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10070098 CITY OF CUPERTIT40 BUILDING PERMIT BUILDING ADDRESS: 10981 FRANCO CT CONTRACTOR:WEST BUILDERS,INC. PERMIT NO: 10070098 OWNER'S NAME: CITY OF CUPERTINO 1608 4TH ST STE 120 DATE ISSUED:07/14/2010 't'NER'S PHONE: 4087773407 BERKELEY,CA 94710 PHONE NO:(510)525-9378 LI LICENSED CONTRACTOR'S DECLARATION yy � BUILDING PERMIT INFO: BLDG f- ELECT f- PLUMB� License Class Lic.# !S r_ ' y MECH r RESIDENTIAL r— COMMERCIAL r YV Contractor ST Date `l I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TRAFFIC OPERATIONS CENTER YARD TEMP POWER (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. Sq.Ft Floor Area: Valuation:$3000 1 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. APN Number:32609025.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter 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, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued Dat 9.18. �7 Signature Date / �( RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Ow r or uthor' d^agent: Compensation laws of California. If,after making this certificate of exemption,I Date:7-0/ /) 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR.- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$3,000 PERMIT TYPE: Electrical Permit PLikN CHECK TYPE: Alteration /Addition / Repair PRIMARY z ,SFD or Dulex �`_ APPLICATION USE: pr,{„ , .TYPE: � a 3 � APPLIANCE/EQUIP TYPE CAPACITY FE E ID QTY BP FEES Temporary Power 1ERT<200 1 $42 TOTALS: $42.00 7 , Elec.Plan Check0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT > ,fOther Elec.Insp. 0.0 1 hrs 1 $42.00 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 09-05I Etf.' 7%09) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 f e PME Unit Fee: $49:.00 PME Permit Fee: $4 :.00 Travel Documentation Fee: ITRA VDOC $4 :.00 Select an Administrative Item Bld T Stds Commission Pee: IBCBSC $1 .00 SUBTOTALS: $12t'.00 $0.00 TOTAL FEE: $127.00 Revised: 6/30/2010 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32609025. 00 DATE ISSUED. . . . . . . : 07/14/2010 RECEIPT #. . . . . . . . . : BS000010864 REFERENCE ID # . . . : 10070098 SITE ADDRESS . . . . . : 10081 FRANCO CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CIPY OF CUPERTINO ADDRESS . . . . . . . . . . : 10555 MARY AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DAVID DE JONG CONTRACTOR . . . . . . . : TO.DD L. WHITLOCK LIC # 29961 COMPANY . . . . . . . . . . : WE3T BUILDERS, INC. ADDRESS 16 )8 4TH ST STE 120 CITY/STATE/ZIP . . . : BE:ZKELEY, CA 94710 TELEPHONE . . . . . . . . : (5L0) 525-9378 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 000. 00 1 . 00 0. 00 1. 00 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. 00 0 .00 127. 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127. 00 VISA --------------- TOTAL RECEIPT 127 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO TEMP' POWER CUPEkTINO PERMIT APPLICATION FORM APN # Date: -7 ILA - ^ I C'� Building Address: , fL � CT 079 Narx}e: � �: ►-a S m k K..: ��r� Phone #: T c'v- �. Contractor: `c--> ERS Phone #: Fax #: Contact: �G Phone #: S f0 --773 -0770 Contractor License #: Cupertino Business License #: Job Description: To C- \-J 4Z Residential El Commercial Valuation (cost of project): 3 Type of Constructi Quantity Fee ID Fee Description Fee Group Permit Type I ERT>1 K Res. Temp Power>I K E 1 REAP14 Amps IERT<200 Res. Temp.Power<200 E Amps 1 ERT2001 K Res. Temp Povfer 2 00-1 K E Amps 1 EPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E 1BCBSC Cal Bldg Standards B ALL PERMIT _ Commission Fee TYPES 1BSEISMICR Seismic Residential B 1 TRAVDOC Travel & Documentation B Fee Revised 01/07/09 L f S I 9 L .0•3i.9/L pqy IOUVtOdO OWAVddl EO� NO1H0n 310)'OZOSL33 335) 0_v NOLL NnOA mEn S _ 3Nn Al--- — _ _ _ S-1L .(F8Y lYAt UUu> I ``Imy n0 S w H 8g o_� wN 4 U APA mm I CMV*LLON Z 5 �tl1�l3WlF300 M3N I FOO MM o — I I 41 030NOMd 000 40 NOIlY001 dFeL I mp I I I L $ 1HOI1000,U I I SY MKM 311SOW AS 0301ASLd t lv NIY1S 03Nn1OtldnNYW30d L 9 0'LV NOISN3S 9 310VJ OIld0 a301d ilOd OZJONV133HS1NIHonaojo*m 1355 OBOV39TTV SNOU NOOW3N 'Np11YONnOf 3lOd 1HOn SOi 0'ZJ 133H5 30 TNHS NO 3 no Y I N H '� tl00d NI Al L 3NUnO I 'LO NO O l NI L 1 VGAYd 0'MY aw MOO103 UONV s31ON i31 s10 ANY11NV5 ONIL03dn0f 0'Z0 L33HS NO NMOHS NNW3N 01 SV 0311W13H11V031YNMW 38 TTYHS 1tl031Y'1 N3VaS Z 11YHdSY ONI S0f3 O 0Z0133HS NO NAWHS SV 0301AONd 3011YHS SIS 9SOH N31W& P :MON IYNOLLI00V 0 S$m oLY N yFr e33S -5 m O s ONnOSV nV 1VOI N m Liina�o 3ON3dNYMOM N Z3'0ZO SL33HS 33S) iOLWU1N00 4 NOILYONMA M N 7 1HOn La3H1s I I _ 3Nn AllfldOSd ONI.SIX3 I 30NA.E I 31V0 NI-N 1 I 3Nn A1tl3dOMd M3N SIL B-.ELL I 'd'SSSL-1311Ytl1 33AJO 0N1151%3— \ ° x• x 3 O 3 .'ter N 00 p�j OO CL dS9BS-ON1O11nL m1VA DNAs.3 m n v v CL CD ao c .o iz o N � m :3 NIVW3tl 01 NOLLVLS - L', dW ONI1Sl v 00 1 O •o C d. < 7 :3r-r N I O Z m m (DQ C CL O O O O" < M M ro .+ ro 0- MCD� M7 X• 6002 LL I. X138 NO3HO - _oQ NOLM:1O Gl N 9 1 9 1 L G � CM ?fi 13= LU W t o 0 tin*�,6` �A Fki s fA Sel h4+ �r Ae mm..r.am..ena mr:tw� z U �an•Do.x rY•;ux se LU - __________________scurrora°cn a 19 Tu I I ash p � LLq 01 Z I �� 8 E nw:a•r.s,.e. it �e - p IMof I U Q W I 4 --------- _ J ZO U — - d Z F- T- 0 0 .e w Z � ` W W a � " O� lot Eoc d'� p jo 8 3 F SUri O O S X Y7 Jg{g ¢ @q _ 1-01 �U y ¢e q2 Z p9C Q �i DOp0Z aiC�g a U I C m is � Y 5 U Ppp �� !c��O m 0 ■/ Z If O d! - W01 !! � ;� '� i A I i r � a°c h A i At I I , Flt ion 5 0 FZJ o° ti 2,2:a6ed Zz0S9tL:01 :wojd 20:zT oTo2-b0-inf Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: JDCVb% F%?-N JLL) LT PERMIT# O OWNER'S NAME: PHONE# 1e> —"7 7 3—O7 ?O GENERAL CONTRACTOR: WET 1" BUSINESS LICENSE# '.99to 1 ADDRESS: pgp0Knw� 'C��4+7 CITY/ZIPCODE: C u 4*e%.v irA-Q *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY NSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complc to the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical CaCs 1 grc..Qr�w� Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Own r/Contractor Signature Date