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15030103I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10431 N DE ANZA BLVD CONTRACTOR: ACCO ENGINEERED PERMIT NO: 15030103 SYSTEMS OWNER'S NAME: APPLE COMPUTER INC 6265 SAN FERNANDO RD DATE ISSUED: 03/17/2015 OWNER'S PHONE: 4089961010 GLENDALE, CA 91201 PHONE NO: (818)244-6571 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] APPLE - REMOVE & REPLACE ROOF TOP BOILER License Class C-- Lic. # 1-?-C>0G Contractor QGCO �nchu��o( Su�cr+sDate� IS 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. 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will c with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 03/1 �I S ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 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 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, 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 Sq. Ft Floor Area: I Valuation: $89900 APN Number: 32633114.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D RMIT ISSUANCE OR lgALLED INSPECTION. M Date: 3 RE -ROOFS: 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. Signature of Applicant: 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. I 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 the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 255059 25533, and 25534. Owner or authorized agent: Date:o3 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 GENERAL PERMIT APPLICATION o�)MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 0 `1 MISC (408) 777-3228 • FAX (408) 777-3333 • build ing(akupertino.orq CUPERTINO \ F1 PLUMBING MECHANICAL ❑ELECTRICAL ❑',I!S('GLLANEOUS PROJECT ADDRESS I D I 1 Q 1 (V 1, APN # /' OWNER NAME vyte, T 1• PHONE ��Oc\ nr (- l(?I 6 J `l_, O E-MAIL STREET ADDRESS CITY, STATE, ZIP C.t+(�rltrl� C A 9_5 Ol FAX CONTACT NAME /+ r:SL (� r �bS l• rCj' PHONE (,StO, •3�{b -'to►8 E-MAIL C.50rae'I's q� Oet 5.Csx- STREET ADDRESS 1133 Hl.c�i I t. N.,e, CITY, STATE, ZIP Sept, U+ 4 45'2^ FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT lel CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ACCOt,u,t,�,rc,� S�r�15 LICENSE NUMBER 7 1Zo6al� LICENSE TYPE C`'-1 BUS. LIC # COMPANY NAME ACCO �nc�t�cc.cd Syylc.Nlg E-MAIL C e"'t. �5 <. AL C �e5 , OtiI 5 FAX CS 1 v 7 � �'� - ►31 _., STREET ADDRESS 1133 A14N�%", A e- , CITY, STATE, ZIP 'N 1 L- SG l,c4t,a� -A PHONE (sto) 3y6- Zo, ARCHITECT/ENGINEER NAME, �.j,4V,,FkVk-L LICENSE NUMBER L �.3y /' �L 1� b v BUS. LIC# COMPANY NAME f`CCO ftYlt`ee {its E-MAIL SCh�vl�tplVIet..�aC.0065.[�I FAX (SI1313 STREET ADDRESS1 t 33 AI'R. CITY, STATE, ZIP ^ Sr � �, �. A Gy5rjr--2 �J'` PHONE /'Std\ l USE OF ❑ SFD. DUPLEX ❑ MULTI -FAMILY BUILDING: COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA NO PROJECT IN ❑ YES FLOOD ZONE `0 NO IS THE BLDG AN ❑ YES`O EICHLER HOME? � NO DESCRIPTION OF WORK D UT Si"Aer , -C,l OG, TOTAL VALUATIONS _ gq rl 00 Y' By my signature below, I certify to each ofthe following: I am the property owner or authorized agent to act e property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating budding constructi n. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date:3161 1� SUPP'LAENKTAL INFORMATION REQUIRED OFFICE USE ONLY w ❑ OVER-THE-COUNTER F' ❑ F,XPRI,,S,S U S ❑ STANDARD G ❑ LARGE a ❑ bLAJOR MEPMiscApp_2011.doc revised 06/21/11 r��.��.��WAl CITY OF CUPERTINO Fw--IPP Fc'TIMATOR — RITILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10431 N DE ANZA BLVD DATE: 03/17/2015 REVIEWED BY: MELISSA 121 APN: 326 33 114 BP#: ` 5Q,30/0VALUATION: $89,900 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building # [P�ENTAMATION 1CM64 PERMIT TYPE: WORK APPLE - REMOVE & REPLACE ROOF TOP BOILER SCOPE APPLIANCE / EQUIP TYPE FEE ID Vwnh. Plun Check QTY UNITS BP FEES Elec. Permit Fee: Boiler/Comp. <=3hp 1BBOILER(1) ,ather Elec. 1-11 1 # $107 PME Plan Check: $0.00 Permit Fee: Supp/. Insp Fee PME Unit Fee: $107.00 PME Permit Fee: $48.00 Construction Tax: TOTALS: Administrative Fee: $107.00 $45.00 NOTE: This estimate does not include fees due to other Departments (i.e. rtammng, ruauc rrurns, Ptic, —•sou•y �•�•• �•- 1' t' n available and are onl an estimate. Contact the Dept or addh I info. District, etc). These Lees es are based on the re tmina FEE ITEMS (Fee Resolution 11-053 Ef : 7if 1!13) Mech. Plan Check 0.0 hrs $0.00 Vwnh. Plun Check k :. Plan Check Mech. Permit Fee: IMPERMIT Plumb. Permit T c --E]F-l- Elec. Permit Fee: Other Mech. Insp.0.0 hrs $48.00 =7rher Plumb Insp. ,ather Elec. 1-11 I umb r., Insp. fere' PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. rtammng, ruauc rrurns, Ptic, —•sou•y �•�•• �•- 1' t' n available and are onl an estimate. Contact the Dept or addh I info. District, etc). These Lees es are based on the re tmina FEE ITEMS (Fee Resolution 11-053 Ef : 7if 1!13) m oa to FEE QTY/FEE MISC ITEMS Plan Check I%ee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. Insp Fee PME Unit Fee: $107.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes O No $0.00 �Idvunced Plarming pore's'. Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICO $25.17 1.0 hrs $143.00 Inspections ISTINSP Inspection, Hourly Bldy_ Stds Commission Fee: 1BCBSC $4.00 SUBTOTALS: $277.17 $143.001TOTAL FEE: $420.17 Revised: 02/1412015