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13060140CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10495 N DE ANZA BLVD CONTRACTOR: T. MARSHALL PERMIT NO: 13060140 ASSOCIATES, LTD. OWNER'S NAME: HATCO ASSOCIATES LLC 7042-B COMMERCE CIR DATE ISSUED: 06/20/2013 OWNER'S PHONE: 4087676665 PLEASANTON, CA 94588 PHONE NO: (925) 734-9999 DECLARATION .TOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S C� «y29 INSTALL (3) EVC STATIONS ON 1ST FLOOR PARKING License Class t��� Lic. # STRUCTURE, RE-STRIPE ADA LOADING AREA ADD NEW // �/ / / / 2 Contractor 1. li N4�� / V&S o Date !/! �` 1 / TRUNCATED DOMES I hereby affirm that I am licensed under the 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 Sq. Ft Floor Area: Valuation: $5000 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 APN Number: 32633110.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION is PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information correct. I agree to comply with all city and county ordinances and state laws relating WITIiIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS ALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, D / costs, and expenses which may accrue against said City in consequence of the Is Date: 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. Date �6/3 RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is Signati;� installed without first obtaining an inspection, I agree to remove all new materials for inspection. 0 OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE I, as owner of the property, am exclusively contracting with licensed contractors to (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the construct the project California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Section 25532(a) should I store or handle hazardous declarations: I have and will maintain a "Certificate of Consent to self-insure for Worker's Health & Safety Code, material. Additionally, should I use equipment or devices which emit hazardous by the Bay Area Air Quality Management District I Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined NN ill maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agen . Date1//� 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. ,If, after making this certificate of exemption, I Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of become subject to the or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) forthwith comply with such provisions Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �/\ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O` 6 (408) 777-3228 • FAX (408) 777-3333 • building(a)cuoertino.oro �U t AE PROJECT ADDRESS I u45 5 A1._1�, A6 v APN# 3 -40 3 110 OWNERNAME �yt� RA i3O �1��� PHONE L:.-� �r Gg . 6 E-MAIL STREET ADDRESS �^ 4 c..L moi'. CITY, STATE, ZIP I FAX PAw ra,to q43� CONTACT NAME PHONE E-MAIL �19M STREET ADDRESS CITY, STATE, ZIP 5�5 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ 1 I \A', 1 CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE: Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes [A No PROJECT IN FLOOD ZONE ❑ Yes NO ❑ SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: # KILOWATTS: TOTAL VALUATION: It? DESCRIPTION OF WORK l / ) 5` V*VV d L _ cE[vE By my signature below, I certify to each of the following: application and the information I have provided is correct. ordinances and state laws relating to build' tstruction. Signature of Applicant/Agent: I am the property owner or authorized agent to act on the property owners behalf 1 have read this I have read ?the cnptionof Work and verify it is accurate. I agree to comply with all applicable local I authorizesentatives of Cupertino to enter the above-identifie prope for inspection purposes. Date:'F111? SU LEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER a :L ❑ EXPRESS U J ❑ STANDARD ❑ LARGE ❑ MAJOR PVApp_2012.doe revised 06/20/12 CITY OF CUPERTINO rm--W FEE ESTIMATOR - BUILDING DIVISION la[A DDRESS: 10495 N DE ANZA BLVD DATE: 06/18/2013 REVIEWED BY: MELISSA hfech. Permil Fee: PN: 326 33 110 BP#: EVALUATION: $15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY USE: Commercial Building rnb. Irrst�, I az>. PENTAMATION PERMIT TYPE: 1 GENCO WORK INSTALL 3 N EV CHARGER ON 1ST FLR PARKING STRUCTURE. RE -STRIPE ADA LOADING SCOPE AREA AND ADD (N) TRUNCATED DOMES NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the vreliminary information available and are only an estimate. Contact the Deptjor addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eft.' 7f %1;'12) Lfech. Plan Check illwnL Plan Check L7ec. Plan Check hfech. Permil Fee: Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. Ocher Plumb Insp.Oiher Elec. Insp. Li 91ech. Insp. ('c e rnb. Irrst�, I az>. 7nc. Insp, Ice NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the vreliminary information available and are only an estimate. Contact the Deptjor addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eft.' 7f %1;'12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Yes 1G) No $0.00 0 hours $133.00 Plan Check, Hourly ISTPLNCK Suppl. PC Feer (F) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 3 # $306.00 Alternative Energy System 1 ICHRGSTA EV Charging Station Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 1) 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: A(Iininistrative Fec , 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 hours $133.00 Inspections ISTINSP Inspection, Hourly Yl-cnel 1)ocmneniulion Fees: Strong Motion Fee: IBSEISMICO $3.15 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $4.151 $572.00 TOTAL FEE: $576.15 Revised: 04/29/2013 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: p sN, jf,, v PERMIT # 3() 6�1 OWNER'S NAME: PHONE # GENERAL CONTRACTOR: TorSG,C, �sSSol. BUSINESS LICENSE # ADDRESS: 7Oq2 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WELL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date Owne ontractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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 Owne ontractor Signature Date AUG/12/2013/MON 12:58 PM T. Marshall Assoc. FAX No,925 734 9996 P,001 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST *Our municipal code requires all businesses worrMng in the city to have a City of Cupertino business license. NO BUILDING FINAL, OR FINAL OCCUPANCY INSPECTION(S) WILL BY SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS ]LAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcodAi -actors: Signature Date Please check, applicable subcontractors and complete the following information. ✓ JOB ADDRESS: l0ViG N, %� i���za ,l�v . PERMIT # —30 CI% I BUSINESS NAME OWNER'S NAME: PHONE # 9Z�. 73q- TTM GENERAL, CONTRACTOR: BUSINESS LICENSE # Z /� ADDRESS:-7O�'2 tan.e7:? 1'5-�� CITY/ZIPCODE: *Our municipal code requires all businesses worrMng in the city to have a City of Cupertino business license. NO BUILDING FINAL, OR FINAL OCCUPANCY INSPECTION(S) WILL BY SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS ]LAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcodAi -actors: Signature Date Please check, applicable subcontractors and complete the following information. ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE ## Cabinets & Millwork Cement Finishing' Electrical Excavation F'encin'g Flooring / Carpeting Linoleum,/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving A-5P9�-L7 Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner-t=Contractor Signature Date.