10090031CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR: ST. JOSEPH OF CUPERTINO
PERMIT NO: 10090031
BUILDING ADDRESS: 10120N DE ANZA BLVD
SZHOOL
" "VER'S NAME: ST. JOSEPH OF CUPERTINO SCHOOL
1)120 N DE ANZA BLVD
DATE ISSUED: 09/07/2010
i, ,-, iVER'S PHONE: 4082526441
('UPERTINO, CA 95014
PHONE NO:
ELECT r PLUMB
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG
License Class Lic. #
MECH r RESIDENTIAL r COMMERCIAL
Contractor Date
,fOB DESCRIPTION: ST JOSEPH OF CUPERTINO CARNIVAL- TEMP POWER
I hereby affirm that I am licensed under the provisions of Chapter 9
GENERATOR
(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.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Sq, Ft Floor Area:
Valuation: $3000
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 31626097.00
Occupancy Type:
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
of this city to enter
EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives
PERMIT
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
may accrue against said City in consequence of the
180 DA S FROM L INSPECTION.
costs, and expenses which
granting of this permit. Additionally, the applicant understands and will comply
=CALLED
with all non -point source regulations per the Cupertino Municipal Code, Section
Date:
9.18.
Issued by: 9
c � -nature Date
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
he following two reasons:
as owner of the property, or my employees with wages as their sole compensation,
till do the work, and the structure is not intended or offered for sale (Sec.7044,
lusiness & Professions Code)
, as owner of the property, am exclusively contracting with licensed contractors to
onstruct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
leclarations:
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
3erformance of the work for which this permit is issued.
[ 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 relatin€
to building construction, and hereby authorize representatives of this city to enter
n the above mentioned property for inspection purposes. (We) agree to save
unify 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.
Signature Date I
RE -ROOFS:
Ul roofs shall be inspected prior to any roofing material being installed. If a roof is
nstalled without first obtaining an inspection, I agree to remove all new materials for
nspection.
signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 255059 25533, and 25534. I will main
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 wi
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Oor authorizedagent: •1 `0
�.- Date:9
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
CITY OF CUPERTINO
1 1 FRF. F.gTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10120 N. De Anza Blvd
DATE: 09/07/2010
REVIEWED BY:
UNITS
APN:
BP#:
*VALUATION: Iso
*PERMIT TYPE: Electrical Permit
PLAPI CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
t 0I;1I- --[PENTAMATION
o�
l^
USE:
trf C�r��t.t1;f
PERMIT TYPE:
Slyppl. hisp
WORK
PME Unit Fee:
SCOPE
PME Permit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
__ —._— --- _---
QTY/FEE
QTY
UNITS
BP FEES
FEIec.
Elec. Permit Fee: IEPERMIT
Generators
1BREMPOWER
. Insp. 0.0 hrs $42.00
1
#
$158
1`aerin1t Fcc:
Slyppl. hisp
PME Unit Fee:
$158.00
PME Permit Fee:
$42.00
Con.wr,, wio, i " a,\
,1(:011sii(Vl
Work Without Permit? 0 Yes No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$158.00
.._ _ _ _ _
.. w...... » ».-.
FEE
__ —._— --- _---
QTY/FEE
Check 0.0hrs $0.00
FEIec.
Elec. Permit Fee: IEPERMIT
-T-7
sr pp/. PC
. Insp. 0.0 hrs $42.00
PME Plan Check:
$0.00
",whip and are a"Iy an estimate. Contact the Dept for addn'1 info.
tvvir.: enese ees (!/e Uas V" Vi[ u[c iuwss.a w. ... ...
FEE ITEMS (Fee Resolution 09-051 Ef. 711%70)
.. w...... » ».-.
FEE
__ —._— --- _---
QTY/FEE
-- -- ---
MISC ITEMS
-T-7
sr pp/. PC
PME Plan Check:
$0.00
1`aerin1t Fcc:
Slyppl. hisp
PME Unit Fee:
$158.00
PME Permit Fee:
$42.00
Con.wr,, wio, i " a,\
,1(:011sii(Vl
Work Without Permit? 0 Yes No
$0.00
Travel Documentation Fee: ITRA VDOC
$42.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$24-1:.00
$0.00 TOTAL FEE:
$242.00
Revised: 9/01/2010
4 ITEMS OF 4
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31626097.00
DATE ISSUED.......: 09/07/2010
RECEIPT #......... BSC00011387
REFERENCE ID # ...: 1OC90031
SITE ADDRESS .....: 10120 N DE ANZA BLVD
SUBDIVISION .......
CITY .............. CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ST JOSEPH OF CUPERTINO SCHOOL
ADDRESS ..........: 10:_20 N DE ANZA BLVD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM MRS. ERIN A EDEN
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: ST. JOSEPH OF CUPERTINO SCHOOL
ADDRESS 1OL20'N DE ANZA BLVD
CITY/STATE/ZIP ...: CU?ERTINO, CA 95014
TELEPHONE .........
FEE ID
UNIT
QUANTITY
.MOUNT
PD -TO -DT
----------
THIS REC
-
NEW BAL
1BCBSC
VALUATION
----------
3,000.00
----------
1.00
0.00
1.00
158.00
0.00
0.00
1BREMPOWER
POWER UNITS
1.00
158.00
0.00
0.00
42.00
0.00
1EPERMITFE
FLAT RATE
1.00
1.00
42.00
42.00
0.00
1TRAVDOC
FLAT RATE
----------
-----42_00
------0_00
----------
243.00
0.00
243.00
0.00
TOTAL PERMIT
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
243.00
---------------
243.00
VOICE ID DESCRIPTION
-------- ----------------------------
101 FOUNDATION
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
103 UFER
104 REBAR 105
304 ROUGH ELECTRICAL 501
505 FINAL ELECTRICAL 510
ANCHOR BOLTS
FINAL ELECTRICAL ENERGY
FINAL PLANNING
i
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12e ANO OLW
IN ACGDANGL VVI 11-1 1 "rU1 i r yr
CUPERTIN CODLS%AN/D ORDINANCES
Q' Dry _
/
le
(ALJ— OF DiLAZ TAPAK A)D_of
s and specifications MUSTt
the job at all times and it is
o
e
je
ake any changes or alterations
bout written permission from
Department, City of Cupertino.((of
/ Lip A�►
this and specifications
f'be
plan
held to permit or to be an
l o the violation of any provisions
Ordinance or State haw.
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CITY OF
CITY OF C;UPERTIN
TEMP POWER
PERM RM
IT APPLICATION FO
CUPERTINO Date: t 2o
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APN #
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Building Address: '�>, d ' v e I
Phone #: L
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O er's Name: �[' �e r� l Y -X( Phone #:
Contractor: Fax #:
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Phone #: �i O� '
Contact: d e r^ o
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Contractor License #: `l `�
Cu ertino Business License #- C CA C n I q
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Job Description: Vii-_ Jobe o u
Commercial b 5U191—� n
Residential Type of Construction: NIA
cost of project):
aluation (S � 00 , p p
it Type
V
Fee � Fee Desc riphon 1�Fee Group Permit
Quantity E
RT<200 Res. Ter1p Power <200
lE Ams E
Res. Temp Polder 200-1K
lERT2001K ATRS--
lEPERMITFE
Electric Permit Issuance
B ALL PERMIT
Cal
Idg Standards TYPES
TRFR
1BCBSC Commission Fee B
1BSEISNIICR Seismic Residential
VDOC TravE;1 &Documentation
B
lP' Fee
Revised 06/12/09