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14080185 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:SOUTHLAND PERMIT NO: 14080185 INDUSTRIES OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 33225 WESTERN AVE DATE ISSUED:08/18/2014 OWNER'S PHONE: 4088730121 UNION CITY,CA 94587 PHONE NO:(510)477-3300 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ 7TH FLOOR, INSTALL TEMPORARY COOLING TO License Class ( �—� Lia Sl. w O�{0 SERVER Contractor S�u � 1UrCq�ate ROOM 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. 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:550000 I have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36901027.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 180 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 FR M LAST ALLED INSPECTION. 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: l with all non-poi t source regulat ns pert e Cupertino Municipal Code,Section 9.18. %\ %l\ ---"E-ROOFS: Signature WWII�� V— 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: [hereby affirm that 1 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 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 I performance of the work for which this permit is issued. will maintain compliance with the Cuperti unicipa Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ' s 2 505, 55 3,and 5534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Dater 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 1 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 CONSTRUCTION PERMIT APPLICATION U-AACOMMUNITY T"DEVELOPMENT DEPARTMENT- BUILDING DIVISION r'� 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 ��(� (408) 777-3228 • FAX(408)777-3333• build'Ino guaertino.oro CUPERTINO ❑'SEW CONSTRUCTION ❑ ADDITION Z ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT n PROJECT ADD RESS S�C`` �j C��- \�L�A f3NR' �InGj /'�J/" OWNER NIMMIS ✓\ LV PHONE I E-MAIL ih��v� 5 Q�i�L �,S`Ps•�ti C>t�.au� � �a�-°��'3� �►;1 r STP-E=ADDRESS CITY, STAT E,ZIP FAX 0 s't-tao'-, C,�-ec v_ v d ;r\u e10k . 5 \ '1 CONTACT NA!✓:E PHONE E-MAIL LISP NNW111Was51 06WIftS5,@ ?('*I'q�C�C�t STREET ADDRESS CITY,STATE, ZIP �r FAX o,,T,D: ❑ ON1N R-BUII.DER ❑ O'WEER AGENT CONTRACTOR ❑COKI?ACTOR AGENT ❑ ARC':-u"I"_CT DNGIN'EHZ ❑ DEVELOPER ❑ TEN.I?N'T CONTnAC OR NAME r. _ .� LICENSEC 11rMb1 ``I\J L\13 LICENSE TYPE I 3L'S.LTC � COMP..NY NA.,9E E-34AILf\ FAX STREETADDRESS CITY,STATE ZIP PHONE y,N.ocs << (_� a�� r ARC=zCT/`FNGTEER NA-IME LICENSENLMSER \ O\LE-MAIJ� COMPANY N.4A4Fy�,a` �N� L FAX STREET ADDRESS Nt� CITY,STATE,ZIP PHONTTE DESCRIPTION OF WORK � EXISTiNGUSE PROPOSED USE COMTR_MIS STORIES USE TYPE I OCC. SQ.FT. VALUATION(S) EXISTO NEW FLOOR DEA40 TOTAL AREA AREA AREA NET AREA BATHILOOM KIM—TEEN 01"tER REMODEL AREA REA4ODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE.AREA: 0 DETACH ❑ATTACH D;'`EL.LIING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? []NO RE- PPLiCATION [�-1 ES---r 1 LS,3S OSIDELOPLOF lSZE�LDG.� —S tS FIN,EDB - TOT.a L VALUATIO PL.AI,MNG APPL R ❑NO PLAiNTZ?`G APPROVAL LETTER EICHLER HOME? ❑NO By Iny signature below,1 certify to each of the following I am the property mkT.er or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correc. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws gelatin t but Ing constructio . I auth ize representatives of Cupertino to enter the above-I'd ' den fied prope y for inspection purposes. S i gnature of Appl icant/Aeent: Date: SUPPLEMEN AL INIFORMATIO I REQUIRED, L41 CaECIZ TYPE.;,µ _.�_ RGUTI G SLIP New SFD or Multifamily dvv,ellings: Apply or demolition permit for © OVERTFIE.COUI�TER � � EU�,DL�GPL•i'�RE�TEAY. existing buildirg(s). Demolition permit is required prior to issuance of building - per it for new building. M �� p _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sT DA�Tzn� uBLrc vaRl s farm if any Hazardous Materials are being used as part of this project. —Copy of Planning Approval Letter or Meeting with Planning prior to �n '❑ 4AJflR� � � �'v`�•-� °0 �A_N3TARI SE�'.�RDIST.PTCT� submittal of Building Permit application. $1dgXpp_2011.doc revised 06111111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20450 scb DATE: 08/18/2014 REVIEWED BY: mendez APN: BP#: Wor t "VALUATION: 1$50,000 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK 7th floor, install temporary coolinq to server room SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (>1 OK cfm) 1MRAIRHA 1 # $72 TOTALS: $72.00 Mech.Plan Check 0.0 1 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech. Insp. 0.0 hrs $48.00 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 preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Eee Resolution 11-053 E. 71131 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $72.00 PME Permit Fee: $48.00 Administrative Fee: (ADMIN $45.00 Work Without Permit? © Yes E) No $0.00 Travel Documentation Fee: /TRAVDOC $48.00 Strom Motion Fee. IBSEISMICR $6.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $221.50 $0.00 TOTAL FEE: $221 .50 Revised: 07/10/2014