13110182I CITY OF CUPERTINO DUIL,DING PERMIT I
BUILDING ADDRESS: 20380 TOWN CENTER LN
OWNER'S NAME: FUND VIII CUPERTINO LLC
OWNER'S PHONE: 4084254594
PLIENSED CONTRACTOR'S DECLARATION
License ClLic.4ContractorDate 2 0 W
I hereby ansed under the provisions of Chapter 9
(commenc00) 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:
1 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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. 1 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
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 pe t. Additionally, the applicant understands and will comply
with all non -point ou repulat�ns r the Cupertino Municipal Code, Section
9.18. // .4
CONTRACTOR: PARAGON PERMIT NO: 13110182
MECHANICAL, INC.
2460 DE LA CRUZ BLVD DATE ISSUED: 11/27/2013
SANTA CALARA, CA 95050 PHONE NO: (408)727-7303
❑
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
REMOVE AND REPLACE MVAC UNIT 50 TON
Sq. Ft Floor Area: Valuation: $100000
APN Number: 36940059.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITIIIN80 DAYS OF PERMIT ISSUANCE OR
180 DAY5 MOM LAST CALLED INSPECTION.
Issued by:
Date:
i RE -ROOFS:
Signature. 1 Date !/ All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I 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
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
Section 3700 of the Labor Code, for the performance of the work for which this
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. 1 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
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,
Signature of Appl
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with thepertino unicipal Code, Chapter 9.12 and
the Health & Safety Code, Section 05 25 3, PAd 25534.
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMT APPUCQTIOM
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 ^ building9cuaertino.org
[:1 PLUMBING CHANICAL ❑ELECTRICAL
❑MISCELLANEOUS
PROJECT ADDRESS /J D AW ;0 604032-
4032
APN # �Gf //®
OWNER NAME
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP FAX
CONTACT NAME
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CITY, TE, I
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME f�VLICEN
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COMPANY NAME 0./
E-MAIL
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFU or DUPLEX ❑ MULTI -FAMILY
BUILDING: OMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE EINO
IS THE BLDG AN ❑ YES
EICHLER HOME? NO
DESCRIPTION OF WORK Ll v L()h jj—
TOTAL VALUATION: 1�fp��.
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provid d is correct I have read the Description ofWork and verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi nstructio . I a orize representatives of Cupertino to enter the above -identified rope rty for inspection purposes.
Signature of Applicant/Agent: A Date:
SUPPEEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
i`�
.rlYrn'M7 " 7TT7M1MTTrrMT7T%T1r1%
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 an the nreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
%._till IL %-PIP �i..tUfrH�tt911fllVtilt
FEE ESTIMATOR - BUILDING MVISION
Plumb, Plan Check
ADDRESS: 20380 town center DATE: 19/27/2013 REYI[EWED RY: Mendez
Mech. Permit Fee: 1MPERMIT
APN:
1BP#:
*VALUATION: 1$100,000
*PERMIT TYPE: Building Permit
PLAN CIIEC]K'QYPE: Tenant Improvement
PRIMARY Commercial Building
Plumb. Insp, Fee:
PENTAMATION FURN/AC
USE:
PME Plan Check:
PERMIT TYPE:
wORK
remove and replace hvac unit 50 ton
SCOPE
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 an the nreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
Mech. Plan Check 0.0 1 hrs $0.00
Plumb, Plan Check
Elee. Plan Check
Mech. Permit Fee: 1MPERMIT
Plumb. Permit Fee:
Ek:c, Permit Fee:
Other Mech. Insp. Elhrs $47.00
Other Plumb Insp.
Offier Elec. Insp.
,4lech. Inch. Fee:
Plumb. Insp, Fee:
Etc,. Insp. Fee:
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 an the nreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY/]FELE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$139.00
Mechanical
A/C Units (> lOK cfm)
Suppl. PC Fee: (F)Reg. ® OT 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Sup pl. Insp. Fee:Q Reg. ®OT Q.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Construction Tut:
Administrative Fee: /ADMIN
$44.00
G
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.001
Select a Non -Residential
Building or Structure
CCS
Al
Travel Documentation Fee: ITRA VDOC
$47.00
Strong Motion Fee: IBSEISMICO
$21.00
Select an Administrative Item
�]
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$163.00
$139.00
TOTAL FEE:
$302.00
Revised: 10/09/2013