11080110CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 5 RESULTS WAY CONTRACTOR: ENVIRONMENTAL PERMIT NO: 11080110
SYSTEM INC
OWNER'S NAME: ECI TWO RESULTS LLC 3353 DE LA CRUZ BLVD DATE ISSUED: 09/08/2011
OWNER'S PHONE: 6502924100 SANTA CLARA, CA 95054 PHONE NO: (408)980-1711
® LICENSED CONTRACTOR'S DECLARATION
License Class'^� Lill � 2-7-� 7 �S
rJ
Contractor Z,1/1(V AAWAA Sy tiaate
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 comply
with all non -point source re lations per the Cupertino Municipal Code, Section
9.18.
Signature Date V I'
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
wil I 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
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.
BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: BLDG 4 & 5 - REPLACE 2 EXISTING HVAC & ADD ONE(l)
NEW HVAC FOR NEW COMPUTER ROOM
Sq. Ft Floor Area: I Valuation: $200470
APN Number: 35720041.5 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
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 25505, 25533, and 25534.
�� aut ed a
ate:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of mrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date I Licensed Professional_
//off 011S2�
1�
CUPERTINO
GENERAL FERMI i APPLICATION
COMMUNITY DEVELOPMENT DEPARTIVIENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 7T7-3333 - buildina(c cuoertino.ora
❑PLUMBING RN=1 MCAL ®ELECTRICAL ❑lvasc LAPIEOUS
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❑ OWNER ❑ OwNER-BUILDER �OWNERA= ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ AR=c-r ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME d oz AN `, _ N
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LIC RISE NUMBER u' ` �707
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NAME
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ARCHTCECi/ENGINEa7ER NAME A /'O
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COMPANY NAME'
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STREET ADDRESS � �i4,2A-�b6A /�E
CITY, STATE,ZP � /�G a 951a9
PHONEY08-?%- f577
USE OF ElSFD or DUPLEX El MULTI-FAMILY
PROJECT 24 WILDLAND ❑ YES
PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
BUILDING: COMMERCIAL
URBAN INTERFACE AREA 19NO
FLOOD ZONE KNO
EICHLERHOME? KNO
DESCRIPTION OF WORK
AM 691VQ1P-A1(1V< ON / T AA00 tfDQA/>o Neu
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TOTAL VALUATION: �(�� I 7
RECEIVED SY: /
By my signature below, I certify to each of the following: I am the property owner or authrrrized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct j have read the Description of Wark and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin nstruction' I authorize representatives of Cupertino to enter the above -identified property for inspection puiposes.
Signature of Applicant/Agen.. Date: /J ;Loa
PLEMENTAL nTnMATION REQUIRED
OFFICE USE ONLY
❑ OVER-THE-COUNTER
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1EPMuc4pp_2011.doc revised 06/_71111
F-M-7
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 5 results way
DATE: 08/15/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$200,470
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION FURN/AC
PERMIT TYPE:
wORK
re lace 2 existing HVAC add 1 for new computer room.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
A/C Units (<=1OK cfm)
1BREMAIR
3
#
$195
TOTALS:
$195.00
Mech. Plan Check 4.0 1 hrs $520.00
1MECPLNC Mech. Permit Fee: IMPERMIT
Other Mech. Insp. 0.0 hrs $44.00
+,
NOTE. These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Ef.. 711111)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$520.00
PME Unit Fee:
$195.00
PME Permit Fee:
$44.00
Cr,st.5'f1 icrifni T ,t
Work Without Permit? Q Yes G No
$0.00
Travel Documentation Fee: 1TRAVD0C
00
Strong Motion Fee: /BSEISMICR
$20
0.5 hrs Admin./Clerical Fee
$41.00 1ADMIN
Bldg Stds Commission Fee: IBCBSC
$9.00
SUBTOTALS:
$832.05
$41.00 TOTAL FEE:
$873.05
Revised: 07/04/2011
. -0-