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14100109 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 2 INFINITE LOOP CONTRACTOR:ICOM MECHANICAL INC PERMIT NO: 14100109 OWNER'S NAME: APPLE COMPUTER INC 477 BURKE ST DATE ISSUED: 10/20/2014 OWNER'S PHONE: 4087833025 SAN JOSE,CA 95112 PHONE NO:(408)792-2292 JOB DESCRIPTION:RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATION ❑ (� INSTALL 2 (N)A/C UNITS IN(E)2ND FLOOR LAB ROOM License ClassC—,�_"C4 Lic.#1 �dlS " 7 (VALHALLA) Contractor j6� � /,. Date4t9"� t(' �E/ I hereby affirm that I 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. 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 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$100000 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:31602106.00 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.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 IT 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 TION. indemnify and keep harmless the City of Cupertino against liabilities,ju costs,and expenses whi m nst said City in consequence of the �J Q granting of this per, itionally,thea licant understands and will com ued Date: with all non-point c regulations per th Cupertino Municipal Code,Se ' n 9.18. �1 RE-ROOFS: Signature Date 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 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 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. I 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(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 a en ces which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the y r it ty Management District performance of the work for which this permit is issued. will maintain compliance with th er no ni ' a Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 255 and 2 534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 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 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 GENERAL PERMIT APPLICATION D�0� M COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•build c>���>�T,�� MISC PLUMBING MECHANICAL ri�ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 7API N E v k I-l � �0� � 3t(, - 02- - (, — ©2- 0 6 OWNER NAME pe, F-MA 7� v2� IL e.0 N r c�n►i STREET ADDRESS,, i /' y�_ Y, Z[P FAX CONTACT NAMES "1 A� T t Z 2-2-03 eM7ILt 4_cSo r a i c:�M'!crlr✓ we STREET ADDRESS Z J� T .S`TQ�TE,ZIP (J �-i1 _ `� F ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICEN BU:Veoe) COMPANY NAME �Al E-MAIL FA cif � STREET ADDRESS ,STATEJ71 9sr�Z ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.r DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK r [ Cv�ulDr"ry �.5 '0 0 gog_ e [ L-1, P&CE �Uc,�c !�c J c va HL— wJ -I Jt< t:�Z+c 1 z.- 6x .,-J TOTAL VALUATION: By my signature below,I certify to each o folio I al property owner or authorized agent to act on the property ow alf. I have read this application and the information I have p ed is rrect. 1 ve ad the Description of Work and verify it is accurate. I o comply with all applicable local ordinances and state laws relating to b g const ion. uth rize r resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ^ �l�•�� SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY w ❑ OYER-THE-COUNTER' 0. F ❑ EXPRESS x U x<. ❑ STANDARD a ❑ LARGE El w MAJOR MEPMiseApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION W�PERMITTYPE: DDRESS: 2 INFINITE LOOP DATE: 10/20/2014 REVIEWED BY: MELISSA PN: 316 02 106 BP#: / � -VALUATION: $100,000 Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY Commercial Building PENTAMATION FURN/AC USE: PERMIT TYPE: WORK INSTALL 2 N A/C UNITS IN E 2ND FLOOR LAB ROOM VALHALLA SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=1 OK cfm) 1BCAIRHA 2 # $286 TOTALS: $286.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech. Insp. 0.0 hrs $48.00Ll NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 11-053 Cff 7/1:73) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $286.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICO $28.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $459.001 $0.00 TOTAL FEE: 1 $459.00 Revised: 08/20/2014