12070107CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10201 N DE ANZA BLVD CONTRACTOR: UNITED MECHANICAL INC PERMIT NO: 12070107
OWNER'S NAME: NMSBPCSLDHB 2161 OAKLAND RD DATE ISSUED: 10/04/2012
OWNER'S PHONE: 4089961010 SAN JOSE, CA 95131 PHONE NO: (408)232-9000
❑ LICENSED CONTRACTOR'S DECLARATION
License Class9y'v— Lic. k g2 2 33 5
Contractor UNS%E m _A; ***ate
I hereby affirm that I am licensed under the provisions of C pter 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 I v Date 2
❑ OWNER -BUILDER DECLARATION
1 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.
BUILDING PERMIT INFO: BLDG T_ ELECT r PLUMB r-
MECH F RESIDENTIAL F COMMERCIAL r-
JOB DESCRIPTION: APPLE - ADD ONE SIX(6)TON CHILLER AT EXTERIOR
LOCATION GROUND LEVEL AT SIDE OF COMMERCIAL
BUILDING, AND INSTALL 480/227 VOLT SUB -PANEL WITH
Sq. Ft Floor Area: Valuation: $70000
APN Number: 32634070.10201 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued
s
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. 1 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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Own hor gent:
Date: I O / Z
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed
FM—F
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10201 n. de anza blvd.
DATE: 07/16/2012
REVIEWED BY: bobs.
APN:
BP#:
*VALUATION: 1$70,000
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
add 1 6ton chiller at exterior location ground level at side of comm bld .
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Cooling Unit
1MCRAA
2
#
$266
l�
TOTALS:
.00
Mech. Plan Check 2.0 1 hrs $266.00
Pliowh. Plarr
Eiez . Phan Ch ck
IMECPLNC Mech. Permit Fee: IMPERMIT
l?r rc,7:i I're
F Ire:
.00
Other Mech. Insp. hrs $45Li
OF'tliburhi'11,y
d
<
. , p.
i
�lnq,;
faL (�c
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
Plan flat:ck Fee
Suppl, PC.' Fee
PME Plan Check:
$266.00
i,ennlf Fcc:
.SUIT[ hisp 1"ce
PME Unit Fee:
$399.00
PME Permit Fee:
$45.00
Conwrrrction Tr_r:
Administrative Fee: IADMIN
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
" (llr ,c6l Plunning FLes.
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: 1BSEISMICO
$14.70
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$814.70
$0.00 TOTAL FEE:
$$ Q
Revised: 07/01 /2012
CITY OF CUPERTINO
Fm--7, FEE ESTIMATOR - BUILDING DIVISION
ADDRESS• lb2ol ti a
ATE: 07/26/2012
REVIEWED BY: jsg
APN:
BP#:
"VALUATION: 1$50,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 REAP7
PERMI '`TYPE:
WORK
Installation of one 480/277 volt sub panel with feeders and conduit.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Special Circuits
1BREMMISC
1
#
$133
TOTALS:
$133.00
- h. Plan Chr'(.k
Pluuuh. Nun Cher
Elec. Plan Check 0.0 hrs $0.00
Elec. Permit Fee: IEPERMIT
Orl;<a' tLfc'CFi. /f!d'rr
C)Mel ' nt,,, ;. .,
Other Elec. Insp. 0.0 hrs $45.00
'�•i�x•f�. Lra.�L,�, h�•�
r
Plar+��L'.�rsLa. lea
Litcc. 1n.,p. F��c:
NOTE: This estimate does not include fees due to Other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Drelinu�ary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS Fee Resolution 11-053 Eff 7/ /I1
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee..
PC Fee
PME Plan Check:
$0.00
l'er"nit Fee-
PME Unit Fee:
$133.00
PME Permit Fee:
$45.00
""onstlilction Till".'
Administrative Fee: IADMIN
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
9ra�rrrxrel P'1«rn:ine{ Fees:
A
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: 1BSEISMICR
$5.00
Select an Administrative Item
W -
Bldg- Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$272.00
$0.00 TOTAL FEE:
Revised: 07/01/2012