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13100182CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR: TB —M -BE PERMIT NO: 13100182 OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS �� `� `C rl/j •Los DATE ISSUED: 10/28/2013 OWNER'S PHONE: 4088730121 PHONE NO: ElLICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lic. # 7 �)J IST FLOOR ELECTRICAL ROOM- REPLACE INTERIOR PANELBOARD Contractor Date 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 Sq. Ft Floor Area: Valuation: $3000 ,Performance of the work for which this permit is issued., -lave and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 36901028.00 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 WITFIIN 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 DAY OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this rmit. Additionally, the applicant understands and will comply Issued by: Date: with all non -p nt urce regulations per the Cupertino Municipal Code, Section 9.18. a / Signature Date / RE -ROOFS: 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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) 1, 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(x) should I store or handle hazardous 1 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 th Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Secti n 25505, 2#33, an Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: te: 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, 1 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 1 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 1 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �'L 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 6 CU ERTI'NO (408) 777-3228 • FAX (408) 777-3333 • building a(-cupertinO.Org \`bbMISC ❑ PLUMBING ❑ MECHANICAL ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS1')e�.� e„w w�� „w, um m APN N ��C2 OWNER N,jlvl) ' 0 C ll (/ PHONE MAIL STREET ADDRESS STATE, ZLiL FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ElOWNER El OWNER -BUILDER El0/ OWNER AGENT CON RACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA E mm 1�I� LICENSE ER &f LICENSEE TYPE BUS. LIC N COMPANY NAME E-MAIL FAX , STREET ADDRESS wWm'� '�� CITY, STAT ', ZIP �, �wVYd PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WI.DLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK TO VALUATION: �� ..- REOJ3IYEC1 Bf / r / L ✓ y i By i ature below, I certify to each of the followin I er or authorized agent to act on the property owner's behalf. I have read this application a ovl e Is correct. I have read the Description of Work and verify it is accurate. I agree to comply withal] applicable local ordinances and state laws relating to ilding con ction. uth r,ZC„representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO ION REQUIREDy1 /J/r%' i / a%%arriii/iii/ol/tamiirrrJ if//l fi 4,17 °�%��l� � r "0 / 0/00/0 0/00/0 IF MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO FM__7 FEE ESTIMATOR - BUILDING DIVISION i�� ii �;i�,..�, i4o:h. 'fart C'hc( /r !'hwo 6 P/rm C"/wc/ 1 h d F°/w/ C h, 1Q>r li Pl,i�jlh pc) mail l'"" Ia" r flco�Gn V"'. Clthcr lir'cI' nsn.E]_L_ 01/wrPlmobI+np (>lfwr .IY�^r.lia.�EaLl Irfc,:17. lop /'c:ePhar+). larsp. F(�" /I'/c(, ln'sIo NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt atr_ )_ Thaco feoc aro hncod an the nrvliminary inlarmntinn availahle and are nnly an actimnta_ Cnniart the Dant fnr addn'1 in(n_ FEE ITEMS (Fee Resolution 11-053 Eff 711113) ADDRESS: 20400 SCB DATE: 1012812013 REVIEWED BY: mendez APN: BP#: - 3 Q a— *VALUATION: $3,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building PENTAMATION PERMIT TYPE: 1GENCOM WORK 1 st floor electrical room- re lace interior panelboard SCOPE $0.00 i�� ii �;i�,..�, i4o:h. 'fart C'hc( /r !'hwo 6 P/rm C"/wc/ 1 h d F°/w/ C h, 1Q>r li Pl,i�jlh pc) mail l'"" Ia" r flco�Gn V"'. Clthcr lir'cI' nsn.E]_L_ 01/wrPlmobI+np (>lfwr .IY�^r.lia.�EaLl Irfc,:17. lop /'c:ePhar+). larsp. F(�" /I'/c(, ln'sIo NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt atr_ )_ Thaco feoc aro hncod an the nrvliminary inlarmntinn availahle and are nnly an actimnta_ Cnniart the Dant fnr addn'1 in(n_ FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes 0 No $0.00 1 hours $139.00 Plan Check, Hourly 1STPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee.o Reg. ()OT10.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con-m-nctioll Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure 0 i 6'rc/Vv/ Ooc't.tlncrnlafur/t Fe esr Strong Motion Fee: 1BSEISMICO $0.63 2.0 hrs $278.00 Inspections ISTINSP Inspection, Hourly Bldp, Stds Commission Fee: IBCBSC $1.00 $1.63 $417.00 = ' TOTAL 1E; $418.63 Revised: 10101/2013