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12020087 CITE'OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20803 ALVES DR FCONTRACTOR:ALTERNATIVE POWER& PERMIT NO: 12020087 TRIC OWNER'S NAME: YMCA OF SILICON VALLEY OX 41 DATE ISSUED:02/21/2012 OWNER'S PHONE: 4083511459 SARATOGA,CA 95071 PHONE NO:(831)338-4887 £,_ M I_:IC:ENSED f_'ONTRAC_'TOR'SDtCLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB' License Class Lie.# MECH RESIDENTIAL COMMERCIAL Contractor ate � JOB DESCRIPTION:REPLACE ELECTRICAL FIXTURE AT EXISTING SIGN I hereby affix tha.I am licensed under the provisions of Chaptero) (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: €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 perfonnance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$800 1 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 occupancy Type: APN Number:32632039.00 p' y permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ut1CrCCE.I agree t0 comply with all i;ttl'and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAPS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which mayaccrue 'nst said City in consequence of the granting of this permit. Additiona e= plicat understands and will comply _ z—'L Date: with all non s. regul €ot J r th . o Riunicipal Code,Section Issued by: 9.18. Sip-nature Date�1'� RE-ROOFS: 0 OWNER-BIJIIDER[IECLARATION All roofs shall be inspected prior to any rooting material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I herebv affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: Date: 1,as owner of the property,or nay employees with wages as their sole compensation, Signature of Applicant: will do the work,and the structure is not intended or offered far sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm tinder penalty of perjury one of the following three declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. t will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use yequipment the rr y re devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sec ions 25505,25533,and 25534. 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 Owne ori _ Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this pen-nit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of vu"rk's APPLICANT C_'ERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this:application and state that the above information is Lender's Name 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 Lender's Address 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 granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: pdtg COPY # ; 1 Sec: Trap: Rng; Sub: Blk: Lot: APN 32632039.00 DATE ISSUED. . . . . . . : 02/21/2012 RECEIPT #. . . . . . . . . BS000016065 REFERENCE ID # 12020087 SITE ADDRESS 20803 ALVES DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER YMCA OF SILICON VALLEY ADDRESS 1922 THE ALAMEDA FL3 CITY/STATE/ZIP . . . : SAN JOSE, CA 950126 RECEIVED FROM JEFFREY W SHEETS CONTRACTOR JEFFREY W. SHEETS LIC. # 22729 COMPANY ALTERNATIVE POWER & ELECTRIC ADDRESS PO BOX 41 CITY/STATE/ZIP SARATOGA, CA 95071 TELEPHONE . . . . . . . . : {831} 338-4887 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ____ ---------- ---- ------------- ---------- __________ lADMIN HOURS 1 .00 41.00 0 .00 41 .00 0 .00 1BC.BSC VALUATION 800 .00 1.00 0 .00 1 .00 0.00 1BREMFIXT NO. FIXTURES 1 .00 65 . 00 0 .00 65 .00 0 .00 1BSEISMICO VALUATION 800 .00 0 .50 0 .00 0 .50 0 .00 IEPERMITFE FLAT RATE 1 .00 44 .00 0 . 00 44 .00 0 .00 1TRAVDOC FLAT RATE 1.00 44 .00 0 .00 _____44_00 ----_-0 .00 ---------- ---------- TOTAL PERMIT ; 195 .50 0 .00 195 .50 0 .00 METHOD OF PAYMENT AMOUNT _-REFERENCE NUMBER ----------------- --------------- CREDIT CARD 195 . 50 AMEX --------------- TOTAL RECEIPT 195 . 50 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20803 aloes dr. DATE: 02/21/2012 REVIEWED BY: BP#: "VALtJATION: $800 APN: PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PENTAIVIATION 1 CEAP11 PRIMARY Commercial Building PERMIT TYPE: USE: WORK re lace electrical fixture at existing sign. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 1 # $65 $65.00 TOTALS: Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: IEPEKAIIT Li Other Elec.Insp. 0.0 hrs $44.00 NO This estimate does not include fees due to other Departments(i.e.Planningr Pow anestimate.eContact the De.,Sanitary rtDfor adtdn'1 into. N District,etc.). These fees are based on the relining in ormation available anMISC ITEMS FEE ITEMS -� � FEE QTY/FEE ' of >,� ;1_.�>„ r{: t t; PME Plan Check: $0.00 PME Unit Fee: $65.00 PME Permit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 Work Without Permit? 0 Yes Q No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Select an Administrative Item I BSEISHICO $0.50 ,�_i 'sjo� � IBCBSC $1.00 ��_: ..__..__....__�_..._....__..._. F-e SUBTOTALS: $195.50 $0.00 TOTAL FEE: $195.50 Revised: 1/19/2012 2 'l GENERAL PERMIT APPLICATION ( V�lU� MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255Is uildin(408)777-322a• FAX(408)777-3333• b � cu ertinO.or MISC CUPERTINO PLUMBING ❑MECHANICAL -®'ELECTRICAL ❑MISCELLANEOUS Z O( �✓ It1 '" AN# PROJECT ADDRESS 1-� ,(J POS E-MAIL OWNER NAME f del ok CITY, STATE /' i �-i!J FAX ADDRESS c^ ^ l Z7_ 3AL IA PHONE�`1 CONTACT NAM7�`t� �-`es STREET'ADDRESS CITE`,STATE ZIP FAX 13VARCHITECT ❑f ENGINEER 13 DEVELOPER [3 TENANT' [3 OWNER ❑ OWNER-B=ER [3OWNER AGENT E3CONTRACTOR ❑CONTRACTORAGENT LICENSF,� BUS.LIC# CO CT A� It rE " fJ LIC FFI ER,j C �4 -,C �, vC E MAII F �FAX 3� COMPANY NA� +�� C t L PHONE SCZ STREET ADDRESS y{ E BUS.LIC# LICENSE NUMBER AROM-ECTIENGINEER NAME FAX E-MAIL COMPANY NAME' PHONE CITY,STATE,ZIP STREET ADDRESSYES ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑NO USE OF ❑SFD or DUPLEX ❑ MULTI-FAMB Y PROJECT IN WMDLAND NO FLOOD ZONE ❑NO EICHLFR HOME? [3 NO BLITI.DING: ❑COMMERCIAL URBAN INTERFACE AREA [3 DESCRIPTION OF WORK ( „Y� e'-� :LUQ uJc Zl rr �br� RECEIVED BY: _ TOTAL VALUATION: ' owner's behalf. I have read this By my signature below,I certify to each of the following: I am the Property°°��°r authorized agent to act on the prop e tah of Cupertino to enter the above-identified property for inspection pufpOses. application and the information I have provide � correct.,. have the tion of Work and verify it accurate. I agree to comply with all applicable local ordinances and state laws relating to struc�err I Leer 1 ' „ L Date: Signature of App]cant/Agent OFF USE ONLY YLI.YP g��;p�NTAL INFORMATION REQUIRED L OVER-THE-COUNTER CUECK ED BY � ❑ EXPRESS DATE - i Z Y ,. ❑ STANDARD U < ❑ LARGE PY.ANNING DEW. ❑ MAJOR DATE "T"G. D1:PT3 jffpM1sCAppj0jj.doc revised 06/21111