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B-2016-3017CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERAn r NO:-B-2016-3017 20230 STEVENS CREEK BLVD CUPERTINO, CA 95014-2210 (369 02 031) DPR CONSTRUCTION A GENERAL PARTNERSHIP REDWOOD CITY, CA 94063 OWNER'S NAME: TORRE AVENUE PROPERTIES DATE ISSUED: 12/19/2016 OWNER'S PHONE: 650-426-1100 PHONE O: (650) 474-1450 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class QENERAL ENGINEERING CONTRACTOR Lic. #953749 Contractor DPR CONSTRUCTION A GENERAL PARTNERSHIP Date 10/31/2018 X BLDG X ELECT _ PL MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: INSTALL 4 EV CHARGING SfTATIONS ON SOUTH ENTRANCE SIDE; I hereby affirm under penalty of perjury one of the following two declarations: INSTALL N 400 AMP DEDICATED PANEL FOR CHARGING 1. I have and will maintain a certificate of consent to self-insure for Worker's STATIONS (AMAZON) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. . - 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 permit is issued. Sq. Ft Floor Area: Valuati�n: $75000.00 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 369 02 031 A (Tenant Improvements) 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, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS F PERMIT ISSUANCE OR source regulations per the Cuperti Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur Date 12/19/2016 Issued by: ABBY AYENDE Date: 12/19/2016 OWNER-BUIL DER DECLA_R ATION I hereby affirm that I am exempt from the Contractor's License Law for one of the ' following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an ' spection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Scc.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sce.7044, Business & Professions Code). Date: 12/19/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by tl�e Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Co, le, Sec 'ong 25505 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall/ be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION ` Date: 12/19/2016 1 certify that I have read this application and state that the above information is I hereby affirm that there is a coristruction lending agency for the performance 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 of work's for which this permit is slued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be u ed as public records. Signature Date 12/19/2016 Licensed CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(aD_cupertino.org , PROJECT ADDRESS o � a � 4 APN # I OWNER NAME G y �QvyG50 PHONE�X� k � E MAID STREET ADDRESSCITY, l r STATE, ZIP A T -i0 FAX �'A'JoLe c CONTACT NAMEI VO �z'Y��11 G ✓. PHONE �-O'�L. 2_ga7 E -MA �iGV C±GYli STREET ADDRESS 0�c)L_'i�� CIT Y, STAT CZIP �12 FAX ❑ OWNER ❑ OwNER-BUILDER ❑ OWNER AGENT 91CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT q ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME ('�� {� LICENSE NUMBER�� LICENSE TYPE Cb BUS. LIC # COMPANY E� E-MAIL , FAX STREET ADDRE � CITY�STA T�F ZIP G� C(15 1 -2—(9\5\ PHONE 07 , - ARCHITECT/ENGINEER NAME / LICENSE NUMBER Qom• ,_ _ BUS. LIC # COMPANY NAME E MAIL ` ^e 1L` FAX STREET ADDRESS CITY, STATE, ZIP -160,5ij- PHONE CA USE OF ❑ SFD or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: X. COMMCrCial URBAN INTERFACE AREA ❑ Yes No FLOOD ZONE ❑ Yes N 'No ❑ SOLAR PANELS JAI ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION:, DESCRIPTION OF WORK RE� ° By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pro ertywner'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 agr e to comply with all applicable local ordinances and state laws relatinto b 'klmg nstmction. I authorize representatives of Cupertino to enter the above-identiled property for inspection purposes. Signature ofApplicant/Agent: Date: SUPPLE T'AL. INFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER-THE-COUNTER ❑. EXPRESS U x ❑ STANDARD U ❑ LARGE a ❑ MAJOR PVApp_2011.doc revised 03116/11