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12060120CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22475 RANCHO DEEP CLIFF DR CONTRACTOR: POWER PLUS SOLUTIONS PERMIT NO: 12060120 CORP OWNER'S NAME: I IOFF-MAN M SAUL AND YVONNE T TRUSTEE 1210 RED GUM AVE DATE ISSUED: 06/2012012 OWNER'S PHONE: 4084463369 ANAHEIM, CA 92806 PHONE NO: (714) 7657551 ❑ LICENSED CONTRACTOR'S DECLARATION C License Class -1 U ..l Lic. 4 ; 7 _-_5 ' /O-, _ _ Contractor t6( Lvt Dale GV 1 hereby a1Tir Thal 1 am licensed on 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 penally 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. 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. APPLICANT CERTIFICATION 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 building construction, and hereby authorize 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 may accrue against said City in consequence of the grinding of this permit. Additionally, the applicant understands and will comply with all non -point source regulations er the Cupertino Municipal Code, Section 9.18. Sinnnlure ❑ Ow TER- 6111JILDER D.CLARATION 1 hereby affirm that 1 am ex am the Contractor's License Law for one of the following two reasons: I, 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044. Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of Labor Code, for the performance of the work for which this 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 Califnmia. If, after making this certificate ofexemplion, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 slate 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 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 permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: INSTALLATION OF 200 AMP TEMPORARY POWER POLE Sq. Ft Floor Area: I Valuation: $2400 APN Number: 35602032.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: /Ei�i/✓ lr�27;0i/ Date:-�G-/Qi 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safely Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I stare or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Qualify Management District I will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health & Safely Code, Sections 25505, 25533, and 25534. Owner autho ed agent: NSTRIICTION LENDING AGF.NCI' 1 hereby affirm that t ere is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT Sec: Twp:, Rng: Sub Blk: Loth APN ........: 35602032.00 DATE ISSUED,...__.: 06/20/2012 RECEIPT #..........: BS000017114 REFERENCE ID # ...: 12060120 OPERATOR: patg COPY # : 1 SITE•ADDRESS....... : 22475 RANCHO DEEP CLIFF DR SUBDIVISION .... CITY ...............: CUPERTINO IMPACT AREA :. .. OWNER ...:......... :HOFFMAN M SAUL AND YVONNE T TR ADDRESS 22475 RANCHO DEEP CLIFF DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED�FROM ....: S.R.BRAY LLC METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT :, AMOUNT --------------- 174.50 --------------- 174.50 REFERENCE NUMBER -------------------- #2300 VOICE ID DESCRI-PTION VOICE ID DESCRIPTION -------- ------------------=----------------- ---------------------------- 402 TEMPORARY POWER CONTRACTOR ........: SR BRAY LIC # 31429 COMPANY ...........: POWER PLUS SOLUTIONS CORP ADDRESS ;.......... : 1210 RED GUM AVE CITY/STATE/ZIP ...: ANAHEIM, CA 92806 TELEPHONE ........: (714) 765-7551 FEE ID UNIT '- QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- -ADMIN ------------- HOURS ---------- ---------- 1.00 41.00 ---------- ---------- 0.00 41.00 ---------- 0.00 1BCBSC VALUATION 2,400.00 1.00 0.00 1-.00 0.00 113SEISMICR VALUATION- _ 2,400.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1ERT<200 UNITS 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 ---------- 174.50 ---------- ---------- 0.00 174.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT :, AMOUNT --------------- 174.50 --------------- 174.50 REFERENCE NUMBER -------------------- #2300 VOICE ID DESCRI-PTION VOICE ID DESCRIPTION -------- ------------------=----------------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO IID``./JI FEE ESTIMATOR - BUILDING DIVISION %L ADDRESS: 22475 Rancho Deep Cliff DATE: 06/20/2012 REVIEWED BY: Sean UNITS APN: BP#: 'VALUATION: $2,400 -PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: $44 PENTAMATION 1REAP14 PERMIT TYPE: WORK Installation of 200 amp temporary ower pole. SCOPE APPLIANCE/ EQUIP TYPE FEE ID PhwIh. Phm 0,e<d QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Temporary Power 1ERT<200 Other Elec. Insp. 0.0 hrs $44.00 200 Amps $44 M.) mil 1S;r: Supp/ 111.,tp hCG' PME Unit Fee: $44.00 PME Permit Fee: $44.00 Colffo w lion i"n Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes (E) No $0.00 TOTALS: Travel Documentation Fee: ITRAPDOC $44.00 Siront; Motion Pcc: IBSEISMICR NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer DErrrict, School District. etc). These fees are based on the vreliminary information available and are only an estimate. Contact the Dept for uddn'I info. FEE ITEMS (Fee Resohmion 11-051 Elf 711111) IIt, n I'l:;n (11, rlr PhwIh. Phm 0,e<d Elec. Plan Check 0.0 1 hrs $0.00 Phm (_ heek Elec. Permit Fee: IEPERMIT Of1w,- Lah.fmp. Ofhv,-Plun,Insp_Li I Other Elec. Insp. 0.0 hrs $44.00 PME Plan Check: $0.00 NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer DErrrict, School District. etc). These fees are based on the vreliminary information available and are only an estimate. Contact the Dept for uddn'I info. FEE ITEMS (Fee Resohmion 11-051 Elf 711111) FEE QTY/FEE MISC ITEMS Phm (_ heek .Glppl. P( "Gtr PME Plan Check: $0.00 M.) mil 1S;r: Supp/ 111.,tp hCG' PME Unit Fee: $44.00 PME Permit Fee: $44.00 Colffo w lion i"n Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes (E) No $0.00 Atll',IMl,/I'I,1II)Illl�. I'ec.N Travel Documentation Fee: ITRAPDOC $44.00 Siront; Motion Pcc: IBSEISMICR $0.50 Select an Administrative Item I31da Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $174.50 $0.00 TOTAL FEE: $174.50 Revised: 06/30/2012 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO. CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(a),cuoertino.ora 12 o co Q-, ( n PLUMBING I -(MECHANICAL dELECTRICAL MMISCELLANEOUS MEP MISC PROJECT ADDRESS22. �I Yrs �-Y10 ` \ APNH (EE --MAIL OWNER NAMF. I J - / STREET ADDRESS m - PHONE L/LG , CRY, STATE, ZIP�I FAC v %'�z ii✓o t CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGEM oNTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHn ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Q� I t V LICENSE NUMBER/A(\ vv�`` LICENSE TYPI� BUS. LICM COMPANY NAME .wT�-� `l� C• V E-MAIL wv FAX STREET ADDRESS n `-j� p� CITY. STATE. ZIP�Q S` -SG, C 1��S- ` PI IONE 4--->1 l ARCIUTECTIENGMNEERJNAAME _ / /L /V f� LICENSE NUMBER BUS. LIICM COMPANY NAME E-MAIL FAX STREET ADDRESS CRY, STATE. ZIP PHONE USE OF IbM or DUPLEX ❑ MULTI -FAMILY BUILDING COMMERCIAL PROJECT IN WBDLAND ❑YES URBAN INTERFACE ARFA O'NO PROIECTIN ❑YES FLOODZONE ❑ NO ISTIIE BLDG AN YES EICIBPR HOME' NO DESCRIPTION OF WORK TOTAL VALUATION: Z U O � FLECEIVED BY:; ni - By my signature below, l ceflify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information 1 have provided is coriect. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and stale laws relating to building constru pon. I a art= representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicantIAgenC Dale: (,o -ZO - \2— NTALIt4F RMATQVIRtD FFICE USE ONLY 'OVER-TTI&COUNTER LYS _ STANDARD G Z>. g.. LARGE ' d. MAJOR MEPMiscApp_201 Ldoc revised 06121111