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13010050 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:22601 VOSS AVE CONTRACTOR:TBD-l'OBL'DEfERMiNED PERMITNO:13010050 OWNER'SNAME: CITYOFCUPERTINO DATE ISSUED:01/082013 OWNER'S PHONE: 4087773308 PHONE NO: ❑ l 10ENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r Limine Class-/v�lie.a 5193 1 MECH' RESIDENTIAL r COMMERCIAL r Contractor /h I hereby affirm that l am licensed under the provisions ofChapter 9 JOB DESCRIPTION:REPLACE(E)TEMP POWER POLE(REF PERMIT (cummencingwilh Sectlon7g00)ofDivfsion3ofike.Uminess&Professiom 810050188) Code and that my license is in fail force and effect. Ihereby affirm under penally of perjury one of the following two declarations: I have and will maintain a ardficale of consent toself-insum for Worker's C-ompcnsation,as provided for by Swim 3700 of the IaborCode,for the performance of the work for which this provide is heated. I have and will maintain Worker's Compensation[entrance,at provided fm by Sq Fl Floor Arch: Valustion:S1687 Scmion 3700 otthe Labor Cale,fm the performanx of the work fm which this permit is issued. ANN Number.34215038.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 have mad this application and state that the above information is correct.l agree to comply with all city and county ordinances and state laws mlating to building construction,and hereby authorize miumsemriives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon ehc above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmlessthe City of Cupertino against liabililic;judgmonis, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs.and expenses which may acerae against said City In consequence of tire 180 DAYS FROM LAST CALLED INSPECTION. granting ofnhis permit. Additionally,the applicant understands and will comply with all non-Point source regulel PCX pertlno Municipal Code,Sectiw �� 9.18. Issued by: �i'q/✓ Date: �•�•�� signatum _Date if ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If roofis 1 hereby affirm that 1 am exempt from the Coolrltlor's License Law for one of installed without first obtaining an inspection,I agree to remove all nmv materials for the following two reasong s: inspection.. I,as owner of the pmpcnor my employees with wages u thew sole compensation, will do the work,and the suucttae is ant intended a offered for sale(Sec.7044, Signature of Applicant Date: Business&Professions Code) I,as owner critic property.am entclusivelycontracling with licensed contractors to concoct the project(See.70114,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penally of perjury one of the following three declarations: HA7ARDOUS MATERLALS DISCLOSURE I hove andwill maintain a Certificate ofConsenl to self-insum far Worker's I have read the harardeui materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 ofthe Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of tire work forwhich this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worlec's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I stere or handle hanrdous material. Section 3700 of the labor Code,dor the perRmancc of the work for which this Additionally,should l use equipment or devices which emit ha2ardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 terrify that in the Performance of the weak fa which this permit is issued,)shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any mmma so w to became subject to the Worker's Compensation laws of California. if,after making this certificate ofaanption,I Owner thori e / become subject to the Worker's Compensation provisions of the Labs Code,l mart Dam: 3 forthwith comply with such provision or this ponnilshall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION Ihereby affirm thin there is a construction lending agency for the pedbrmance ofworAs I certify that 1 have rad this application and state than the soon information is for which this pcimit is issued(Sec.3097,Civ CJ coreci-l agree to comply with all city and counlymcillumoes and surto laws relating Lenders Name to building construction,and hereby authorize representatives ofthis city to enter upon the above mentioned property for bespection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City ofCLped'mo against IiabiiitieGjudgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per We Cupertino ManieipaJ Code,Section 1 understand my plans shall be used as public records. Licensed Professional Signature Did: GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ^ O�0 MIS C GUPERTINO (408)777-3228'FAX(406)777-3333• buildinaa()cuoertino.ora ❑PLUMBING ❑MECHANICAL LECTRICAL ❑wsm.LANEOUS PROJECTADDREIS 11 3 OWNER NAME .\ PHONE �� EMAII. WC M0. STREET ADDRESS CITY,STATE,ZIP - C. yih t` FAX 'nt A it CONTACT NAME PHONE STRZETADDRESS C LILY STA FAX 13 OWNER ❑ owNER-BunmER ❑ OWNERAGENT ❑comucroR ❑CONTRACTOR AGENT 13 ARLHITEL7 ❑ENGINEER ❑ DEVELOPER ❑TSNW" CONTRACTORNAME LICENSE�Mj 'LICENSE TYPE BUS.LIC# COMPANY NAME y _ E-MAIL FAX STREET ADDRESS T(, r C r,, CITY,STATE,ZIP µ' (I PHONE ARt3iI7ECDM.NGINEER NAME k)I G(�j Y3 LICENSE NUMBER /t- qqo BUS.LIC H COMPANY NAME' E-MAIL FAX �Ik STREET ADDRESS 'AllCITY.STATE,ZIP PHONE USE OF ❑SFD.DUPI.SX E3MUL77-FAMILY PR=IN WIDLAND .O YES PRoIECTDI ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? 0 NO DESCRIPTION OF WORK S � TOTAL VALUATION: RECEIVED BY: By my signature below,I certify to each of the following: I am the owner or authorized agent to act on the property owner's behalf. I have read this application and the information I bave prov ed is correct. I hav d Descriptio of Work and verify it is accutatc. gree comply with all applicable local ordinances and state laws relating td buil ' ctian. I a Be srnta'v of Cupertino to enter the abov -id ti5ed party for inspection pialmes. Signature of Applicant/Agent: Date: L SUPP MENTAL INFORMATION REQUIRED oMFlce use ONLY N VER-THE-COUNTER Y ❑ EXPRESS U tl ❑ STANDARD U z ❑ LARGE 13 MAJOR MEPMuc4pp_2011.doc revised 06/21/11 2415 San Ramon Valley Blvd Suite 4343 San Ramon, CA 94583 sustainable www.sustainabieenergysolutions.co 2fl2lgu :solutions CA Lic. #851997 January 7",2013 Attn: Albert Salvador,P.E., C.B.O. Building Official City of Cupertino 10300 Torre Ave Cupertino, CA 95014 Re: BAAQMD pernnission to act as my agent to obtain permit for new temporary power pole at 22601 Voss Ave,Cupertino, CA—Monta Vista park Dear Mr. Salvador This letter grants BAAQMD personnel authority to act as my agent for the purpose of applying for and obtaining an over the counter permit required for replacement of a temporary power pole at the Monta Vista Park air monitoring site located at 22601 Voss Ave, Cupertino,Ca. Thank you, T m Bea Sustainable Energy Solutions 925-383-6412 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION VIM ADDRESS: 22601 VOSS AVE DATE: 01/08/2013 REVIEWED BY: SEAN APN: BP#: 'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARYPENTAMATION 1GENCOM USE: Commercial Building PERMIT TYPE: WORK SCOPE � p ' J L Y 25f4 J z �..y,. Xledr. Plan Check Plumb.Plan Check Elec.Plan Check ibfech. Permit Fee Plumb.Permit Fee' Elec. Permit Fee: Other dlaeh. Insp, Other Plumb 7n.sp. Li Other Elec.Insp. Wech. lm7p. Fee: Plumb. hap.Fee: Glee,Insp.Fee' NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District etc). These ees are based on the prehoWna in ormation available and are only an estimate. Contact the Dept)*addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 0 hours Plan Check,Hourly Suppl.PC Fee: Q Reg. Q OT 10.0 1 hrs $0.00 $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes O No $0.00 Suppl. Insp. FeelD Reg. Q OTFO-01Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee: O Work Without Permit? O Yes O No $0.00 0 Advanced Planning Fee: $0.00 2-1 hours Inspections (D Travel Documentation Fees: $266.00 ISTINSP Inspection,Hourly Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 � a�i� $0.00 $266.00 i :,>+(;�:��,"� 107r4LFFE„� $266.00 Revised: 10/01/2012 BAAQMD Temporary Power Pole Detail APN 342-15-038-00 22601 Voss Avenue, Cupertino, CA (Monta Vista park) 7:"'17-�a "..� ♦ .. .. • r QCr �[ %:'cfS B=e NOTE:No separate meter on pole. Power supplied t by City of Cupertino from Community Center Bldg. J J { J fs?l10'�we ♦♦ J � J s--•ce Temp Power Pole Replacement per 8/19/2010 Alt. Materials and Methods Request—Permit#10050188 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone:408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: yr PERMIT# 3D DD SQ OWNER'S NAME: GIT 4G Gv !VD PHONE# GENERAL CONTRACTOR: N SINESS LICENSE# ADDRESS: G CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTO S HAVE OBTAINED A CITY O F CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 64' — Signature Date Please check applicable subcontractors and complete the following information: V 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 6 a Owner/Contractor Signature ate Gouste maps 22601 Voss Ave,Cupertino,CA 95014 Search Maps Show search options Find businesses,addresses and places of interest. Get Directions My Maps Collaborate C Edit A '�"' ' Trai�c l��tore_. .,r7 > ,. 22601 Voss Ave Monta Vista Park Overhead view with dimensions 0 vievws. - Unlisted . Created on Apr 15 - Updated 1 minute ago By syamaichi + Rate this map -Writa a comment / Line 1 _ �, ' ,. ! 66.4 meters from trailer to Woodbridge Ct. .1-* Line 2 �7 �'d•'-'•-''�"�`'u'.,�p-'Q1 CTS''�'-�'�'' �►�''�^'�,� :° J 121.9 meters from trailer to McKlintock Lane Electric EMIL, t'> Line Z - Line 3 � - Last Updated by syamair_.hi �: 1 minute ago 64.9 meters from trailer to Voss Ave. Total distance: 400.43 ft Line 4 _ ` _ 121.9 meters from trailer to McKlintock Lane -_ 90.8 meters from trailer to Foothill Blvd Electric service line and telephone line to pass overhead from east end of main park building and x temporary utility pole. Approximately 18 meters (60 - ,, ft) T Z w , L " 71ans and a i ns MUST be kept at t ° @� 9`d-r ti.:: r. is unlawful to make an Q Hide or 31 ns on�ame,or to deviate `°� nom, ,without ap r ❑- oval from the Building Official 2264'1 Voss Ave Monta Vista Park �. F - I p and cs, ations S ❑v 22601 Voss Ave, Cupertino, CA 95014 s SHALL N ❑ 22601 Voss Ave Monta Vista Park i - c i ❑ 22601 Voss avenue, cupertino, ca ❑ Untitled The temporary utility pole is located in the paved parking lot near the intersection point of the blue lines shown above. The lengths of the overhead lines are 87 ft. OFFICE COP . JAN 0 8 2013 B�; _ C3 ` f Electrical main >. panel room e utility pole 'AI: � a. e < a .r - •�,� a yr .. � r .., P'rapcsed Trails �i tion (11'x24) I I r :- w i v 't y`*''� �{c�.i ^� �. •rte i' wr�p►a� l :'4-I rcrlorical Tower Lo n (Tx5 ~ • A • i a Pressure Treated Utility Pole North ovr i'I Le ad re-nt e d ilt lilt T 1 I-Le 8,7 pole r r r� s� 10 Ci Yin tI.ff Ia;?lr Wt' tt'Lonit.i it'jf1--Ttt'-ail et' �- at t i : ac e _ r T Ttility ro 0ra ii i ra at•11ef' 11e ti ld S,rr,rz�_e t_�EffLeI i 1 1�_1 r f' ea-..re r_.d g3 r. 1 i�� i � i'i i t 1�_�1_�.1t• 1_�1��r t' t'o i i f o Tr e:rh an 1 p uld 1 g 1 ID t• C1 rda Vi.--.ta re reatic ir'L canter b1171ch-L•T