15090192CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20674 HOMESTEAD RD
OWNER'S NAME: SOBRATO INTERESTS ET AL
OWNER'S PHONE: 4082872040
❑ LICENSED CONTRACTOR'S DECLARATION
License Class '_[sa Lic. #
Contractor�f/.k f tT->" �?4 ^. Date' ,o
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. 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.
P10have 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. 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this perm Additionally, the ap ant understands and will comply with
all non-point X s c G the ertmo Municipal Cody e Section Q
I .8,.
s ng tj yF? s 4 k r ' tai 11 .
Signaifire°
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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)
2. 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. 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.
2. 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.
a. 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
1 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.
Signature Date
CONTRACTOR: BEST ELECTRICAL CO PERMIT NO: 15090192
INC
667 WALNUT ST DATE ISSUED: 09/29/2015
SAN JOSE, CA 95110 PHONE NO: (408)287 -2040
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL 112.5 KVA TRANSFORMER; 400 AMP PANEL (1000
DEGREE PIZZA).
Sq. Ft Floor Area: I Valuation: $21000
APN Number: 32010066.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
I
Issued by:'���1/ ����s 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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work'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.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION ME P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 MISE;
(408) 777 -3228 • FAX (408) 777 -3333 • building(Qcupertino.org ,�° ®/��1��
❑ PLUMBING ❑ MECHANICAL ® ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS Ilow tg/v V
APN #
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❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ER CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER
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LICENSE TYPE
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BUS. LIC
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COMPANY NAME
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STREET ADDRESS
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PHONE
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ARCHITECT/ENGINEER NAME
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LICENSE NUMBER
BUS. LIC #
COMPANY NAME
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CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI - FAMILY
BUILDING: CR COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ® NO
PROJECT IN ❑YES
FLOOD ZONE B NO
IS THE BLDG AN El YES
EICHLER HOME? NO
DESCRIPTION OF WORK /
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TOTAL VALUATION: d00.0 6
RECEIVED BY;
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the D ription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c ction. I authoriz resentatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of ApplicantlAgen Date:
SUPPLEMENTAL INFORMATION REQUIRED
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MEPMiscApp_201 Ldoc revised 06121111
CITY OF CUPER'TINO
FEE ES'TIMA'TOR — BUILDING DIVISION
r
ADDRESS: 20674 HOMESTEAD RD
DATE: 09/29/2015
REVIEWED BY: SEAN
UNITS
APN:
BP #: !
"VALUATION: 1$21,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
#
PENTAMATION
PERMIT TYPE: 1 CE I i
WORK
INSTALL 112.5 KVA TRANSFORMER; 400 AMP PANEL 1000 DEGREE PIZZA).
SCOPE
Suppl. irzsh Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPERMIT
Transformers
1BREMPOWER
Other Elec. Insp. 0.0 hrs $48.00
1
#
$179
Services
1 ECT2001 K
Suppl. irzsh Fee
400
Amps
$72
PNM Unit Fee:
$251.00
PNM Permit Fee:
$48.00
Construction Tay:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes Q No
$0.00
TOTALS:
Travel Documentation Fee: I TPA VD0C
$251.00
Strong Motion Fee: IBSEISMICO
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
Afech. Plan Check
Plumb. Plan Check
Elec. Plan Check 0.0 hrs $0.00
Lte& Permit Fee:
Plumb. Permit Fee:
Elec. Permit Fee: IEPERMIT
Other dtech. Irrsp.
Other Plumb Insp.
Other Elec. Insp. 0.0 hrs $48.00
Llech. Insp. Fee:
Plumb, hrsp. Fee:
Iilec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Permit Fee:
Suppl. irzsh Fee
PNM Unit Fee:
$251.00
PNM Permit Fee:
$48.00
Construction Tay:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning ing Fees:
Travel Documentation Fee: I TPA VD0C
$48.00
Strong Motion Fee: IBSEISMICO
$5.88
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
SUBTOTALS:
$398.88
$0.00 TOTAL FEE:
1 $398.88
Revised: 07/02/2015
>/S•D cC � i oI ' �
Korbmacher Engineering, Inc.
Geotechnical Environmental Material Testing Special Inspection
4.60 Preston Court, Suite B, Livermore, CA 94551, PO 13ox 405, Livermore, CA 94551 925
EPDXIED/ANCHOR BOLT INSTALLATION q-3`�I
Client
AND SPECIFICATIONS AND
THE APPLICABLE WORKMANSHIP PROVISIONS OF THE REFERENCED CODE(S), UNLESS
Project
NOTED OTHERWISE:
Location:
Location
n
Drawing #:
1'� �.�54
Reported to
❑ Slab Install
Plans By
Anchor Type/Size:
Approved by
Concrete Strength:
t...�. (!. i i "' i �
(Fa x)
r -
Job No. ! f Page - of j
Inspector
Date
at the jobsite. Permit #
Date
Date
THE FOLLOWING WORK IS TO THE BEST OF MY KNOWLEDGE IN COMPLIANCE WITH THE APPROVED PLANS
AND SPECIFICATIONS AND
THE APPLICABLE WORKMANSHIP PROVISIONS OF THE REFERENCED CODE(S), UNLESS
NOTED OTHERWISE:
Location:
Detail #:
Drawing #:
❑ Slab Install
8temwall Install
Anchor Type/Size:
Concrete Strength:
t...�. (!. i i "' i �
r�. ��• `")'" i f�� �' �i �'' `' tt...
:� i ; +�; `-G•,.. t�,.t_s i.f-•.1` �,�
.i...
Hole Size: ! 1i
# of Anchors
zA
iI i.
Hole Depth:
s
_
s •--
1.
Total # of Anchors: I
Hole Position:
Remarks: ,
DIY ,
' i
M
E
Epoxy Type:
Spacing: ❑ 12" D.C.
Other:
Holes were clean and dry and anchors fully embedded in epoxy or placed according to Manufacturer's
Yes
No
recommended procedures.
COPIES TO:
OBSERVATIONS REPORTED ABOVE ARE INDICATIVE OF CONDITIONS FOUND AT THE EXACT
LOCATION AND TIME OF OBSERVATION ONLY, THE ABOVE SERVICES AND REPORT WERE
PERFORMED ACCORDING TO THE TERMS AND CONDITIONS OF THE CONTRACT BETWEEN THE
CLIENT AND CONSULTANT. OUR SERVICES WERE PERFORMED ACCORDING TO THE STANDARD
OF CARE INCLUDING THE SKILL AND JUDGEMENT THAT IS REASONABLY EXPECTED FROM
SIMILAR SITUATED PROFESSIONALS PRACTICING IN THIS OR SIMILAR LOCALITIES AT THE TIME
THIS REPORT WAS PREPARED. NO WARRANTY, GUARANTY, OR REPRESENTATION, EXPRESS
OR IMPLIED, IN INCLUDED OR INTENDED.
Reviewed by
DATE
>/S•D cC � i oI ' �
Korbmacher Engineering, Inc.
Geotechnical Environmental Material Testing Special Inspection
4.60 Preston Court, Suite B, Livermore, CA 94551, PO 13ox 405, Livermore, CA 94551 925
EPDXIED/ANCHOR BOLT INSTALLATION q-3`�I
Client
AND SPECIFICATIONS AND
THE APPLICABLE WORKMANSHIP PROVISIONS OF THE REFERENCED CODE(S), UNLESS
Project
NOTED OTHERWISE:
Location:
Location
n
Drawing #:
1'� �.�54
Reported to
❑ Slab Install
Plans By
Anchor Type/Size:
Approved by
Concrete Strength:
t...�. (!. i i "' i �
(Fa x)
r -
Job No. ! f Page - of j
Inspector
Date
at the jobsite. Permit #
Date
Date
THE FOLLOWING WORK IS TO THE BEST OF MY KNOWLEDGE IN COMPLIANCE WITH THE APPROVED PLANS
AND SPECIFICATIONS AND
THE APPLICABLE WORKMANSHIP PROVISIONS OF THE REFERENCED CODE(S), UNLESS
NOTED OTHERWISE:
Location:
Detail #:
Drawing #:
❑ Slab Install
8temwall Install
Anchor Type/Size:
Concrete Strength:
t...�. (!. i i "' i �
r�. ��• `")'" i f�� �' �i �'' `' tt...
:� i ; +�; `-G•,.. t�,.t_s i.f-•.1` �,�
.i...
Hole Size: ! 1i
# of Anchors
zA
iI i.
Hole Depth:
s
_
s •--
1.
Total # of Anchors: I
Hole Position:
Remarks: ,
DIY ,
' i
M
E
Epoxy Type:
Spacing: ❑ 12" D.C.
Other:
Holes were clean and dry and anchors fully embedded in epoxy or placed according to Manufacturer's
Yes
No
recommended procedures.
COPIES TO:
OBSERVATIONS REPORTED ABOVE ARE INDICATIVE OF CONDITIONS FOUND AT THE EXACT
LOCATION AND TIME OF OBSERVATION ONLY, THE ABOVE SERVICES AND REPORT WERE
PERFORMED ACCORDING TO THE TERMS AND CONDITIONS OF THE CONTRACT BETWEEN THE
CLIENT AND CONSULTANT. OUR SERVICES WERE PERFORMED ACCORDING TO THE STANDARD
OF CARE INCLUDING THE SKILL AND JUDGEMENT THAT IS REASONABLY EXPECTED FROM
SIMILAR SITUATED PROFESSIONALS PRACTICING IN THIS OR SIMILAR LOCALITIES AT THE TIME
THIS REPORT WAS PREPARED. NO WARRANTY, GUARANTY, OR REPRESENTATION, EXPRESS
OR IMPLIED, IN INCLUDED OR INTENDED.
Reviewed by
DATE