13050159 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS.,10725 N DE ANZA BLVD CONTRACTOR:REDWOOD ELECTRIC PERMIT NO:13050159
GROUP INC
OWNER':S NAM10725,DE ANZA'LLC 2775 NORTHWESTERN PKWY DATE ISSUED:05/22/2013
E;
OWNER'S PHONE SANTA CLARA,CA 95051 PHONE NO:6503695555 . "
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License Class 1 Lie.# ` a m ' APPLE-ADD OUTLETS TO EXISTING OFFICE SPACE AND
ELECTRICAL CONNECTIONS TO MECHANICAL SPLIT
Contractork�l o Date SYSTEMS
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:$100000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32610065.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct'I agree to comply with,all city and county ordinances and state laws relating WITHIN 0 DAYS OF PERMIT ISSUANCE OR
to!building construction;and hereby authorize representatives of this city to enter
upon ttie above;tnention,64 property for inspection purposes. (We)'agree to save 180 DAY `dM LAST CALLED INSP CTION.
indemnify and keep harmless the,City of Cupertino against liabilities,judgments,
costsI an erises!whieb ma accrue ainst said Ci inconsequence uence of the fi
' y City q Issued b f Dater r t .
granting'of this permit! Additionally,the applicant understands and will comply y' „
with allnon p mt source regula ns por e Cupertino Municipal Code,Section
9 18 ! 1 RE-ROOFS:
Signature i Date ` ?ni" All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materia l$for.
—' inspection.
❑ OWNER BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm,that�am exempt from the Contractors License Law for one of
the follow►ng!two`reasons II' ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
L as,owner of the property;br my employees with wages as their sole compensation,
will do the work„and the rstructute is not intended or offered for sale(Sec.7044,
Busi cess',&Professior}s Code) !
I,as owner of th'e pzopgrt ;am exclusively'contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct e 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,Certifilcate 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 Fu cipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S ti s 255,2553 ,An 34.
dSection 3700 of the Labo;Code,for the performance of the work for which this g � t �Owner or authorized a ent: m ; Date:
permit is issued.,! I,!, I '
I certify,that in the,pe'ormance 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
Compei}sation''laws of Calif, ia. '1 after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become!sub�ect 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 wrth,such 1provision 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 builciingl constructigN and hereby authorize representatives of this city to enter
upon the above mel property for,inspection purposes.(We)agree to save ,
o ARCHITECTS DECLARATION
mderuiri fy and keep ltarmll the City of Cupertino against liabilities,judgments,
costs and expenses!Iwbroh!may accrue,against said City in consequence of the I understand my plans shall be used as public records.
granting of tkzis'permit1 Additionally,the applicant understands and will comply
with all Inop pgintls 1 e regulatal ns,'per the Cupertino Municipal Code,Section Licensed Professional
9 1$
Date
Signature
I
III, I
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: rGj`, /fid l lZ DATE: REVIEWED BY: s '�
APN: BP# �L jj�� _5� *VALUATION: j$100,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1GENC0
WORK apple- add outlets to existing offices ace and electrical connections to mechanicals lits stems
SCOPE
I:�-.,t
NOTE:This estimate does not include fees due to other Departinents(La Planning,Public Works,Fire,Sanitazy Sewer District,School
District,etc.). Thesefees are based on the reliminal_ hi orznation available and are only an estimate. Comztact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $133.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl.Insp.Fee:Q Reg. 0 OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
.w.. .,_... .. . .,, l;I. O
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee. $0.00 ® hours Inspections Q
$532.00 1STINSP Inspection,Hourly 0
Strong Motion Fee: IBSEISMICO $21.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $25.00 $665.00 TOTAL FEE:' $690.00
Revised: 04/29/2013