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12050132 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21185 RAINBOW DR CONTRACTOR:MCCLELLAN PERMIT NO: 12050132 DEVELOPMENT OWNER'S NAME: SUZANNE BESLER 1448 ENTRADA VERDE PL DATE ISSUED:05/16/2012 OWNER'S NF.: 9259449108 ALAMO,CA 94507 PHONE NO:(925)944-9108 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL13 CONINIF.RCI.U. License Clas 4 Lic.4 �'1g�b 1 TEMPPOWER Contractor ��L°. ^ �_v Date 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:$500 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the woror ich this APN Number:36210052.00 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 upon the above mentioned propcny for inspection purposes. (We)agree to save 180 DAY r M LAST CALLED INSPE TIO indemnify and keep harmless the City of Cupertino against l iabil ities,judgments, costs,and expenses which may accme against said City in consequence of the qGr granting of this permit. Additionally,the applicant understands and will comply Issued by: �C Date: with all non-point source regulations per 1 e pertino Municipal Code,Section 9.18. _ RE-ROOFS: Signature / Date All roofs shall be inspected prior In anyroofing 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 I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 comp:nsalion, will do the work,aid the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the propcny,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE: consimct the project(Sec.7044,Business&Professions Code)- 1 have read the hazardous materials requirements under Chapter 6.95 of the California Ileallh&Safety Code.Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one orthe following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code.Section 25532(x)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 Arca Air Quality Management District performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino\ nicips Code.Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for byf .the Ilealth&Safety Code,Sectio . 5505,255 ,and 534. Section 3700 of the Labor Code,for the performance of the work for which this \ f permit is issued. Owner or authorized agent: Date:—&— I certify that in the performance of the work for which this permit is issued,I shall not employ anyperson many manner so as to become subject to the Worker's Compensation laws of California. IL after making this cenificate ofexemption,I CONSTRUCTION LENDING AGENCY 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 comity 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, ARCHITECT'S DECLARATION 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 nun-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date GENERAL.PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 950143255 _ misc. CUPERTINO (408)777-3228-FAX(408)777-3333•building0cuDerono.Ory IZo�o l3a PLUMBING MECELANICAL OaXCrRICAL MISCyraNcOUS PROMECTADDRESS a\\ i AI"1,3 t6 OWNERNAME M VVs rtr1A IJ �I to a UIF:1'1•ISN J •��j SLREE[ADDRESS )".�g `/r ST ZD'A V1,4.n 1 "U CONTACT NANE T �V[� p 7 V 7 e-ranD:eu-IL 2 She �obe1 - SIRPSTADDRESS i �,,( PI .SfA�� C F S <i�- Lo� ❑ORNNER 13OWNER-BUEDER . f.1 OWNEZAOD? ❑cmrmAcma .13tDMMC1ORAG4lT ❑ AscurraZ 0 mm= a DEV=t ❑maurt CONI'RACIO Lt@I Nl1Ea� —UiL�S E� Y�r1�LUU29naTYPE COMeANYNAME G I+ CFAX STRWADDR03 . Ae• I&Y. �zffi L4 06 � Sac uc0x8 a-5�7�8 -c�C10 5 PBO�gop-3lZ-221.3 ARCFDTECT/FNOINFFB LICENSE NUMBER Mus LIC x COMPANY NAME' B4QUL FAX STREET ADDRESS CITY.STATE IID PHONE USE OF ❑SPDwwnm ❑.MULTI- mmy FROXECTw WEDLANO ❑0YEv PRmBGTw (]YES DTIB BLDG AN ❑YES aURDINO: ❑WW1ffACMt. URRANINTFRFACBAREA NO PIDOD ZONE 0 No Ex3an NOME? ❑No DESCRIPTION!OF WORK Wier— TOTAL ie—TOTAL VALUATION: RECENED BY: By my signature below,I rctity to each of&a following I am the pmpmty owner ar authorized agent to act m the propC4 dwder's bebWE I have rod this applicadoa and the inform dim I have provided is eortecL�bDeaxiptim of Wmk®d verifyague m it is accmete. I agcomply with all applicable local mdmanca and Stam laws ralanng to boil ' Iow tem¢t of Cupertma to enter the above-identi5ed Furperty for iospesdon pol�osm Signature ofAppgmttAgmt - Data: poi SUPPLEN ENTAL INF. ON REQUEU D OmCE USE ONLY ❑ OYER-TtlR{OUNT£R 6 ❑ RaaRm ❑ STANDARD u ❑ LARGE 6 ❑ MAJOR AdEPMkr 1pp_2011.doc revised 06/21/11 t. �►� - Ter ��' United Site Services of California: M Salesperson Contact 3408 Hillcap Avenue GRISELDA BARRON San Jose,CA 95136 Mobile:408-640-9284 Office:800-322-2263 x4440United Fax:408-578-0610 SITE SERVICES® griselda.baron@unitedsiteservices.com Site Service Quotation Quote No.: 414-30873 Quote Date: 05/14/12 Quote Expires: 06/13/12 Sell To: MCCLELLAN DEVELOPMENT Ship To: MCCLELLAN DEVELOP T MARK GARCIA - 1.185.RAINBOW DR 1448 ENTRADA VERDE PLACE ALAMO,CA 94507 ALAMO,CA 94507 Cust.#: USS-50195 Attn: MARK GARCIA Phone: 925-944-9108 Phone: 209-629-3784 Terms: Due Upon Receipt Comments&Special Instructions 'CUSTOMER TO HANDLE CITY PERMIT/POWER FEES Any extra labor Will be$100.00 per hour/per man. All poles must be inspected by the governing jurisdiction and United Site Services Will make certain said poles pass inspection. Travel time Will be charged for partial pick up. Travel times will be billed at the rate of$100.00 per hour/per man.Normal wear on breakers,receptacles,etc.Will be repaired at no extra charge,damages to units from abuse Will be charged to your company.All poles and temporary power equipment are the responsibility of the customer once the poles and equipment is onsite. For removal and/or installation of poles a minimum of 72 hours notice is required. All poles must be accessible or install/removal with truck,if unable to remove poles with our truck there will be a$100.00/per pole fee to remove by hand. United Site Services is not responsible for the holes left onsite upon removal of poles. Prior written authorization from United Site Services is required for any changed/modification to United Site Services equipment. All prices good for 30 days from the date quoted.When installing on private property or at customers discretion, United Site Services is not responsible for any damages caused by drilling for power pole installation. Item Unit Quantity From Thru Unit Price Total Price Pole-Mein Over 100AMP EA 1 05/15/12 Indef 40.00 40.00 per billing cycle Power Install-MAIN OVER 100A EA 1 05/15/12 05/15/12 300.00 300.00 one time Pole-Mein Over 100AMP Subtotal:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340.00 Project: Received: Invoice #: Fi�dAp�oiral: OfRee Approval: Company: n ( Trade K pmMAppmved: Contract#:o Cil Cost Code: )43v D VD Date Pail: Check Date Entered to AP: <--is- - 147 Lion Re : Back charge: Comment Subtotal: 340.00 Accepted: Date: Tax: 3.30 Hemp To:United Site Services,PO Box 59287,Phoenix.AZ.8SO72.3207 Total: 343.30 NOTE: Total prices have been calculated for t billing period only.Damage Waiver is optional.Please read the terms and conditions on the last page of this document for more irdormaticn. r TERMS AND CONDITIONS Rev 5609 1.Acceptance Customer shall be deemed to have accepted these terms and 7.Equipment Contamination While portable restroom units are in Customer's conditions upon the earliest to occur of (i)two business clays after receipt of an possession,Customer shall prevent any contamination of such units with or from invoice from Company;(it delivery of items of equipment('Equipment')identified in radioactive,volatile,flammable.explosive,toxic or hazardous materials(including the invoice to the site designated in the invoice(the'Site')and use or acceptance oils,paints, adhesives and solvents). Company will not remove any waste other thereof,or(iii)acknowledgment or other conduct of Customer indicating acceptance, than DSW from portable restrooms and storage containers('Other Waste').In the Than terms and conditions shall supersede any inconsistent terns of any purchase event Other Waste is found in the Equipment,Customer shall arrange and pay order or other documents of Customer, for separate removal of such Other Waste. Until such Other Waste is removed, Customer may not terminate the Period and Customer is liable for all charges ac- 2.PaymentTerms All agreements are subjectto approval by Company.Customer pued during such period. shall pay all charges by Company during the tern(the'Period)shown in the invoice. All Company Invoices are due and payable upon Customer's receipt of the 8.Liability Except to the extent Customer is not liable for damage to Equipment invoke. Customer shall be liable to Company for interest at the rate of 1.5%per under the Damage Waiver program described in Section 5,Customer agrees to month,or such lesser rate as may be the maximum lawful rate from time to time, defend,indemnify and hold Company harmless to the maximum extent permitted on all overdue accounts, Customer shall pay all additional charges for services by law from and for all claims, lawsuits,damages, expenses and other losses separately requested by Customer or made necessary by Customer's breach of arising out of the rental or use of Equipment delivered to or rented by Customer. these Terms and Conditions,including but not limited to,moving/relocation charges. Customer's obligation will apply to the extent permitted by law to all accidents or special service charges,and special delivery and removal charges. In the event incidents regardless of whether same occur as a result of Customer's or third party's Customer's account becomes delinquent.Customer agrees to pay Company all negligence,fault or other legal liability Customer will have no obligation to defend, collection expenses,including reasonable attorney's fees. indemnify or hold harmless Company if the accident or incident arises out of the 3. Service The Company offers Servicing as an option on all portable rest- sole negligence or willful misconduct of Company.Company,its officers,directors, employees and agents shall not.under any circumstances.be liable to Customer rooms- kr consequential,incidental,special,exemplary or punitive damages arising out of 4.Damage Waiver The Company offers a damage waiver program on certain or relating to the Equipment. Customer's sole and exclusive remedy for any claims Equipment. Customer may decline the damage waiver by completing and or causes of action arising out of or related to the Equipment shall be to recover executing the appropriate section at the end of these terms and conditions. from Company direct damages in an amount not to exceed the amount paid by Unless Customer has declined the Damage Waiver in writing before the com- Customer for use of the Equipment. mencement of the Period or within five tininess days of the date of the first Irrveim 6,No Prorating Agreed upon rates are the complete billing periods and are not to Customer for any Equipment identified with a Damage Waiver on the invoice, to be prorated. whichever is later,Company shall impose,and Customer shall pay,any Damage Waiver fees indicated on the invoice and(provided Customer has not breached any 10.1fermination Company may terminate this agreement and remove the Equip- of these terns and conditions)Customer shag have no responsibility kr accidental mem immediately in the event(i)Customer fails to pay any amount when due to structural damage to the Equipment,EXCEPT(1)Customer shall be liable for theft Company. (ii)Customer otherwise breaches or rejects any of these Terms and of any Equipment and for any losses resulting from any willful agrossly negligent Conditions,(iii)there is any loss of or damage to the Equipment.(iv)any lien is acts or omissions of Customer or any of its agents.servants and employees,and placed,or is proposed to be placed,on any of the Equipment or(v)a proceeding (ii)if Customer has other insurance covering such loss or damage.Customer shall in bankruptcy or for other protection from creditors is commenced by or against exercise all rights available to 0 under such insurance,take all actions necessary to Customer. Company shall not be responsible for loss of any personal property on process such claim and assign such claim and pay any and all proceeds from such the SAS,which may be caused by removal of any of Company's Equipment pursu. insurance to Company. If Customer declines the Damage Waiver,Customershall be am to this paragraph, liable for any loss or damage to the Equipment,regardless of muse or fault,except kr reasonable wear and tear,and Customer shall pay Company the actual cost 11.Governance This agreement shall be governed by and construed in actor. of repair or replacement cost thereof.and in addition thereto,for Company's loss dance with the laws of the state,shown on the invoice, in which the Company's of use of the Equipmem, In the event of any loss of or damage to the Equipment, Mace of business is located,without giving effect to any choice or conflict of law Customer shall promptly notify Company of such loss or damage and shall provide provision or rule that would muse the application of the laws of any jurisdiction Company with copies of all reports relating to such loss or damage,including police other than such state. Each of the parties submits to the jurisdiction of any state reports,informal investigation reports and insurance reports Thedamagewalver or federal court seting in such state,in any action or proceeding arising out of or described In this section does not apply to portable toilets and containers relating to this agreement. All claims in respect of the action or proceeding may which become Contaminated with haradous materials or rwntaminanb de- be heard and determined in any such court. No failure by Company to exercise scribed in Paragraph 7 while In the Customer's control and possession. any fight hereunder shall operate as a waiver of any other right hereunder,and a waiver of any right on one occasion shall not constitute a bar to or a waiver of any 6.Equipment Location Customer warrants and represents that it has exercised such right on any future occasion. All modifications to these Terms and Conditions due diligence and cafe in the selection of the location it has designated for the shall be in writing. placing of portable toilets,temporary fencing,portable storage containers and any other Equipment provided by Company,and further agrees to give directions and 12.Taxes 8 Fees Customer Shall pay any and all taxes,license tees or permit supervise the placement of such temporary fencing,storage containers,portable fees arising out of use of the Equipment, Customer shall pay such taxes whether toilets and other Equipment. such taxes are shown on the invoice or whether such taxes are later claimed by a governmental authority. In the event of a claim by a governmental authority for 6.Equipment Responsibility Company will deliver the Equipment to the Site taxes related to the Equipment,Customer shall pay to Company such taxes on at the commencement of the Period and will remove the Equipment at the end demand. of the Period. If servicing has been ordered by Customer.Company will remove any domestic septic waste('DSW)from portable restrooms,if applicable.on the 13.Additional Terms Additional Terms and Conditions apply to rental and service service day(s)scheduled by Company. In the event Company is unable to Service of Storage Containers('Sheds')and Temporary Power equipment These Terms& the Equipment on the Service day due to a holiday, inclement weather, or other Conditions are shown on the back of your contract for these items. interfering circumstances,Company shall service the Equipment on the earliest 14.Errors&Omissions Company reserves the right to correct any erroneous business day,excluding Sundays,available in accordance with Company s other information that may appear in the invoice of may have appeared in a prior invoice service commitments. Company shall be grafted access to the Equipment at any including,without lin dation,Customer's name or address,or billing amounts. time for any servicing, maintenance or removal of Equipment. Customer shall not remove the Equipment from the Site, and Shell not move the Equipment on 15.Condhknal Payments Any paymentcheck,or otherform of paymentthatyou the Site without written permission from Company Customer shall not modify the Send us for less than the full balance due mat is marked'paid in fulr or contains equipment. Customer shall not Sell, rent lease or otherwise lose possession of a similar notation, or that you otherwise tender in full satstacion of a disputed the Equipment.nor shall Customer permit any lien to be placed on the Equipment amount, must be sent to United Site Services Inc.. 200 Friberg Parkway. Suite Customer acknowledges that Company has no control over the use of the Equip- 4000,Westborough,MA 01581.We reserve all our rights regarding these payments ment by Customer,and Customer agrees to comply,at Customer's sole expense, (e.g..if it is determined there is no valid dispute,or if any such check is received at with any and all applicable municipal.county,state,federal or quasiyovemmental any other address,we may accept the check and you will still owe any remaining laws,ordinances,regulations and guidelines,including ANSI Standard Z4.3 and balance).We may refuse to accept any such payment by returning 4 to you.not the requirements of the'Guide for Clean Portable Sanitation'published by PSAI, cashing it or destroying t.All other payments that you make shall be sent to the if applicable. address on the invoice. Debbie Magallanez From: Mark Garcia(markgarcia925@sbcglobal.net] Sent: Monday, May 14, 2012 5:40 PM To: Debbie Magallanez Cc: Mike McClellan Subject: Fw. Temp. PowerQuote-MCCLELLANDEV Attachments: MCCLELLAN DEV. 414-30873.pdf ----- Forwarded Message---- From: Griselda Barron <oriselda.barron(dunitedsiteservices.com> To: "markgarda925(@sbcglobal.net" <markgarda925(ulsbcolobal.net> Sent: Mon, May 14, 2012 5:38:30 PM Subject: Temp. Power Quote-MCCLELLAN DEV Good afternoon Mark, I have attached quote for your upcoming project. Per our conversation this has been scheduled for install Wed. 5/16/12. Thank you. Griselda Barron Electrical Deparlinew Under/Sue Services. inc 3403 llillcap:t re San Jose. GI 95130 Direcl:4031284-4440 F¢i: 4/13/773-0610 eriseldn.bnrrnn(id unilerlsile.vervicee:con, Ill]iledsile.verric'ea cont Porlable Re.slroonrs, Ternporan,Fence, Porter and More 1 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36210052.00 DATE ISSUED. . . . . . . : 05/16/2012 RECEIPT #. . . . . . . . . : BS000016837 REFERENCE ID # . . . : 12050132 SITE ADDRESS . . . . . : 21185 RAINBOW DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SUZANNE BESLER ADDRESS . . . . . . . . . . : 21185 RAINBOW DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MCCLELLAN DEV CONTRACTOR . . . . . . . : MICHAEL W. MCCLELLAN LIC #' 32229 COMPANY . . . . . . . . . . : MCCLELLAN DEVELOPMENT ADDRESS . . . . . . . . . . : 1448 ENTRADA VERDE PL CITY/STATE/ZIP . . . : ALAMO, CA 94507 TELEPHONE . . . . . . . . : (925) 944-9108 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41.00 0. 00 41 .00 0. 00 1BCBSC VALUATION 500 .00 1 . 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 500 .00 0 .50 0. 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1 .00 44 . 00 0. 00 44 .00 0. 00 IERT<200 UNITS 1.00 44 . 00 0. 00 44 .00 0. 00 1TRAVDOC FLAT RATE 1.00 44 . 00 0. 00 44 .00 0. 00 ---------- ---------- --- ------- ---------- TOTAL PERMIT 174 . 50 0 . 00 174 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ----- -------- ------- CREDIT CARD 174.50 me --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------------------------ -------- ---------------------------- 402 TEMPORARY POWER