12110043 CITY OF CUPERTINO.BLTILDING.PERMIT ,
.BUILDING.ADDRESS: 109.00 N BLANEY AVE CONTRACTOR:MATRIX HG,INC. PERMIT.NO: 12110043
OWNEWS,NAME PACIFIC;GAS AND ELECfR-IC-CO 2355'WHITMAN RDSITE.A DATE ISSUED: 11%16/2012
OWNER'S PHONE: 4.153173740 CONCORD,CA'94518 PHONE NO:(925)459-9200
❑ LICENSED CONTRACTOR'S DECLARATION JOB,DESCRIP,TION: RESIDENTIAL❑ COMMERCIAL
11
License Class _ Lic.:# .� ?j.� REPLACE 9 ROOFTOP MECHANICAL UNITS ADD.NEW
STEEL
Contractor°M6&4•-.ir; Date PLATFORM ON EXISTING ROOFTOP
I hereby affirmthat l am Iicensed:under the provisions of.Chapter 9 1.1/19/12-REV#1 -REVISE WELD TOBOLTS ON°PLATFORM
(commencing!with Sectnio7000)of Division 3,ofthe Business&Professions 3/15/13—REV#2-ADD GRATING TO ROOF BETWEEN
Code and.that-my licensc Js iu,full force and effect: UNITS
7 hereby affirm under penalty of perjury one of thc;following`two declarations:
1 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:$589976
-1 have and will maintain Worker'slCompensation Insurance,as provided.for by
Section 3700 of the Labor Code,for the performance of the-work for which,this APN Number::31603045.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
(`certify tliat.l have read this application and state that the above informafion is PERMIT EXPIRES IF WORK IS'NOT.STARTED.
correct.1 agree to comply witli';all.city and county ordinances and state.laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE.OR
,to building construction;and hereby authorize representatives o-fthis'city to enter
.upon the above meritionedproperty for,inspection"purposes; (We)_"agree;to�save 180 DAIS FROM LAST CALLED INSPECTION..
indemnify and keep harmlesstthe City of Cupei"tino against liabilities;judgments,
costs,and expenses which,may accrue against.said City in consequence ofthe
granting of this permit. Additionally,,,the7applicant understands and will comply Issued by:-.� Date:
-with all non-point urce regulations per the Cupertino.'Mi ni6pal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofsshall,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
'
Fhereby affirm that I am exempt from the ConSignature of Applicant: Date:.
tractor's,License Law for one of
the following two reasons: AL_ L,ROOF COVERINGS TO BE CLASS"A:"OR BETTER
[Jas owner of the property,or my employees with wages as.their'sole compensation,
will do the work,and the structure isnot 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.&-Safe-ty Code,Sections,25505,25533,and 25534. I:will
hereby affirmunderpenalty of perjury one of-the followinggthree maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the'
declarations:. Health!&Safety',Code;. Seetion 25532(a)should Lstore or handle hazardous
(;have and"will:maintain a Certificate of Consent to self'insure for Worker's material. Additionally;should 1 use equipment or-devices which emifhazardous
Compensation,as•provided for by Section 3700 of the-Labor Code,for;the sie.confaminants as defined bythe Bay Area Air Quality:Management District.(
performance of the work-for which.this,permit Iis issued. will maidtaiin compliance with the,Cupertino Municipal Code,Chapter 9.12.and
l have and will'maintain Worker'.Compensation Ins urance,°as,provided for by the Health&Safety Code;,Sections 25505,25533,end 25534.
Section.,3700 of the Labor:Code,for,the performance of the work for which this
Owner or authorized agen' Date:' ,
permit is issued.
certify'that in the performance:.of the Work for,which this permit is'issued,I shall
not employany 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 agencyfor the performance of
forthwith:comply with,such,provisions or this permit.shall be'deemed revoked. work's for which thi's•permitis issued'(Sec.3097-;Civ C)
Lend'er's Name'
APPLICANT CERTIFICATION Lender's Address
I.certify'thatI;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.'(W.e)agree to save:
indemnify and:keep harmless the City of Cupertino againstliabilities,judgments, ARCHITECT'S DECLARATION
costs;,and expenses`which,may'accrue against said City inconsequence 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 Ili e'Cupertino Municipal Code,Section Licensed-Professional .
9.18.
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: .10900 N BLANEY,AVE CONTRACTOR:MATRIX HG,INC. PERMIT NO: 12110043
OWNER'.$NAME: PACIFIC,GAS AND ELECTRIC.CO 2355 WHITMAN RD STE A DATE ISSUED: 11/16/2012
OWNER'S PHONE: 4153173740 CONCORD,CA 94518 PHONE NO:(925)459-9200
❑ LICENSED CONTRACTOR'S DECLARATION
w p BUILDING PERMIT`INFO: BLDG- ELECT' '" PLUMB
,License Class p Lia#
MECH'" RESIDENTIAL COMMERCIAL
Contractor: IA'1 yr`y�f�1 yt"'��j Dale l I � �6 ` r.�i
I hereby affirm that I am.licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 9 ROOFTOP MECHANICAL UNITS ADD NEW
(commencing with Section 7000)of Division 3 of the Business&&Professions STEEL
•Code.and that.my license is'.in full-force and effect. PLATFORM ON EXISTING ROOFTOP
hereby affirm under penalty of perjury.one of the following two declarations:
Lhave and will maintain a certificate of consent to self-insure.for Worker's
Compensation,(as provided•for by Section`3700 of.the:Libor,Code,;for the
performance of the work for which this permit is issued.
(':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. Sq.Ft Floor Area: Valuation:$589976
APPLICANT CERTIFICATION
I.certify,that I.have read this application-and state that the above information is APN Number:31603045.00 Occupancy Type:
correct.I agree to complywitli all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this cit 4o enter
upon,the.above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the Cityeof Cupertino against liabilities;judgments, PERMIT,EXPIRES,IF WORK IS NOT STARTED
costs,and expenses which may accrue against said'City in corisequenceof the
granting of this permit. Additionally,the applicant understands•and.will comply WITHIN,180 DAYS OF PERMIT ISSUANCE OR
with.all non-point sou a egulations per the Cupertino Municipal Code,Section 180 D YS FROM ST CALLED INSPECTION.
9.18.,
Signature_1. Date i/ b 2 Issued by: Date:,
❑ OWNER-BUILDER DECLARATION
hereby affirm that?am•exempt from the Contractor's License'Law for one of RE-ROOFS:
the following two,reasons: All-roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I.agreeao remove all new materials for
will-do the work,and;the-structure•is not;intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner-of the property;am exclusively-contracting with licensed contractors to Signature,of Applicant: Date:
construct the project,,(Sec.7044,Business&Professions Code).
he affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3.700 of the Labor Code,for the
°performanceof the work for which,this,permick issued.. I,have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Corrlpensation.lnsurance',as provided for by California Health&Safety Code;-:Sections 25505,25533,and 25534. I will maintain
Section3700 ofthetLabor"Cd&,jor the•performance of the work for.which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,;Section 25532(a)should I.store or handle hazardous material.
permit is issued. Additionally",should I use equipment or devices which emit,hazardous air
I certify that in the performance`:of the work forwhich,this perrn&is:issued,l shall contaminants as detined.by the Bay Area Air Quality Management District-twill
noternploy any person in,any manner so as7to become,subjectjo.the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certifcate'ofexemption,I Health& ty Code,Sections-25505,25533,and 25534.
become subject to the Worker's Compensation provisions of:the;Laboe Code,I must
forthwith comply with such provisions or this permit shall.be.deemed revoked. Owner a thorized agent:
Date:
APPLICANT CERTIFICATION. CONSTRUCTION LENDING AGENCY
I certify that I have read this application and-state thatthe above,information is
correct.I,agreerto.comply with.alI city,and county ordinancesand,state laws.relating I hereby:affrm that4here is.a.construction lending agency for the performance of mrk's
to building construction,and.hereby authorize representatives.of•this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the'above,mentioned property for inspection purposes.(We),agree to save Lender_'s Name
indernn6.and keep harmless the:City of Cupertino against liabilities,judgments,
costs,and,expenses'which may accrue against said.City'in consequence"of the Lender's Address
granting of this,permit.Additionally,the applicant understands and will comply
with all.non=point source regulations per the Cupertino Municipal Code,Section. ARCHITECT'S DECLARATION`
9.18.
l'understand my plans•shall be used as public records.
Signature Date
Licensed.Professional
CITY OF CUPERTINO BUILDING PERMIT -
ATE
BUILDING ADDRESS: 10900,N BLANEY AVE CONTRACTOR:MATRIX,HG,,INC. PERMIT NO: 12110043
OWNEWS;NAME: PACIFIC GAS AND.ELECTRICE0 2355 WHITMAN RD STE.A DATE ISSUED: 11/16/2012
OWNER'S PHONE: 4153173740 CONCORD,CA 94518 PHONE NO:,(925)459-9200
❑ LICENSED CONTRACTOR'S DECLARATION r
n BUILDING PERMIT.INFO: BLDG ELECT PLUMB rl
License Class Lica# 2 G-e
,/ �j mNC / MECH RESIDENTIAL COMMERCIAL C
V(.
Contractor �' /`l (Xty— 1O Date -
1,hereby affirm thata am licensed under the provisions ofChapter 9 JOB DESCRIPTION:.REPLACE 9 ROOFTOP MECHANICAL UNITS
(commencing with Section 7000)ofDivis'ion 3 of the,Business,&Professions ADD NEW STEEL PLATFORMON EXISTING ROOFTOP 1/19/12-REV#1
Code and thaVmy license is in full force and effect. -REVISE WELD TO BOLTS ON PLATFORM AND REVISE THE
STANDARD SLEEPER LUMBER.SPECIFICATION-11/19/12 REV#] ISS'D
herebyaffirm'und'er penalty,of`perjury, one of theTollowiitg two°declarations:
I,have�and will,maintairra 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 mai ntain.Worker's Compensation.In sorance,as,provided for by
Section 3700 ofthelabor Code,for ttie,performance of the'.wo_rk for which this
permit is issued.
APPLICANT CERTIFICATION Sq.Ft-Floor Area: Valustion:3589976
I certify that I have,read'this application and,state that.-the above inforrnation.is
correct.I agree:to comply'with all city and county ordinances and state laws.relating APN Number:31603045.00 Occupancy Type:
to buildingconstruction,and hereby authorize representativ.es.of this city to enter
upon the above mentioned property for inspection purposes. (We)agree'to save
indemnify and keep harmless the C' of Cupertino:against°liabilities,judgments,
costs,and expenses:which may a e against said City in consequence of the
granting of.this permit. Additio al the applicant understands and.will.comply PERMIT EXPIRES IF WORK IS NOT STARTED
with-all non-point source regu ti s per the Cupertino-Municipal Code;Section WITHIN 180 DAYS OF PERMIT ISSUANCE OR
9.18. L /Q 180 DAYS FROM LAST CALLED INSPECTION.
Signature r ` !r Z
Issued by: � �/✓ ,07/ Date:
❑ OWNER-BUILDER DECLARATION
Lherebyaffirm that I am exempt from the Contractor''s License Law for one of
the following two reasons
RE=ROOFS:
1,as owner of the
property,or my employees with wages as their sole compensation, All roofs shallbe.inspecied•priorto any roofing material being installed.If a roof is
will do the work,and 'the structure.is not.intended or offered forsale(Sec:7044, installed without first obtaining an inspection,.I agree to remove all new.materi'al'sfor
Business&.Rrofessions?Code) inspection.
I,":as owner of.the property,.am exclusively contracting with licensed contractors to
construct%the project(Sec.7044„Business&Professions Code). Signature of Applicant: Date:
1 hereby affirm under penalty ofperjury one,of the follow ing,three
declarations: ALL ROOF COVERINGS TO BE CLASS"A”OWBETTER
I have and will maintain a Certificate of Consent-to self-insure for'Worker's
Compensation,as provided;for by+Section3700:of the Labor Code,for the
performance of the-work•for which;this permit is;issued. HAZARDOUS MATERIALS.DISCLOSURE
['have and will maintain'Workec's Compensation Insurance,as provided for by I have read the hazardous materials requiremenWunder.Chapter6.95 of the
Section'3700 of the Laborode;'for the performance of the work for which this California Health&c Safety,Code,Sections.25505,25533,-and:.25534. I will maintain,
permiGis issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Lcertify that in,the;performance of.the work for which.this permit is issued,.)shall Safety Code,Seetion 25532(a)should I.store or handle hazardous"material:
not employany person in any manner so.as to become subject to the Worker's Additionally,should I use:equipment or devices which emit haza[dous air
contaminar(6,as defined bythe Bay Area Air Quality Management District
Compensation laws,of California. If,after making this certificate of exemption,I maintain compliance w' the Cupertino Municipal Code,Chapter 9.12 and the
becorneisubject,to°the Worker=s Compensation provisions.of the Labor Code„I;must Health&,Safety Code 'et
ions 25505,25533,andr25534.,
forthwith comply with-such provisions.orthis permit shall be deemed revoked.
Owner or"authorize gent:
APPLICANT CERTIFICATION Date: ' ,Z--
I certify that.)have read this application_and stat_e'that,the above information is
correct.I agree to comply with all city and county ordinances and state;laws relating CONSTRUCTION LENDING AGENCY
to.building construction,and hereby authorize representatives.of this city to enter I hereby affirm that there is a.construction lending agency for the performance of Hork's
upon-the above mentioned property forr,inspection purposes.(We),agree'to,save for which this permit is-issued(Sec.3097,Civ C.)
indemnify^and.keep,harmless the City of.Cupertino againsH iabil ities,judgments, Lender's.Name.-
costs,and expenses which,may accrue against said City in consequence ofthe
granting-.of this permit.Additionally";the applicant"understands•and will,comply Lender's Address
with all non-poinusou ce;regulations per the,Cupertino,Municipal,Code,,Section
9.18.
ARCHITECT'S DECLARATION
Signature Date 1 understand:my plans shall be'.used as public records.
Lieensed:Professional
CITY OF CUPERTINO
FEE'EST,IMATORI-B:UILDaING DIVISION .
ADDRESS: 10900`N BLANEY
AVE DATE: .03/15/2013 REVIEWED BY: MELISSA
APN: , 31.6.03 045 BP#:: /000 *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY. PENTAMATION
SFD or Duplex. 1GENRE i
USE: PERMIT'TYPE:
WORK "REV#..2 -ADD GRATING TO ROOF AREA BETWEEN MECHANICAL UNITS
SCOPE
FOE MA
L1ech:I'(an Check Pliwlh.. Plum(:.'heck Elcc.. /'l an Chock
1?ech..11ww ii Fec: Alumh. Permil'Fee: 11"lee PermilTee;-
—]
Lk,"h
.Alech.lnsp. . oillo-Plumb Imp. C)ther L'lcc.,lnsp.� Li..Insp_'Fee' Plumb. hisp:Pee L;lcc.Insp. FL-e.,
NOTE: This estimaie,does not inelude.jees.due to other Departments(i.e.Planning,Public.Works,Fire,Sanitary Sewer District,School
.District,eta). These.fees are based on;the_ relimina information available and are only an estimate. Contact the.De t or addn 7 info.
FEE ITEMS(Fee Resolution 1I-053 E�'..7/IY12) FEE QTY/FEE MISC ITEMS
Plan Check.Fee: Hourly,.Only? ®Yes E).No $0.00 hours Plan Check,Hourly
Supp!. PC,Fee: Reg. OT 0.0 hrs $0.00 $266.0,0 ISTPLNCK
PME Plan Check: $0.00
Permit Fee $0.00
Supp!. InFee .0 OT
PME Unit.Fee: u.00
PME,Permit,Fee: $0.00
'Construction,:Tcr_r:
A.dini is&(jti,VL'•.l'L,e: O
Work Without Permit? Yes (F) No ' $0:00 O
Advanced Planning,Fee. $0.00. Select allon=Residential
`"!ravol I.)occrrnehturiort.h'ees: Building or Structure:
-Strong, Mofion Fee:. $01.100 Select an Administrative Item•'
i3W::Stds:Commission Fee: $0.00
50 Vw-
H �� SUBT®TALS $0.00 $266:00 ` ti roALFEE $266.00
Revised:' 01/0112013
CITY OF CUPERTINO
FEE,ESTIMATOR- BUILDING DIVISI=ON
IIF ADDRESS:'10900 N. Blaney Ave DATE_: 11/19/2012 REVIEWED BY: Sean
AEN: BP#: 'VALUATION: Iso
*PERMIT TYPE Building P@rmit PLAN CHECK-TYPE: Addition
PRIMARY SFD or DulexPENTAMATION
USE'; p : PERMIT TYPE.PERMIT
WORK Revision #t, reviseweld to bolts on piatform and revise.the,standard sleeper lumber specification.
SCOPE
alt."Cit.,.f�/i.14•(�Fit�:i: t','edfP-l), hlrsT?(,i•'.'.'Y' ft1CC..hi';?r:(_iiBt;1.
(th,"r niiUt?h Ji ;;, Ll
;,?7i%i't I'lec,Jl"tSt:.
Fee,-
NOTE: This
ireNOTE::This estimate does not include fees•.due to other Departments(i.e.Planning,•Public•Works,Fire,Sdnitary,Sewer.District,,School
District,etc). These ees,are based on-thepirelimina information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution.I 1-033,kj1. FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? O.Y;es IE) No $0.00 2 hours, Plan Check,Hourly
-Supp]. PC.Fee: (F) Reg.. OT 0:0 hrs. $0.00 $266.00 ISTPGNCK
PMt Plan.Check: $0.00
Permit Fee: $0.00
Suppl. Insp.`Fee-0 Reg. O OT FO.Q firs $0.00.
PME Unit Fee,: $0.00
PME Permit Fee: $0.00
C.:n;zslrr�cti'%ii 1�xs;:
Work Without Permit? 0 Yes O No $0.00
Advanced.Plannin� Fee:; $0.00 Select a Non-Residential G
7,.Favel Docwnenta/it�l�.F"G�,3: Building or Structure. O;
i
Strom Motion.Fee.' $0.00 Select an Administrative Item
Bld'>.:S tds Commission Fee: '$0.00
:. ,,.. aMY, ; V �SUBTOTAI STOTA�L FES $266.00
$0 00 $266.00 ,tv .....
Revised: 10/01/2012
CITY OF CUPERTINO
FEE,ESTIMATOR— BUILDING DIVISION
IkADDRESS:_ 10900 N. Blaney Bldg A. DATE: 11/07/2012 REVIEWED BY: bob s.
PN: BP#c 1 I���L 'VALUATION: 1$589,976
xPERMIT'T,YPE: Building Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY Commercial Building PENTAIVMATION 1GENC0
USE: PERMIT TYPE: A
WORK replace 9 r O*oftop mech. units. add new steel platform onexisting rooftop.
SCOPE
'�,^ - t ' '.Fa,..v
�>.
Mech.Plan Check 0.0 hrs $0.00 Phin,b. Plan Check Elec.Plan("'heck
Mech.Permit Fee: IMPERMIT Fl—h-Permil Fee: Elec.'Permit Fare:
'Other Mech.Insp. 0.0 hrs $45,.00 Oilrer:Plumb Irsp. Other li'Icc,Rul'), Lj
Mech, Insp. G<<c: P.hirnh: fa p. Fee: flee. Intip,Fere:
NOTE.,This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School.
Distriet,etc. . Thesefees are basedwnihepreliminary inforthation.available',andareonly an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution-3 1-053'Eff 711/12). FEE QTY/FEE MISC ITEMS
-Plan Check Fee: Hourly Only? 0 Yes.® No $0.00 hours Plan Check,Hourly
Suppl: PC Fee: (j) Reg. () OT0.0 hrs $0.00 $266.00 ,1STPLNCK
PME Plan Check: $0.00 9 # Mechanical
Permit Feer; Hourly Only? e)Yes Q No $0.00 $1,1,97.00 IB,CAIRHA A/C Units(<=10K cfm)
'Suppl: Insp. Fee-E) Reg:' ®'OT 0,0: hrs $0.:00
PME Unit Fee: $0.00 .
PME Permit Fee:. $45..00
Conswuca;n. :l-a:c_
Administrative Fee: /ADMIN $42.00
Work'Without.Permit?` ® Yes 'No $0.00
Advanced Plannin.iz Fee: $0.00 hours Inspections
Travel Documentation Fee:, ITRAVDOC $45.00 $266.00 1ST11VSP Inspection, Hourly
Strong Motion Fee: IBSEISMIGO' $123.89 Select an Administrative Item
Bldg'.Stds.Commission Fee-, IBCBSC $24:00
., .. � � SUBT,OTALS.' $1 729.0 a
$279:89 0 TOTAL FEE• $2,008.89
Revised: 10/01/2012