12080091 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10730 N BLANEY AVE CONI'RACI'OR:' PERMITNO: 12080091
OWNER'SNAME: CUPERTINOMINI WAREHOUSE PARTN EJC U QL` 1C DATE ISSUED:081082012
OWNER'S PHONE: 9252340647 PHONE NO:
LuJ, LICENSED IX)VIRACT'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUN113
`'f r
License Class _ Lic.q 4 0 I S
f l0� 0 c '9g f} N1ECf1 r r RESIDENTIAL COMMERCIALr
Contractor Uatc
hereby affirm(hat 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 40 AMP BREAKER WITH 60 AMP BREAKER,
(commencing with Section 7000)of Division 3 of the Business S Professions CHANGE
Code and Ihat my license is in full force and effect. OUT W8 CABLES TO R6 CABLES
I hereby affirm under penally of perjury one of(he following two declarations:
I have and will maintain a centficme Of consent 10 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 pemtit 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 die work for which this
permit is issued Sq.FI Flom Area: Valualion:$700
nrrLu:.w r clsRTrrlc\•ITON
I certify that I have read this application and state that the above information is APN Number:31643009.00 Occupaney'rype:
correct.I agree to comply with all city and county ordinances and state Imus 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 hamilessthe City ofCupertino against liabilities.judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source reguhuia per the Cupertino municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. �{
Signature C� Date" Issued 62•, Da[e�
❑ OWNER-BUILDER DECLARATION
hereby affirm(hal l am exempt front the Ctn(ractor's License Law for line of Rh:ROOFS:
the following(w o reasons: All roofs shall be inspected prior to any roofing material behg installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business fi Professions Code)
1,as owner of the properly,ani exclusively contracting wish licensed contractors to Signature of Applicam: - Date:
construct the project(Sec-7044,Business&Professions Code).
I hereby affirm under penalty of perjureone of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR 13F ITER
declarations:
I have and will maintain a Certificate of Consent to self insure for Worker's IIA-%ARDOUS MA TERIAI S DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfommnce of the work for which this permit is issued 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance•as provided for by California Broth S S:deq'Code.Sections 25505.25533,and 25534. 1 will maintain
compliance with(he Cupertino Municipal Code,Chapter 9.12 and the Health S
Section 3700 ol'Ihe Labor Code,for the performance of the work for which this
P Safety Code,Section 25532(u)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I certify that in the perfommnce of die work forwhich this permit is issued,I shall contaminants as defined by the Bax Area Air Qualify Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation Imes ofCalifomia. If,after making this certificate ofexemplion,I Ilealth S Safely Code.Sections 25505,25533,and 25534.
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 Owner u"ynb ,zed en(• G p /�
OII � Date: I 0
.11'1'LIG\N'I'CF:K'1'I FIG\'1'If1,N CONSTRUCTION LENDING AGENCY
I certify(hat I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances lad state laws relating I hereby affirm thm there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city m enter for which this permit is issued(Sec.3097,Civ C.
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep hamiless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCI IIT-ECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
:IADDRESS: 10730 n. blaney ave. DA'Z'E: .d'_1 t_ REVIEWED BY: bobs.
Ni 6P#: 'VALUATION: $700
*PERMIT TYPE: Electrical Permit PLAN CIIECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTANIATZON
USE: Commercial Building PERMITTYPE: 10EAP
WORK replace 40 amp breaker with 60 amo breaker, change out#8 cables to #6 cables.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Conductors 1BREMMISC 1 # $133
Recep/Switch/Outlets 1BREMRECEP 1 # $45
'TOTALS: $178.00
bfech. Plan Check Plumb.Plan Check Elec. Plan Check 1 0.0 1 hrs $0.00
bfech.Permit Fee: Plumb.Permit Fee: Elec. Permit Fee: IEPERbfIT
Orher Afech.Insp. Other Plumb/asp, Other Elea Insp. 0.0 hrs $45.00
.Neth.limp.Fee: Plumb. hmp. Fee: Elce.imp.Fee:
NOTE: This estinuue does not include fees Clue to other Departments(i.e. Planning, Public 1 Porks, Fire,Sanitary Seiner District,School
District,etc.). These fees are based on the preflininan information nvniluble and tyre onh,an estimate. Contact the Det for adt/n7 in o.
FEE ITEMS (Fee Resolution 11-053 E(f 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PML" Plan Check: $0.00
Permit Fee:
Suppl Insp Fee
PME Unit Fee: $178.00
PME Permit Fee: $45.00
Conswuctlon Tax:
Administrative Fee: 1ADMIN $42.00
Work Without Permit? 0 Yes Q No $0.00
Advoncecl Planning Fces:
Travel Documentation Fee: ITRAVDOC $45.00
Suronu Motion Fee: IBSEIS1111CO $0.50 Select an Administrative Item
131de Stds Commission Fee: ISCBSC $1.00
SUBTOTALS: $311.50 $0.00 TOTAL FEE: 1 $311.50
Revised: 07/01/2012
1 2,02�<-3c>9
GENERAL PERMIT APPLICATION E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 112 In I s c
CUPERTINO (408)7771-3228 • FAX(408)7777-3333 • buildinOrcDwoerJnO.oro M
❑PLU2vflING ❑MCC:--4NiCAL CT-?-'CAL ❑WSCc'LL<NcOUS
PROZECT ADDRESS :,FN' C)
D
OWNER NAME t'I O J( L 'LCLhPt'C� "HONE E-MAC
ST E"T ADDRESS I CiiY. STA ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS Cf7-`.'.STATE- ZIP FAX
❑owsa ❑ OWNER-Bun R ❑�7OWNER AGL� CONT CrOR ❑CON, C OR AG NT ❑ ARC -C ❑EYO ER ❑ DEVELOPER ❑ VANT
CON7RACTOR NAME ` //E/ IVA Q I LICENSE Nu'w,/�/� LICENSE T:yE BUS.LIC 4
Cf/ (�/ `Y`-Y 1 /' / , Com/
COMPANY;LAME 4-( V-a 0 Fl Tcm(C. -MAB- T�/p�rO/ '/` G(�„{.• /n�.} I FAX
SFAEBT ADORES CW/AT /� ' / ,�C-'� I PNGa��3�067
ARCH-1, ?1GLv'=R NAM'c I LICENSE NUMBER I BLS.LICA
COMPANY NAME I :MAC FAX
SiREEr ADDRESS I =.STATE,IIP I PHONE
USE OF ❑SrDmDUPL.X ❑ MUL--FA y PR=N WBDLAND ❑ YES PROTECTN ❑YS IST' BLDG AN ❑ YS
BIRLOING: mg N.- 5C I URBAN N - FACE AREA ❑ NO I FLOOD ZONE ❑NO I Elco- HOMM ❑NO
DESCRIPTION OF WORK
u-z t ('E) YoA ,acv 0 Z,,d1f 7e4 Lc�-j
TOTAL VALUATION: 00 I RECEIVED BY: L /
3y my signature below,I certify to each of ae:ol!owirg: I,:he prope.-1 own,or avhor'ud agent to act on the property owner's behalf: I have read this
application and the information.I have provided is cor:ecL I have toad the Des=pdon of Work and verfy it is accarate. I agree p comply with all applicable local
ordinances and sa¢laws reladrg� ild:n co ej I an:bori=r-_presectacves of Coper..:.c:- id+ d 5r ie.—;."or inspection pu;�Cses.
Signattreof Applirart/Agenm pate; f//OC/
SUPPLE.N[A.L.INFORNLATION REQTj= o CE USE ONLY
tf'y OVER-THE-COUNTER
❑ EXPRESS
u
J ❑ STANDARD
U
5
❑ LARcE
❑ MAJOR
ePRNuc4Dp_2011.doc revised 06/21/11