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11040137CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6 INFINITE LOOP I CONTRACTOR: ICOM MECHANICAL INC I PERMIT NO: 11040137 OWNER'S NAME: APPLE 1477 BURKE ST l DATE ISSUED: 04/19/2011 FIR'S PHONE: 4089744876 ❑ /! LICENSED CONTRACTOR'S DECLARATION License Class L � �!7�' Lic. 4 / a0 4 Z Z` Contractor ICO/ "( /"1L-U�9QDate S 17 ( 1 hereby affirm that 1 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. 1 hereby affirm under penalty of perjury one of the following two declara6(&s:- I have and will maintain a certificate of consent to sell'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. dditional the applicant understands and will comply with all non -point so a re t r the Cupertino Municipal Code, Section 9.18. �7 Signature_Dater IL OWNER -BUILDER DECLARATION 1 hereby affirm that 1 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). 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 ths 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, 1 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 1 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, co—;, and expenses which may accrue against said City in consequence of the mg of this permit. Additionally, the applicant understands and will comply all non -point source regulations per the Cupertino Municipal Code, Section 9.18, Signature Datc SAN JOSE, CA 95112 PHONE NO: (408)792-2292 BUILDING PERMIT INFO: BLDG f— ELECT I- PLUMB MECH Jr— RESIDENTIAL f- COMMERCIAL JOB DESCRIPTION: BASEMENT - REPLACE EXISTNG DOMESTIC: COOLING WATER SKID(DCW) WITH NEW MORE EFFICIENT MODEL(COLD WATER BOOSTER SKiD BREAK TANK) Sq. Ft Floor Area: I Valuation: $14250 APN Number: 316021 10.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 PAYS 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 Appl Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 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 1 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,*e Cupertino Municipal Code, Chapter 9.12 and the Health & Soty Co , tions 25505, 25533, and 25534. N eAl - M-1 r CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of —rk'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. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6 INFINITE LOOP CONTRACTOR: ICOM MECHANICAL INC PERMIT NO: 11040137 OWNER'S NAME: APPLE 477 BURKE, ST DATE ISSUED: 04/19/2011 OWNER'S PHONE: 4089744876 SAN JOSE, CA 95112 PHONE NO: (408)792-2292 ❑ LICENSED CONTRACTOR'S DECLARATION r— BUILDING PERMIT INFO: BLDG ELECT PLUMB {y License Class �� Lic. # � 2 �— O - -- � � Contractor [ �}7�—Date /�� C�, 9W,1( MECH RESH)ENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BASEMENT - REPLACE EXISTNG DOMESTIC COOLING (commencing with Section 7000) of Division 3 of the Business & Professions WATER SKID(DCW) WITH NEW MORE EFFICIENT MODEL(COLD WATER Code and that m license is in full force and effect. y BOOSTER SKID BREAK TANK) I hereby affirm under penalty of perjury one of the following two declara 1ohrs 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 Sq. Ft Floor Area: Valuation: $14250 permit is issued. APPLICANT CERTIFICATION APN Number: 31602110.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. dditional the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point so a reg i r the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. SignatureG� Date Date: Issued by: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I 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 agree to 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). I hereby 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 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. o Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which t -s permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with a Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & S ty Co f ns 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such or this permit shall be deemed revoked. Owner t. provisions Date: L (r APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of Nwrk'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 indemnify 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. I understand my plans shall be used as public records. Signature Date Licensed Professional __ CITY OF CUPERTINO r-,. FEE ESTIMATOR - BUILDING DIVISION ikADDRESS: 6 infinite loop DATE: 04/19/2011 REVIEWED BY: bobs. x, I APN: BP#: "VALUATION: $14,250 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: I PENTAMATION 1CMAP1 I PERMIT TYPE: WORK remove and replace domestic cold water booster skid break tank. SCOPE Mech. Plan Check 1.0 hrs $126:00 f'i=Omb r't( r'RI:h Elec. Plan Check k.0 hrs $126.00 1MECPLNC Mech. Permit Fee: 1MPERMIT r h,";b, F>>,- ,, t IELCPLNC Elea Permit Fee: IEPERMIT Other Mech. Insp. 0.0 hrs $42.00 ��)�i�E.-, t`'i�:,rl; ter,>�;. Other Elea Insp. 0.0 hrs $42.00 NOTE: These fees are based on the preliminary in ormation available and are onlv an estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Resohition 09-051 E,�f. 7/1/101 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 $6 # $63.00 Mechanical IBAPPLOT Other Appliance/Equip Suppl. PC Fee: G Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $252.00 0 Electrical $42,00 IBREMCOMAP Appliances Permit Fee: $0.00 Suppl. Insp. Fee:G) Reg. 0 OT 0.0 hrs $0.00 1� Electrical $158.00 IBREMPOWER Other Power Devices PME Unit Fee: $0.00 PME Permit Fee: $84.00 Tax 1-1 Acoustical Fee: 0 Yes (D No $0.00 0 G Work Without Permit? 0 Yes G No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $42.00 Strom Motion Fee: IBSEISMICO $2.99 0.5 hrs $39.00 Admin./Clerical Fee 1ADMIN Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS* $381.99 $302.00 TOTAL FEE: $683.99 Revised: 01/15/2011