12030064 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10000 TORRE AVE CONTRACTOR:ACCO PERMIT NO: 12030064
ENGINEERED SYSTEMS
C
OWNER'S NAME: TORRE AVENUE PROPERTIES 6265 SAN FERNANDO RD DATE ISSUED:04/05/2012
OWNER'S PHONE: 4087384444 GLENDALE,CA 91201 PHONE NO:(818)244-6571
LICENSED CONTRACTOR'S DECLARATION F_ r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# °Z t r
.�° MECH RESIDENTIAL COAVVIERCIAL
Contractor q c to bate JOB DESCRIPTION:APPLE-REMOVE AND REPLACE THREE(3)COOLING
ONLY
I hereby affirm that I am licensed under the provisions of Chapter 9 ROOFTOP PACKAGED A/C UNITS.LIKE FOR LIKE
(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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$300000
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:36902030.00 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 WORD IS NOT STARTED
correct.I 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,
ai it in consequence of thecosts,and expenses which may accrue against s
Issued b r Dater
granting of this permit. Additional ,the lie at nderstands and will comply Yz
with all non-point source regu�ati pe th C ped ino Municipal Code,Section
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
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under,Chapter 6.95 of the
I
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 Qua A agement District I
will maintain compliance with the Cu cutin N inic e,Chapter 9.12 and
performance of the work for whichthis permit is issued. p p o p
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect'ons 25505,25 3 afii 2 3 p—
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ate: J ` Z_
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Connpenslion 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 relafing
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
i
CITY OF CUPS TIN
FEE ESTIMATOR BUILDING DIVISION
t I
ADDRESS: 10000 4arre eve. DATE: 43/14/2412 RE�TIEWED BY: bobs.
"VALUATION: $300,000
,5 0301 BP#: /?a_3 1J
"PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/Repair
PRIMARY PENTAMATION
USE: Commercial Building PE T TYPE: FURN/A
wo remove and replace 3 cooling on[ rooftop acke ed A/C units. Like for like.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (>10K cfm) 3 # $390
TOTALS: $390.00
1\4ech.Plan Check 4.0 hrs $520.00
11A4ECPLNC Meeh.Permit Fee: IMPERA11T
, 7 ,:
Other Nfech.hasp. 0.0 hrs $44.00
NOTE: This estimate does not include fees dare to other Departments(i.e.Planning,Public Morks,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the Prefininan,ira or»uatiorr availabl�and e on1 au estinaa#e. Contact tlae De t maddra'1 in o,
FEE ITEMS Ll"ce Resoliftion 11-05 R' '7,11;'17) FEE QTMISC ITEMS
PME Plan Check: $520.00
PME Unit Fee: $390.00
PME Permit Fee: $44.00
Administrative Fee: 1,4DMIN $41.00
Work Without Permit? 0 Yes Q No $0.00
Travet Documentation Fee: 1TUVD0C $44.00
Strom iytotio n Fee: 1BSEISh1ICo $63.00 Select an Administrative Item
Id, Stds Coiiin ission Fee: 1BCBSC $12.00
SUBTOTALS: $1,114.00 $0.00 TOTAL FEE: $1,114.00
Revised: 1/19/2012