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11080216CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21220 HOMESTEAD RD OWNER'S NAME: 7-ELEVEN OWNER'S PHONE: 8172974535 1�1 LICENSED CONTRACTOR'S DECLARATION License Class 0,1t) Lic. # Z Contractor �-hVW Date -3V (( I hereby affirm that I am licensed under t e 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 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 granting of this permit. Additionally, the applicant understands and will comply with al I non-poi7t,,regula 's per the Cupertino Municipal Code, Section 9.18.SignatureDate ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from 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, wil I 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: 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. 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, 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 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 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. CONTRACTOR: SYLVANIA LIGHTING PERMIT NO: 11080216 SERVICES 2200 CABOT DR STE 300 DATE ISSUED: 08/30/2011 LISLE, IL 60532 PHONE NO: (978) 777-1900 BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r MECH RESIDENTIAL r— COMMERCIAL I — JOB DESCRIPTION: REPLACE 34 RECESSED 2X2 LED FIXTURES 64 WATS 120/277 VOLTS Sq. Ft Floor Area: I Valuation: $4000 APN Number: 32605086.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issu y: Z 'ice 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owne or aut brize2 gent: (ic.. Dater( � CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mrk'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. Signature Date I Licensed Professional CITY OF CUPERTINO Fm FEE ESTIMATOR — BUILDING DIVISION lalADDRESS: 21220 HOMESTEAD RD DATE: 0813012011 REVIEWED BY: MENDEZ APN: BP#: 'VALUATION: F$4,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: —1 PENTAMATION 1 CEAP1 1 PERMIT TYPE: WORK REPLACE 34 RECESSED 2X2 LED FIXTURES 64 WATS 120/277 VOLTS SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Fixtures, Lighting 1 BREMFIXT 34 # $121 TOTALS: $121.00 NOTE- These foov are hmodnn tho nrolindnary infnrmadan availahlp and aro nniv an.-winwie- i-nniart tho Dmt far addn'linfo_ FEE ITEMS (Fee Resolution 11-053 EX 711111) FEE QTY/FEE MISC ITEMS Q �ppi. PME Plan Check: $0.00 . . .......... . PME Unit Fee: $121.00 PME Permit Fee: $44.00 yy Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: I TRA VDOC $44.00 Stronp- Motion Fee: IBSEISMCO $0.84 0.5 hrs Admin./Clerical Fee $41.001 1.4DAEN Bldg Stds Commission Fee: IBCBSC $1.00 ...... $210.84. $41.00 $251.841 Revised: 07/04/2011