012 OWNER'S PHONE: 4085679900 SUNNYVALE, CA 94086 PHONE NO: (408) 738-0333 LICENSED CONTRACTOR'S DECLARATION` r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class f= �ry �j 6 Lic. # �� 2-i � T " ` Contractor K ME- 6tMft�% I Date I \ MECHRESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter JOB DESCRIPTION: INSTALL NEW 120 LB CHILLER WITH NEW PUMPS, NEW (commencing with Section 7000) of Division 3 of the Business & Professions CHAIN LINK FENCE, RE -STRIPING FOR EXISTING PARKING Code and that my license is in full force and effect. GARAGE 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $192391 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31620086.10050 Occupancy Type: 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 constriction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which ma accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. A ilio ly, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source egulatr s per the Cupertino Municipal Code, Section 9.18. Date:/ 6 Issued by: Signature Date ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material berg installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants a ed by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain coiance wr the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & afe , Se 'ons 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must Q er it da. t, Date: Z forthwith comply with such provisions or this permit shall he deemed revoked. •) • " ' """""' APPLICANT CERTIFICATION ONSTRUCTION LENDING AGENCY I certify that l have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of cork's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Leader's Address 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 ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional FM_7 CITY ©F CUPERTIN© X\ FEE ESTIMATOR - BUILDING DIVISI©N Mech. Plan Check0.0 hrs $0.00 E';: c <:, . Mech. Permit Fee: IMPERMIT Other Mech. Insp. <i1-7 0.0 hrs $44.00 :;3i:f. r:'t;r f:... NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nrelininary information available and are only an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Lar 711111) 10050 n. wolfe rd. DATE: 12/07/2011 7RFVIEWED BY: bob s. MIADDRESS: APN: BP#: "VALUATION: $192,391 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE:-7PERMIT 0.0 PENTAMATION 1 GENCOM TYPE: WORK install new 120 Lb. chiller, with new pumps, new chain link fence re -stripping for existing parking stall. SCOPE F-1-1 # Mechanical $65.00 1BAPPLOT Other Appliance/Equip Mech. Plan Check0.0 hrs $0.00 E';: c <:, . Mech. Permit Fee: IMPERMIT Other Mech. Insp. <i1-7 0.0 hrs $44.00 :;3i:f. r:'t;r f:... NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nrelininary information available and are only an estimate. Contact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Lar 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes () No $0.00 F__27 hours $260.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 lvs $0.00 PME Plan Check: $0.00 F-1-1 # Mechanical $65.00 1BAPPLOT Other Appliance/Equip Permit Fee: Hourly Only? 0 Yes 0 No $0.00 Suppl. Insp. Fee:Q Reg. 0 OTF0,01hrs $0.00 F-547 If Fence $392.00 (FENCE>6FT Fence, Non -Masonry >6' PME Unit Fee: $0.00 PME Permit Fee: $44.00 0 # $130.00 Mechanical IMCRAA Cooling Unit Administrative Fee: IADMIN $41.00 0 E) Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) A Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICO $40.40 1.0 hrs $130.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $8.00 A': ;';<' `;; ?......... $ 177.40 $977.00 E ::::.:::..::::::....:....... ........: $1,154.40 Revised: 1010112011