HomeMy WebLinkAbout15010081 Permit DocsCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:(O93S N TANTAU AVE CONTRACTOR: CUPERTINO ELECTRIC PERMIT NO: 15010081
INC
OWNER'S NAME: CAMPUS HOLDINGS INC 1132 N 7TH ST DATE ISSUED: 01/14/2015
OWNER'S PHONE: 4089968181 SAN JOSE, CA 95112 PHONE NO: (408)991-1000
El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL O
License Class /G -/0 Lie. #-4-T-- / /7`/W 7 AC2; PHASE II- INSTALL TEMP. POWER
Contractor filet a', L hoil 7DfdcL / —r 4/ -/5
1 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 hvo 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
ftformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $600000
44, rave 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: 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
upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LLED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the Issued by: Date:
granting of this p remit. A , the applicant understands and will comply
with all non oin sou regulations r the Cupertino Municipal Code, Section
9.18.
- /4! RE -ROOFS:
Signature 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 -BULL 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
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 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. 1 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
the 'uperti ode, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sec 'ons 550 , 25533, an 25 4.
Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: '_1
performance of the work for which this permit is issued. will maintain compliance wit
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
�.r��� CITY OF CUPERTINO
I VMI FFr. ESTIMATOR - BUILDING DIVISION
a�J
ADDRESS: 10435 n Tantau rd
DATE: 01 /1 412 01 5
REVIEWED BY: Mendez
APN:
BP#: 50/
`VALUATION: l$60,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
Commercial Building
PENTAMATION 10EAP14
PERMIT TYPE: 4
USE:
WORK
ac2; phase II- Temp. Power
SCOPE
APPLIANCE/EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Temporary Power
1ECT>1K
1,600
Amps
$84
TOTALS:
$84.00
Elec. Plan Check 1.0 hrs $143.00
IELCPLNC Elec. Permit Fee: IEPERMIT
OtherElec.Insp. 0.0 hrs $48.00
1:/cc . 6a -q2- I-ce
NOTE: This estimate does not includefees due to other Departments (i.e. Planning, ruotic rrorks, Fire, .,ummry newer ma",
'rt_ !__.. _ _ a.. -..4.....i... ....,.r....;..,..., :..r . ,..a..., oo.,nnhln and nre only an estimate. Contact the Dept for addn 4 info.
rrlatrici, en.:. r neae era me ✓uacu un ...c ..............
FEE ITEMS (Fee Resolution 11-053 Elf. 711 13)
................. _. _____-_
FEE
_---- _-
QTY/FEE
MISC ITEMS
PME Plan Check:
$143.00
PME Unit Fee:
$84.00
PME Permit Fee:
$48.00
Administrative Fee: JADMIN
$45.00
Work Without Permit? O Yes Q No
$0.00
I I A
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICO
$16.80
Select an Administrative Item
Bldg- Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$387.80
$0.00
TOTAL FEE:
$387.80
Revised: 01/06/2015