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11020098 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10518 S BLANEY AVE CONTRACTOR:POWER PLUS SOLUTIONS PERMIT NO: 11020098 CORP OWNER'S NAME: BLANEY VENTURE LLC 1210 RED GUM AVE DATE ISSUED:02/25/2011 ( R'S PHONE: 4082531168 ANAHEIM,CA 92806 PHONE NO:(714)765-7551 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class G /O Lie.# 7 3,3<:> MECH r— RESIDENTIAL r— COMMERCIAL Contractor �,,,�e✓ /��G S Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEMP POWER POLE FOR 5 LOTS(]925SQ IN (commencing with Section 7000)of Division 3 of the Business&Professions TOTAL)-10518,10508 S BLANEY&6773,6783&6793 Code and that my license is in full force and effect. CLIFFORD 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 Sq.Ft Floor Area: Valuation:$3772 permit is issued. APPLICANT CERTIFICATION APN Number:36911062.00 Occupancy Type: 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 PERMIT E IRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN AYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAY M LAST CALLED INSPECTION. with all non-point source regulations per t Cupertino Municipal Code,Section 9.18. Issued by: G" Date: signature Date .2%2 5-// L OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner,opu4= forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save i• inify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36911062 . 00 DATE ISSUED. . . . . . . : 02/25/2011 RECEIPT # . . . . . . . . . BS000012770 REFERENCE ID # . . . : 11020098 SITE ADDRESS . . . . . : 10518 S BLANEY AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BLANEY VENTURE LLC ADDRESS 790 S BLANEY AVE CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM . . . . : S.R. BRAY LLC-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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 772 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 772 . 00 0 . 50 0 . 00 0 .50 0 . 00 1EPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127 . 50 0 . 00 127 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 127. 50 #1304 --------------- TOTAL RECEIPT 127 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 790 S. Blaney Ave. DATE: 02/25/2011 REVIEWED BY: gs APN: I BP#: *VALUATION: 1$3,773 1;;PIERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Temporary Power PENTAMATION 1 REAP 14 SFD or Duplex PERMIT TYPE: WORK Temp power SCOPE APPLIANCE/EQUIP TYPE FEE ID AMPS VOLTS BP FEES Service(incl. Temp. Power) 1 ERT<200 200 <=600 $42 fF,t'< �S-lc'c:;t 1'iCYt"t _-n f�,f.r .<<..57{.>L'_ f tcfil11 7 ,.�2.'G�i Elec.Permit Fee: IEPERMIT $42.00 NOTE: Theseees are based on the preliminaryin ormation available and are onl an estimate. Contact the De t or addn'l info. FEE ITEMS (Tee Resolution 09-051 EtL 77;'10j FEE QTY/FEE I MISC ITEMS ,SZtppl. PC lf,. i PME Unit Fee: $42.00 PME Permit Fee: $42.00 C_`ouswiw tiun 77rL. Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 .1r � ,�l�� Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.00 $0.00 TOTAL FEE:` Revised: 01/15/2011 e�,, CITY C`- CITY OF CUPERTINO TEMP POWER CUPERTINO PERMIT APPLICATION FORM APN Date: 2— 2_1 Building Address: Owner's Name: Phone #: �&A Contractor: a:) Phone #:q.L C-L<--Zp C�; Fax#: Ct I(C �l Contact: Phone It- - i Lvi n Contractor License Cupertino Business License Job Description: C, -1-7 Residential Comeicial ❑ Valuation (cost of project : Type of Construction: N/A Quantity Fee ID Fee Description Fee Group Permit Type IERT<200 Res. Temp Power <200 E IREAP14 Amps IERT2001K Res. Temp Power 200-1 K E Amps IEPERMITFE Electric Pen-nit Issuance IBCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICR Seismic Residential B ITRAVDOC Travel & Documentation B Fee Revised 12/06/10