14030057 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10460 BANDLEY DR CONTRACTOR:ACCO ENGINEERED PERMIT NO: 14030057
SYSTEMS
OWNER'S NAME: CUPERTINO INDUSTRIAL ASSOCIATE 6265 SAN FERNANDO RD DATE ISSUED:03/26/2014
OWNER'S PHONE: 4087835395 GLENDALE,CA 91201 PHONE NO:(818)244-6571
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL El COMMERCIAL 0
�j APPLE-REMOVE& REPLACE 2 FORTY TON ROOF TOP
License Class /�Lic.# I Y✓ �j o A/C
Contractor sm,A �it+��Da 4_)1i LG r 1PACKAGE' PACKAGE UNITS AND I TWO TON ROOF TOP A/C
I hereby affirm that I am licensed under the provisions of Chapter 9 UNIT, LIKE FOR LIKE AND SAME LOCATIONS
(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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$200000
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 APN Number:32633105.00 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 'DAYS'9F 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 ROM IXST CALLED INSP CTION.
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 Issued by: Date.
with all non-point source regulati ns p r e C rtino Municipal Code,Section
9.18. -
yI ..��JJ RE-ROOFS:
Signature ate v 3 `k� 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 new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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). 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 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 Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino MunieiW'al Co e,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,255 n 25 4
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
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 l 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. l 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
O
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CONSTRUCTION PERMIT APPLICATION
Is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 \` ko
CUPERTINC3 (408) 777-3228• FAX(408) 777-3333 •building0cupertino.org \v\
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
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❑OWNER ❑ OWNER-BUILDER OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
C NTRACTO NAME LICENSE NUMBER I^ ,t LICENSE TYPE BUS.LIC#
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COTOPANY NAME E-MAIL FAX
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ARCHITECT/ENGINEER NAME jA ! abme LICENSE NUMBER BUS LIC#
COMPANY NAME J E-MAIL FAX
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DESCRIPTION OF WORK
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EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
b -ce k USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL Irl,
AREA AREA0 A AREA NET AREA I/Z '`,,i
BATHROOM KIT HEN OTHER 1.�+ ti
REMODEL AREA (I ,�y REMODEL AREA Vt I � REMODEL AREA -+ qy
PORCH AREA DECK rq)REA TOTAL DECK/PORCH AREA GARAGE AREA: ,DVETArCH
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I V (4 ❑ATTACH
#DWELLING UNITS IS A SECOND UNIT ❑YES SECOND STORY []YES
J BEING ADDED? f�;,N�O ADDITION?
PRE-APPLICATION ❑
PES [F YES,PROVIDE COPY OOFF IS THE BLDG AN YES I R TOTAL VALUATION:
PLANNING APPL#lj;�NO PLANNING APPROVAL LETTER EICHLER HOME? NO 1 u v V
By my signature below,I certify to each of the following: I a e prop wner or auth ed agent t e property o ehaif. I have read this
application and the information I have provided is Correct I v read e D s'ription of Work and verify it is ree to comply with all applicable local
ordinances and state laws relati to building constructi Iorize repr senjes of Cupertino to enter the above-identi`ed pro erty for inspection purposes.
Signature of Applicant/Agent 7 �z Date: o,3
4 - -
SU MENTAL INFORM ION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD Or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form 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
El MAJOR El SANITARY SEWER DISTRICT
submittal Of Bllilding Permit application,
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10460 BANDLEY DR DATE: 03/10/2014 REVIEWED BY: MELISSA
APN: 326 33 105 BP#: 4103Uf_5 "VALUATION: 1$200,000
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY Commercial Building PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK APPLE - REMOVE & REPLACE 2 FORTY TON A/C PACKAGE UNITS AND 1 TWO TON A/C
SCOPE PACKAGE UNIT, LIKE FOR LIKE AND SAME LOCATIONS
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (>1OK cfm) 3 # $417
TOTALS: $417.00
Mech.Plan Check 0.0 1 hrs $0.00
Mech. Permit Fee: IMPERMIT
Other Mech.Insp. Folhrs $47.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff: 7 Tjz3j FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $417.00
PME Permit Fee: $47.00
F-1
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes Q No $0.00
Travel Documentation Fee: ITRA VDOC $47.00
Strom Motion Fee: IBSEISMICO $42.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $8.00
SUBTOTALS: $605.00 $0.00 TOTAL FEE: $605.00
Revised: 01/15/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: tX4%/,& PERMIT# A/0300-5
OWNER'S NAME:(A1,, `r-1;%Kv 1Aq r1CSC CA CJiCS PHONE# 411;�) 2
GENERAL CONTRACTOR: Ci0BUSINESS LICENSE# Z
ADDRESS: ' CITY/ZIPCODE:—Q6tn L�'ityr ri
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS 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:
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
C1
O er/Contractol~Signature Date