12080283CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18880 HOMESTEAD RD
CONTRACTOR: CUPERTINO ELECTRIC INC
PERMIT NO: 12080283
OWNER'S NAME: CUPERTINO OFFICE PARTNERS LLC
1132 N 7TH ST
DATE ISSUED: 08/28/2012
OWNER'S PHONE: 4087997346
SAN JOSE, CA 95112
PHONE NO: (408)991-1000
❑ LICENSED CONTRACTOR'S DECLARATION
r ELECT r PLUMB
License Class C4 0 Lic. # G 3
BUILDING PERMIT INFO: BLDG
r r r
MECH RESIDENTIAL COMMERCIAL
Contractor1_ t Qt hn&),y ! 1LUTJA C_ Date b/a4-z-
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: APPLE - 2ND FLOOR -CONNECT (E) POWER CIRCUITS TO
(commencing with Section 7000) of Division 3 of the Business & Professions
NEW OFFICE FURNITURE POWER POLES AND BASE FEEDS,
Code and that my license is in full force and effect.
PROVIDE NEW RECEPTACLES TO EXISTING WIREMOLD
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
Sq. Ft Floor Area:
Valuation: $40000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31609037.00
Occupancy "l y pc:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. A4ditionally, the applicant understands and will comply
180 DAYS M LAST CALLED INSPECTION.
with all non -point ur li no unicipaoe, Section
g atons per the Cupertino upertiMunicipal CdSi
9.18.
"-
Is Date:
Signature Date �0�� /�
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
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.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 2553W25534.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
Owner ent:
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
ONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm at re is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aQcupertino.org
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❑ OWNER ❑ OwNER-BunzER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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USE OF ❑ SFD .,DUPLEX ❑ MULTI -FAMILY
PROJECT INWILDLAND ❑ YES
PROJECT IN
❑ YES
IS THE BLDG AN ❑ YES
BT'LDING: PCOMNEERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE
❑ NO
EICHLER HOME? ❑ NO
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DESCRIPTION OF WORK
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TOTAL VALUATION: o(, I
RECEIVED
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act On d4property
owner's behalf. I have read this
application and the information I have provided is correct. have read the Description of Work and verify it is accVrate.
I agree to comply with all applicable local
ordinances and state laws relating to building conssttiuctio I authorize representatives of Cupertino to enter the above-ide ified pr perty for inspection pu@oses.
Signature of Applicant/Agent:GC fZ�� "�— Date:
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SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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1EPMiscApp_2011.doc revised 06/21111
CITY OF CUPERTINO
I/!JI FEE ESTIMATOR — BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc-). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E�" 7if ,1,11)
18880 Homestead Rd
DATE: 08/28/2012
REVIEWED BY: Sylvia
PAADDRESS:
APN:
BP#: O �O R
`VALUATION: $40,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
Irrcp. Fee:!-
PENTAMATION 1GENCOM
I PERMIT TYPE:
WORK
A le- 2nd floor- CONNECT E POWER CIRCUITS TO NEW OFFICE FURNITURE POWER POLES
SCOPE I
AND BASE FEEDS, PROVIDE NEW RECEPTACLESTO EXISTING WIREMOLD RACEWAY
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc-). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E�" 7if ,1,11)
Mech. flan Check
llh nrb. Plan Check
Elec. Plan Check
Ate1:I1. Pernrt I
Plrrmb. Permit Fee:
Elce. Permit ree:
Other• Alech. Insp
Other Plumb Insp.
Other Elec. Insp.
11:, V< (I:.
Irrcp. Fee:!-
j 7(,,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc-). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E�" 7if ,1,11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
1 hours Plan Check, Hourly
$133.00 ISTPLNCK
Suppl. PC Fee: Q Reg. 0 OT
p.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee -0 Reg. 0 OT
k,0
hrs
$0.00
PME Unit Fee:
$0.00
PNIE Permit Fee:
$0.00
Construction :Tay:
Adil,mistP4tive Fee:
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
0 hours Inspections
$399.00 ISTINSP Inspection, Hourly
Q
0
l ravE l 1)oc rua ntation Fees:
Stron- Motion Fee: IBSEISMICO
$8.40
Select an Administrative Item
Bldg `,tds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$10.40
$532.00
--F-
TOTAL FEE:
$542.40
Revised: 07/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 0obc) Omz'&WAO
PERMIT # Z
OWNER'S NAME: A ti
PHONE #
GENERAL CONTRACTOR: (, / T
BUSINESS LICENSE # 9
ADDRESS: 1137 A10414 4"
CITY/ZIPCODE: 7—
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL S CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. If
I am not using any subcontractors:
VL�&4tuvl D to
Please check applicable subcontractors and compleefe the following information:
Contractor Signature
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
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Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Contractor Signature
Z 6
It 2,
E16te