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13060142 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18880 HOMESTEAD RD CONTRACTOR:T.MARSHALL PERMIT NO: 13060142 ASSOCIATES,LTD. OWNER'S NAME: CUPERTINO OFFICE PARTNERS LLC 7042-B COMMERCE CIR DATE ISSUED:06/20/2013 OV^ER'S PHONE: 4087276665 PLEASANTON,CA 94588 PHONE NO:(925)734-9999 I� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL11 License Class 00 6_4111 Lic.# �� r�7 INSTALL(N)EV CHARGER ON IST FLR PARKING STRUCTURE.RE-STRIPE ADA LOADING AREA Contractor 1 r✓�� r1� � Date/��ZG�f 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. Sq.Ft Floor,Area: Valuation:$15000 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 APN Number:31609037.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter 180 DAYS L LED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 4 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the slued b Date: granting of this permit. Additionally,the applicant understands and will comply ,1 12--dh with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 7 any roofing Signatur -, ? __ Date � �//� 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505 25533 �d 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen/ _ Dater 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date i i KJC OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION r ADDRESS-0495-N`DE Al ZA-BLVD• DATE: 06/18/2013 REVIEWED BY: MELISSA APN: 326 33 110 BP#: /30690/7' Pll 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1GENCOMj WORK INSTALL N EV CHARGER ON 1ST FLR PARKING STRUCTURE: RE-STRIPE ADA LOADING SCOPE AREA E4)-®0ME$ -- Xfech. Plan Check Phuub. Plan Check Elect.Plan Check Xkch. Perron Fee: Plrurrb. Permit Fee: Dee, Permit Fee: Other Afcch.Insp. Other Phmih Insp. Other Elec.Insp. ELL�j 1Akch.Insp,Fee: Phnub. Nsp, Fete: Elec.hrsp,Fere: NOTE: This estimate does not include fees due to other Deparnnents(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These.fees are based on the prelintinar in ormation available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resohition 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ()Yes Q No $0.00 hours Plan Check,Hourly Suppl.PC Fee: Q Reg. 0 OT 0,0 hrs $0.00 $133.00 ISTPLNCK i PME Plan Check: $0.001= # Alternative Energy System Permit Fee: Hourly Only? 0 Yes Q No $0.00 $102.00 ICHRGSTA EV Charging Station Suppl.Insp.Fee-.(F) Reg. Q OT kmo I hrs $0.00 PME Unit Feer $0.00 PME Permit Fee: $0.00 Corrsrtrction Tax: '4clInitlisirative I'ee: Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 hours Inspections Travel DocoineWotion Fees: $133.00 ISTINSP Inspection,Hourly Strong Motion Fee: IBSEISMICO $3.15 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $4.151 $368.00 TOTAL FEE: ` $372.15 i Revised: 04/29/2013 AUG/12/2013/MON 12: 58 PM T. Marshall Assoc. FAX No. 925 734 9996 P. 002 � 8uiada�g Aepartment City Of Cupertino 10300 Tozxe.A,venue Cupet-tino,C,A 9�014-325� C U P E RT I N O Telephone:408-777-3228 Fax:408-777-�333 CONTRACTOR/SUBCON'TR..4CTOR LIST JOB ADDRESS:I&$�4 ��yr,r'f,�G v �-r�'r•� �'E�RM��'# � �"' OV�NER'S NAME: � PHON��# 9Zs 73�C��l�t GENERAL CONT�.P.CTOR: %, %� �c,ft �?�;G�; BUSIN�SS LICENSE# Z��i`� ADDRESS:��/Z l,,r�„r�rlt't'ritl�' Y�Y�.�,,,.r�r� l'.4 `,n G CZTY/ZLPCODB: *Our municipal code xec�uiures a1�busiuuesses tivorlcing in the city to b�flve a Cxty o�Cupexrit�to busiaess license. NO SUILDIIVG FLN.A,�, OR �'JNA.�. OCCUPANCY' INSPECT�ON(S) W�.L� BJE SC�DULEA UNT�. TAE GENER.A.�, CONTkZA.C'Z'OR A�TA .�LL SUBCONTJ[�A.CTORS I�Av� OBTAZNED A, C�7CX OF CU.�EI�TZNO BUS�SS LZCENSE. Z a��o't usxz�g any subcontractors; � Signature Aate P�Qase cb.e��app�xcable subcontractors and comple�e t�ie followiu�g xmfor�mation: ✓ SCJBCONTR.AC'�'O�.t � fiY1SX1YES5 N�1� BUS�T�SS LZC�NSJE# Cabia�ets �NCxllwork Cezx�.ent Fiu�ishing. � Electrical � E�cavation � Fencin� Floorin�./Carpettut�g � Linoleum/Wood Glass/GZazimg Heatir�g Zz�5ulatioz� Laztdscaping z,athiz�:g �ason.ry Painting/Wa1lpa�ex . Paving �1�c�Uf�.l e¢Sr�l�K-� . � ��9� Plaster�n� P1Ltm.bzng � Roofirag Septic Tank Sheet Meta1 Sk�eet Rock Tile -— .--r fr�-•-''��j c: � . '` __<�"��'"'r•"`:� �i_,,�..�—�-_ �/�Q��? _ . , _ Owne�ont�actor Sigr�atuxe Date