13120142CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 MARIANI AVE
CONTRACTOR: ICOM MECHANICAL INC
PERMIT NO: 13120142
OWNER'S NAME: MISSION WEST PROPERTIES
477 BURKE ST
DATE ISSUED: 12/18/2013
OWNER'S PHONE: 4089290900
SAN JOSE, CA 95112
PHONE NO: (408)792-2292
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 0
/j,
APPLE- INSTALL CDA PIPING IN UNDERGROUND BORE
License Class e 20i / Lic. M ny �� 2�
TO
Contractor tePARKING
ZOl 3.
LOT VAULT STORM DRAIN SUBMERSIBLE
PUMPS IN
I hereby affirm that 1 am licensed under the provisions of Chapter 9
VAULT
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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
mpensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $89000
rmance of the work for which this permit is issued.
Rave
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: 31622018.00
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. l 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses h may accrue t said City in consequence of the
Date:with
granting of this pe it Ad;it5iy,;ap licant understands and will comply
Issued by:
all non -poi s rce reth Cupertino Municipal Code, Section
9.18.
��
RE -ROOFS:
Signature Dat
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
Signature of Applicant: Date:
1 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
1 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(a) 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 Ar I ality Management District 1
performance of the work for which this permit is issued.
will maintain compliance with th pe ino n' ipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti s 2550 2 3, nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner �( u)
permit is issued.
or authorized agent: Date
1 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
1 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
UN
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 n(��
(408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.orq 0\
❑ NEW CONSTRUCTION ❑ ADDITION 1�LALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS ( N C
APN n � / :?— 2
OWNERNAME I\.,..^�.
PHQ4(j 2',J `
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STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAMEl"1
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PHONE t
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STREET ADDRESS ^ n � �.�
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FAX
❑ OWNIER ❑ OWNER-BUTL/DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 6I),c _
LICENSE NUMBER
L}GE1�SE TFa
C)( -
BUS. LIC X L
CD
COMPANY NAME <<e�
[
E-MAIL
FA
Y
^6(
STREET ADDRESS
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CITY TE, ZIP a} 5-(-112—
PW /
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC k
COMPANY NAME
E4,1AIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
/N f ! m1%
EXISTING USE
PROPOSED USE
CONSTR. TYPE
# STORIES
USE TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECKAREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
a DWELLING UNITS:
IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑ NO ADDITION? ❑ NO
PRE -APPLICATION ❑YES �' YES, PROVIDE COPY OF IS THE BLDG AN ❑ 1'FS
RECEIVE
IOTA A:
PLANNING APPL N ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO
in the property owner or authorized agent to act on the property owner's behalf. I have read this
By Iny signature below, I certi"ides
application and the informationave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati[horize representatives of Cupertino to enter the above -identified proper( for inspection purposes.
Signature of Applicant/Agent:Date: l
SUPPLEMENTAL JN ATI QUIRED
PLANCHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑' Bun.nYNG PLAN REQ IEw
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
pennit for new building.
❑ E\PRESS`
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC N VORKS
fonn if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑' FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SE\VER DISTRICT
submittal of Building Pen -nit application.
❑ ENVIRONMENTAL HEALTH
61dgApp 2011.doc I-evised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
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 preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolulion 11-053 Eff 7111131
ADDRESS: 20400 MARIAM AVE
DATE: 12/18/2013
REVIEWED BY: MENDEZ
APN:
BP#: 3101901 Llc
"VALUATION: $89,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
USE: Commercial Building
-7PRIMARY
PENTAMATION
PERMITTXPE: 1GENC0
WORK
APPLE- INSTALL CDA PIPING IN UNDERGROUND BORE TO PARKING LOT VAULT STORM
SCOPE
DRAIN SUBMERSIBLE PUMPS IN VAULT
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 preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolulion 11-053 Eff 7111131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
r
1 hours
$139.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: (j) Reg. 0 OT0.0
hrs
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 preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolulion 11-053 Eff 7111131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
1 hours
$139.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: (j) Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee -0 Reg. 0 OT0
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:$0.00
Select allon-Residential E)
Building or Structure 0
�
fiYri+'/ i�Qclfl7lFlt1/FltCtr7 f'c'€".5:
Strong Motion Fee: IBSEISMICO
$18.69
=hrs
$417.00
Inspections
ISTINSP 7Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$22.69
$556.00
TOTAL FEE,
$578.69
Revised: 10101/2013
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: (—b
PERMIT # 13 120/ 2—
OWNER'S NAME:
OWNER'S
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
'Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUINCY I CTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB O RA RS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. ��°
I am not using any subcontractors "��
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date