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12070192CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20400 STEVENS CRE17K 13LVD CO\I'RACI'OR: MEC ELECTRICAL P ERMITNO: 12070192 OWNEXSNAJIE: CUPERTINO CITY C17NTER BUILDINGS 2560 WYANDOTFESTSPE C DATE ISSIIF,D:07R4G012 OWNER'SPBONE: 4088730121 MOUNTAIN VIEW, CA 94043 PHONE NO: (650) 151-9333 ❑ • LICENSED CO\ fRACI'OR'S DEICLARATION License Class 0, rO Lic.4 ss Contract Date �? 1-2 1 hereby affur n Thal I am licensed under the provisions of Cltal er 9 (commencing wish Section 7000) of Di%ision 3 of the Business S Professions Code and that my license is in fall force and effect. hereby of vin under penalty of perjuy one of the follne'ing two declarations: 1 have and will maintain a certificate of consent to self -insure for Worker's Compensation, ars 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 perlbnnance of doe work for which this pemrit is issued A I'I'LIC,\\ 1' CIiR'1'IFIC,\'PION 1 certify that I have read this application and shite that the above information is correct. I agree to comply with all city and county ordinances and stale 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 hamdess the City of Cupertino against Iiabilities,judgments, costs, and expenses which may accrue against said City in consequence of the granting of this pemnit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature�� Date ❑ , OWNER -BUILDER DECLARATION hereby aflinn that I am exempt from the Contractor's License Lanfor 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 S Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business x Professions Code). hereby affirm under penalty of perjury one of the following three 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 tire 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 I'or which this Permit is issued. I cenify,that in the perfomnance of die 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 cenilicate of exemption, 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. APPLIC\NTCERTI FIC TION I certify that I have read this application land state than the above information is correct. I agree to comply with all city and county ordinances mid 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 indenmily 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 land will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date BUILDING PERMIT INFO: BLDG (- ELECT r PLUMB r ;r iNECII r RESIDENTIAL 1-. COMMERCIAL r JOB DESCRI PTION: PARKING GARAGE - INSTALL ELECTRICAL DISCONNECT FOR ELEVATOR Sq. Ill I loor Aron: I Valuation: 54200 AI'N Number: 36901028.00 1 Occupancy Type. PERMIT EXPIRES IF WORK IS NOT STARTED ' WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECT'ON. Issued by: �I J 6.1 Dut�'? q RE -ROOFS: All roofs shall be inspected prior to my 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 I'D BE CLASS "A" OR 13E ITER IIA%ARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California health S Safety Code. Sections 25505. 25533, and 25534. 1 n'ill maintain compliance with the Cupertino Municipal Code. Cha pier 9.12 and the Ilealth S Safety Code, Section 25532(x) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health S Safety Code. Sections 25505, 25533, and 25534. Oss;'rtec' d a t: Date: /Z i CONSTRUCTION LENDING AGENCY I heieby affirm that there 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 Address ARCIIITECI" S DECLARATION I understand my plans shall be used as public records. Licensed .n.- CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 20400 Stevens Creek Blvd. DATE: 07/24/2012 RF.YIENED Bl': jsg UNITS APN: BP#: I 'VALUATION: $4,200 *PERMIT TYPE: Electrical Permit PLAN CIIECK TYPE: Alteration I Addition /Repair PRIMARY USE: Commercial Building # PENTANIATION PERMITTYPE: 10EAP YORK Install electrical disconnect for elevator SCOPE Suppl. Insp FPL APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check Ql'l' UNITS BP FEES Elec. Permit Fee: I EPF.RAIIT Special Circuits 1BREMMISC Other Elec. Insp. 0.0 hrs $45.00 1 # $133 Permit Fee: Suppl. Insp FPL PME Unit Fee: $133.00 PME Permit Fee: $45.00 Construction Tat:' Administrative Fee: LIDU/N $42.00 Work Without Permit? O Yes Q No $0.00 TOTALS: A Travel Documentation Fee: ITRAI DOC $133.00 Strone Motion Fee: 18SEISAHCO NOTE: This winmte does not include jeav due to other Departments (i.e. Planning. Public Works, Fire, Sanitary Seiner District. School District, ere.). These feev are based on the prefinzinan information available and are on/t• an estimate. Contact the Dept for adhln'I in a. FEE ITEMS (Fee Resoh+tion 11-053 F_lT 7/1/1 /) .Neth. Plan Check Plumb. Plan Check Elec. Plan Check 0.0 hrs $0.00 blech, Permit Fee: Ph+mh. Permit Fee: Elec. Permit Fee: I EPF.RAIIT Orher ,tlech. Insp. prher Plumb Insp. Other Elec. Insp. 0.0 hrs $45.00 ,Ilach. hap. Fee: Plumb. lisp. Fee: Flee. Insp, Fee: NOTE: This winmte does not include jeav due to other Departments (i.e. Planning. Public Works, Fire, Sanitary Seiner District. School District, ere.). These feev are based on the prefinzinan information available and are on/t• an estimate. Contact the Dept for adhln'I in a. FEE ITEMS (Fee Resoh+tion 11-053 F_lT 7/1/1 /) FEE QTY/FEE MISC ITEMS Plan Check Fee: Stippl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp FPL PME Unit Fee: $133.00 PME Permit Fee: $45.00 Construction Tat:' Administrative Fee: LIDU/N $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fees: A Travel Documentation Fee: ITRAI DOC $45.00 Strone Motion Fee: 18SEISAHCO $0.88 Select an Administrative Item Bldg Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $266.881 $0.001 TOTAL FEE: $266.88 Revised: 07/01/2012 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin0(a)woertino.orD I IPLIIMRIND FIMECHANICAL IY I ELECTRICAL 1 IMISCELLANEOUS vt9Z MEP MISC PROJECT ADDRESS 20400 Stevens Creek Blvd AM c� — 0 OWN NAME Prometheus: Cupertino Ci Center #13d,ff� PHONE E-MAIL STREET ADDRESS 20400 Stevens Creek Blvd CITY.STATfIPC CA 95014 FAX EGM'ACT NAMEBob Camarda PHO"E 8-873-0121 amarda rometheusre .com STREET ADDRESS Same as Above CITY, STA FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT IR CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Michael Medina LICENSE NUMBER 583390. I LICENSE TYPEC _ 10 BUS, LICK CO11PANY ' MEC Electrical Construction &MAD. mikemedina@yahoo.com FAX STREET ADDRESS 2560 Wyandotte St. Ste. C `HFY•ST"TF,Mountain View CA 94043 P"O"E 408-590-5813 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC i COMPANY NAME E-MAIL FAX STREET ADDRESS ,.l CITY. STATE, ZIP PHONE USE OF ❑SFD.DUPLEX ❑ MULTI -FAMILY BUILDING: OCOMMERCIAL PR02ft BiiPIIALAND❑ YES URBAN IMTRFACE AREA ❑ NO PROJELTIN ❑ YES FLOODZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOMER ❑ NO DESCRIPTION OF WORK Provide for install electrical disconnect and associated wiring for atrium elevator. TOTAL VALUATION: $4200 RECF.IVEDBY: By my signature below, l certify to each of the following: I am the property owner ar authorized agent to act on the property owner's behalf. 1 have read this application and the information 1 have provided is conect. I have read the Description of Warn and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building concoction. 1 authorize representatives of Cupertino to enter the above -identified propeny for inspection purposes. Signature of Applicant/Agent: Date: July 15, 2012 SUPPLEMENTAL INFORMATION REQUIRED OMCEUSEONLY ❑ OYER-TH&COUNTER 6 I- ❑ Exkm Y W' - U ❑ STANDARD - 5 ❑. LARGE 6 ❑ MAJOR MEPMiscApp_I011.doc revised 06/21// 1 LL STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF OCCUPATIONAL SAFETY AND HEALTH TEMPORARY PERMIT TO OPERATE A 'PA,41MUC'e'p, Responsible Party: y �1-re�9 MO[fi�7L" L l.�V.�D�2 r Number Date of Inspection Void After Location t% aPh-024 Street and Number City or Town Load Permissible(' PoundsInspect r iviacnuit- i yRe STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF OCCUPATIONAL SAFETY AND HEALTH THIS TEMPORARY PERMITOR COPY MUST BE POSTED IN t CAR 9 State of California EDMUND G. BROWN JR., Governor Department of Industrial Relations Division of Occupational Safety and Health ELEVATOR, RIDE, AND TRAMWAY UNIT sE '1F w` ALTERATION INTENT TO INSTALL FORM Today's date 7/18/12 C91 FORR P Pursuant to section 3001(a)(1) and section 3001(a)(4) of California Code of Regulations Title 8 Elevator Safety Orders. Accept this letter as notice. Drawings and submittals may be necessary. Elevator Company Name Paramount Elevator Corporation Billing Address 7.3.7 2171 Harbor Bay Parkway, Alameda, CA 94502 Telephone Number 7.3.12 (510) 864-1025 7.3.24 Req # 8. CQCC # CC -03-012732 Address of Alteration of Elevator: Street: 20400 Stevens Creek Boulevard (PAGE 1 OF 2) City: Cupertino Zip Code: 95014 Building Name: Number of Units 1 Permitted California Electrical Code of Record. Year 2007 California State ID Number 86027 Check one Check one Complete Passenger ® Cable Traction ❑ Rated Load Freight ❑ Hydroelectric ® Rated speed Dumbwaiter ❑ Roped Rise Escalator ❑ Hydroelectric ❑ Control type Wheelchair lift ❑ Overhead Drum ❑ VRC ❑ Basement Drum ❑ LULA ❑ Screw Drive ❑ Special Purpose ❑ Chain /Belt Escalator ❑ Other ❑ Rack Et Pinion ❑ Other ❑ List Below the applicable Requirements of 8.7 and 8.4 ASME A17.1-2004 Req # 8. 7.3.7 Req # 8. 7.3.8 Req # 8. 7.3.12 Req # 8. 7.3.24 Req # 8. 7.3.29 2500 100 20'6" Solid State Description Machine Room Description Wiring Description Operator Description Valve & Piping Description Tank The elevator shall be 100% completed before requesting an inspection. Prepared by: Michael D. French Estimated Completion Date: 7/20/12 Doc# EU -237 Rev. 6/13/2001 State of California EDMUND G. BROWN JR., Governor Department of Industrial Relations Division of Occupational Safety and Health ELEVATOR, RIDE, AND TRAMWAY UNIT E r pt S • ~f P w - 6 ALTERATION INTENT TO INSTALL FORM Today's date 7/18/12 °4...... P Pursuant to section 3001(a)(1) and section 3001(a)(4) of California Code of Regulations Title 8 Elevator Safety Orders. Accept this letter as notice. Drawings and submittals may be necessary. Elevator Company Name Paramount Elevator Corporation Billing Address 2171 Harbor Bay Parkway, Alameda, CA 94502 Telephone Number (510) 864-1025 CQCC # CC -03-012732 Address of Alteration of Elevator: Street: 20400 Stevens Creek Boulevard (PAGE 2 OF City: Zip Code: Building Name: Number of Units 1 Cupertino 95014 Permitted California Electrical Code of Record. Year 2007 California State ID Number 86027 Check one Check one 2500 Passenger ® Cable Traction ❑ Freight ❑ Hydroelectric Dumbwaiter ❑ Roped Escalator ❑ Hydroelectric ❑ Wheelchair lift ❑ Overhead Drum ❑ VRC ❑ Basement Drum ❑ LULA ❑ Screw Drive ❑ Special Purpose ❑ Chain /Belt Escalator Other ❑ Rack Et Pinion ❑ Other ❑ Complete Rated Load 2500 Rated speed 100 Rise 20'6° Control type Solid State El List Below the applicable Requirements of 8.7 and 8.4 ASME A17.1-2004 Req # 8. 7.3.31.5 Req # 8. 7.3.31.9 Req # 8. 7.3.31.8 Req #8. Req #8. Description Controller Description Emergency Lowering Description Emergency Operation Description Description The elevator shall be 100% completed before requesting an inspection. Prepared by: Michael D. French Estimated Completion Date: Doc# EU -237 7/20/12 Rev. 6/13/2001