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10100101 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10101 N DE ANZA BLVD CONTRACTOR: PERMIT NO: 10100101 OWNER'S NAME: TREND MICRO PROP MGR C (__ DATE ISSUED: 10/13/2010 PHONE NO: IER'S PHONE: 4082571500 ❑ ��LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT I— PLUMB F License Class l vr�` '�1 � MECH r— RESIDENTIAL COMMERCIAL wt` ' Contractor Qi_y -( Date OG� '2--(/U I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: LAWN-HEALTH FAIR ON OCT 27,2010 11:30-1:30 POWER FOR TEMPORARY STRUCTURE,40X40 TENT LOCATED ON (commencing with Section 7000)of Division 3 of the Business&Professions LAWN 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. I have and will maintain Worker's Compensation Insurance,as provided for b Section 3700 of the Labor Code,for the performance of the work for i h Sq.Ft Floor Area: Valuation:$4000 permit is issued. APPLICANT CERTIFICATION APN Number:32634071.00 Occupancy Type: 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 relatin; 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, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section / 9.18. /2 or —I J Issued by SignatureA4 Date �"' )I \! k OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one A 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 I,as owner of the property,or my employees with wages as their sole compensatic n, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Date: Business&Professions Code) Signature of Applicant: 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: HAZARDOUS MATERIALS DISCLOSURE 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 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& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this 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 shal 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 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I Owner o a t o iz deat: become subject to the Worker's Compensation provisions of the Labor Code,I m ist ��7 Date: V forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there 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 i-' -unify and keep harmless the City of Cupertino against liabilities,judgments. Lender's Address and expenses which may accrue against said City in consequence of the g.. ang 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 I understand my plans shall be used as public records. 9.18. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $4,000 *PERMIT TYPE: Electrical Permit PIAN CHECK TYPE: Alteration /Addition / Repair PRIMARY l , 1 PENTAMATION 1 CEAP 14 USE: Commercial Building 1 ,� tr`;.� PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $42 TOTALS: $42.00 Elec.Plan Check 0.0 hrs $0.00 l;Jz. Ptrait Fc . it r"ll )'o- Elec.Permit Fee: lEPERMIT Other Elec.Insp. 0.0 hrs $42.00 NOTE: These fees are based on the preliminary in ormativn available and are only an estimate. Contact the Dept for addn'l in o. FEE ITEMS (Fee Resolution 09-051 Ej". 7,7"'10j FEE QTY/FEE MISC ITEMS /jftld; PME Plan Check: $0.00 1'"llw-,sif Fcc: sulnp/. 17isp F(A' PME Unit Fee: 642.00 PME Permit Fee: 642.00 c�zz trtacriorz Tax rlt't)L1)�1i'%I1 hc'Y'Ie'ii `E't>. Work Without Permit? 0 Yes E) No $0.00 I'Iczorrtr`rr,�r F'e'�'�: Travel Documentation Fee: ITRAVDOC $42.00 i Strong Motion Fee: $0.50 Select an Administrative Item Bldu Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: $ 0 Revised: 9/29/2010 04—/ CITY OF' CUPERTINO 5 ITEMS OF 6 PERM-'T RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B'.-k: Lot: APN . . . . . . . . . 3:?634071 . 00 DATE ISSUED. . . . . . . : 1 )/13/2010 RECEIPT #. . . . . . . . . B3000011736 REFERENCE ID # 1)100101 SITE ADDRESS 1101 N DE ANZA BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TREND MICRO PROP MGR ADDRESS 10101 N DE ANZA BLVD CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM PNY EVENT, LLC CONTRACTOR 'IBD - TO BE DETERMINED LIC # 00096 COMPANY 'IBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE IDUNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 000 . 00 1 . 00 0 .00 1. 00 0 . 00 1BSEISMICO VALUATION 4, 000 . 00 0 .84 0 .00 0 . 84 0 . 00 1ECT<200 UNITS 1. 00 42 . 00 0 .00 42 . 00 0 . 00 1EPERMITFE FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 .00 0.00 42 . 00 ------0_00 ---------- --- ------ ---------- TOTAL PERMIT 127 .84 0 .00 127 . 84 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- --- ---------------- - 304 ROUGH ELECTRICAL 402 TEMPORARY POWER 505 FINAL ELECTRICAL Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: C> al PERMIT# l0 ld OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# l ADDRESS: i t CITY/ZIPCODE: J /1 U� C�.C6�' *Our municipal code requires all businesses working in the city to have a City of Cupertino Asiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON I RACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: L Signa re Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # 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 ' Owner AContractor Signature Date C> A mmo 74 14 C) ILI + a IN A(,( k)Hi)AN;1 I i* GIT'Y N!INOAN IDINANCE DATE SIGNED This sit M plan and specifications KA %4%L I and it I' kept o t l,t_lt all tiniw, -ratior C ,nlawiu!to make any �:,vy �,hancjeor "ItE, On same without A, "(, permision frc:,y F r -he Building De arlmont (�tty,)f CuperItotir)'s the stamping olthv�01wandspecifica NOT bit ri V,""It f)r 1()tie" —W. j)roviFoon, A tt- ,ipr)r -i; C11 Cn Q1 TRU 0, 1 v o fi 2 Cy C T CITY OF / v/ v/ C12- / CITY OF CUPERTINO TEMP POWER CUPERTINO PERMIT APPLICATION FORM APN # �, f 0-71 ?( Date:oa—o b to Building Address: ( 95 O V 1010L&1Dif hmfi, V ev-tin Owner's Name: Pone #:. . � U,�ShGc , �� Phone #: Contractor: r `�V / f IC{Vl4w-) OWI'4�q'7 37� i[VFax#: qL5 1 Contact: Phone #: C;wl (L 14n� �� -� U 37-23RLJ Contractor License #: NJ/ �, ' )(6l 6c -" i�(7 75 Cupertino Business License #: 1\o1-1 J Description: CL{'r U'h �' +-�7�/ 11 :30 - Residential Commercial f Valuation cost ofproject): Type of Construction: N/A -Wousf ot Quantity Fee ID Fee Descriplon Fee Group Permit Type IE T<200 Res. Temp Power<200 E I EAP14 Amps 1 ERT2001 K Res. Temp Power 200-1K E Amps 1EPERMITFE Electric Permit Issuance IBCBSC Cal Bldg St,,,ndar is B ALL PERMIT Commissior.Fee TYPES 1BSEISMICR Seismic Residential B ITRAVDOC Travel & Documentation B Fee Revised 06/12/09 r tbt �1 e C j(A f7 v 4S- L ire,, Marl