15070063L
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10460 BANDLEY DR
CONTRACTOR: CUPERTINO ELECTRIC
PERMIT NO: 15070063
INC
OWNER'S NAME: CUPERTINO INDUSTRIAL ASSOCIATE
1132 N 7TH ST
DATE ISSUED: 07/09/2015
O ER'S PHONE:
.SAN JOSE, CA 95112
PHONE NO: (408)991-1000
LICENSED CONTRACTOR'S 'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
=•
INSTALL NEW 1600 AMP SWITCH BOARD, INSTALL 41
�
License Class Lic. #
POWER OUTLETS FOR FUTURE POWER POLES
!
Contractor t % w *2V.. del'� Date
I hereby affirm thafI am licensed under the provisions Chap er 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
` r
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
Com ensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Moo "�°
Valuation: $18000
F o mance of the work for which this permit is issued.
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
AP u 263 00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
EXPIRES IF WORK IS NOT STARTEi D
correct. I agree to comply with all city and county ordinances and state laws relating
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 FROM LAST CALLED INS: ION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
IL
costs, and expenses which may accrue against said City in consequence of the
granting of this permit'. Additionally, the applicant understands and will comply
Issued by: Dater
with all non -point source regulatio pgrCupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Datel!!F!
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.
El OWNER-BUILDE R 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. 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 coniaminants 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 MunicipalCode, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 505, 5533, nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this'u'
"• ' _ _..; ,
Owner or authorized agent: Date: O
4
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
Compensation laws of California. If, after making this certificate of exemption, 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 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
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 non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10460 BANDLEY DR
CONTRACTOR: CUPERTINO ELECTRIC
PERMIT NO: 15070063
INC
OWNER'S NAME: CUPERTINO INDUSTRIAL ASSOCIATE
1132 N 7TH ST
DATE ISSUED: 07/09/2015
OWNER'S PHONE:
SAN JOSE, CA 95112
PHONE NO: (408)991-1000
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class00 Lie. # L �'� W
INSTALL NEW 1600 AMP SWITCH BOARD, INSTALL 41
POWER OUTLETS FOR FUTURE POWER POLES
Contractor _C1,{ p Q r � I- De-,+Date 0 S
I hereby affirm that I am licensed under the provisions Chap er 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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
sation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $18000
O'0mer
mance of the work for which this permit is issued.
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
permit is issued.
APN Number: 32633105.00
Occupancy Type:
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 D FROM LAST CALLED INSP CljION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
hlfe;
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non-point source regulation per the Cupertino Municipal Code, Section
9.18.
Signature De�
ate
RE-ROOFS:
All roofs shall be inspected prior to y roofing material being installed. If a roof is
an
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
ElOWNER-BUILDERDECLARATION
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
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 505, 25533, nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner D,tej(9 �2_al
permit is issued.
or authorized agent:
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
Compensation laws of California. If, after making this certificate of exemption, 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 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
10063
GENERAL PERMIT APPLICATION � E � � �� MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
40300 TORRE AVENUE • CUPERTINO, CA 950143255
M IR C
C U PE RTI N O—{ r—� r-7
I 1PLUMBiNG I IMECHAWrCAi_ MRLRCTRTCAL 1 IMISC@i.i.AwponS
(408) 777-3228 •FAX (408) 777-3333 • buildin4Ca�cunertino.or9
PROJECT ADDRESS APN ti
nl
O1 ERN M PHONE
E-MAIL
STREET ADDRESS
CITY, STATE. ZIP
FAX
One Infinite o
CONTACT NAME
PHONE
7rMAIL
STREET ADDRESS
STATE, ZIP
PAX
❑ OWNER ❑ OWNER•BUR.DER ❑ OWNERAGENT IXCONTRACTOR ❑ CONTRACTORAGENr ❑ ARCHITECT ❑ ENc;u;EER 13 DEVELOPER ❑ TENANT
IXCONTRACTOR
CONIRACTORNAME
LICENSENUMBER
UCENSETYPE
Bus. LICB
John Walters
174637
C10
697
COMPANYNAME
Cupertino Electric
E-NIAIL
ohn waiters cei.c
FAX
408-275-6492
STREET ADDRESS
1132 N 7th St.
CITY STATE,ZIP
gan Jose CA 95112
PHONE
408-808-8016
ARCHITECTIF.NOINEER NAME
LICENSE NUMBER
BUS. Lice
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑sFDorDUPLEX ❑ MULTI -FAMILY
PROJECT INWILDLAND ❑ YL -S
PROJECT IN
❑ YES
IS THE BLDG AN ❑ YES
BUILDING: OMMERCIAL
URBAN WTERFACEAREA ❑ NO
FLOODZONE
❑ NO
EICHLERHOME? ❑ NO
DESCRUMON OF WORK
� _ B b oo �.a - •vol �,,,1. �� V� a a r
(\,
1 \ ♦ n. -A 1 f -M t:_.1..�.�r,
tl
oles
Install .. po'„ e
TOTALVALUATION: $18,000.00 RECEIVED BY*
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
7-7-15
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ ovEn-THGcouNTER
�pW+
r!
❑ EXPRESS
❑ STANDARD
❑ LARGE
13 MAJOR
L
a
MEPM&MRpp 2011.doe revised 06/21/11
CITY OF CUPERTINO fj ` el �
FEE ESTIMATOR - BUILDING DIVISION F�j
19
ADDRESS: 10460 BANDLEY DRIVE
DATE: 07/09/2015
REVIEWED BY: PAUL
UNITS
APN: 326 33 105
BP#:
*VALUATION: 1$18,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Amps
PENTAMATION
PERMIT TYPE: 10EAP A
WORK
INSTALL NEW 1600 AMP SWITCH BOARD INSTALL 41 POWER OUTLETS FOR FUTURE POWER
SCOPE
POLES
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
�
Services
1 ECT>1 K
1,600
Amps
$84
Recep/Switch/Outlets
1BREMRECEP
Su1)pl. Insp Fee.
41
#
$153
PME Unit Fee:
$237.00
PME Permit Fee:
$48.00
Construction 1 ax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (2) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$237.00
Strong; Motion Fee: IBSEISMICO
114ech. hasp. Fee:
pliallU, h:sp. tree:
I-jec.1,7sp. /-ee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
T►ic/rias nan 1 Th— fon. rantart the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check. Fee:
�
Suppl..PC Fee
PME Plan Check:
$0.00
Permit ITee:
Su1)pl. Insp Fee.
PME Unit Fee:
$237.00
PME Permit Fee:
$48.00
Construction 1 ax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (2) No
$0.00
Adv,uncecf Planning Fees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong; Motion Fee: IBSEISMICO
$5.04
Select an Administrative Item
Bldp, Stds Commission Fee: IBCBSC
$1.00
SUBTOTAL S« ;
$384.04
$0.001--"- TOTAL FSE _
$384.04
Revised: 07/02/2015