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14030100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10557 GASCOIGNE DR CONTRACTOR:GRAND NEST PERMIT NO: 14030100 CONSTRUCTION OWNER'S NAME: BEVIA HOLDING LLC 13428 CHRISTINE DR DATE ISSUED:03/17/2014 OWNER'S PHONE: 4083323887 SARATOGA,CA 95070 PHONE NO:(408)891-8059 a LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL INSTALL TEMPORARY POWER POLE License Class j 'n JLic.#��f�•��j�rC°'��/�� Contractor V 1) I 5-( IAA' fy t4 I hereby affirm t at 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500 Vave 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:37528007 00 Occupancy Type: permit is issued. r APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHINPERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save YS F LAST CALLED INSPECTION. 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 co y Iss with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. 17 RE-ROOFS: Signature _ Date t 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I 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 declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:=//,!/L, Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C) 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 GENERAL PERMIT APPLICATIONMEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION o 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408) 777-3228•FAX(408)777-3333•building aacupertino.orct MISC ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS ® �(� /� Z D� I APN# OWNER NAME 3 �a 1 LL_n C I PHONl✓ -$,3 3 3�� E � ID 11VV aVN A 00. C.ti5Y1'1 STREET ADDRESSCITY, STATE,ZIP.- I FAX Saw.eIt5 A4" CONTACT NAME I I PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ 01AWERAGE11U ❑ CONTRACTOR ❑COA*IRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME , LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAII, FAX STREET ADDRESS CITY,STATE,ZIP PHONE J a ; r S ARCHITECTIENGWEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CTIY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MAUI-FAMILY PROTECT IN WU DLAND ❑ YES TILOOECTIN ❑YES IS THE BLDG AN ❑YESBUILDING: ❑COMNtERCIAL URBAN WIERFACE AREA ❑ NO D ZONE ❑NO EICHLER H01E7 ❑ NO DESCRIPTION OF WORK -� TOTAL VALUATION: m a_ ; WE 11 M1 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope ' ehalf I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ' Date: SUPPLE NTAL IATFORMATION RE UIRED - � Q � OEFlCESJS1rOA7s�,� �, NINE, M. TER12 TH1rC9LZtTNIN�� RME � a TA�'DAItI3 �� M r MAJOR • ; MEPMisc,4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10557 GASCOIGNE DR DATE: 03/17/2014 REVIEWED BY: MELISSA APN: 375 28 007 BP#: 14010012 *VALUATION: $500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1REAP1 WORK INSTALL TEMPORARY POWER POLE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $47 TOTALS: $47.00 +� b o-" 3M" a; AGw# zl i'cIt_ 7`icr,t C&'(.k PhI10). Plan Ow(k Elec.Plan Check 0.0 hrs $0.00 F1t>cr' V";-olit F:ee: iliml). PermiF Pee: Elec.Permit Fee: IEPERMIT —1 1 C�d1ie�.: fc°c . 1r<<*. (hire; PTtenslt In.:}>- Other Elec.Insp. 0.0 hrs $47.00 '�Icco. ff?sp. 1 ee: I'r'rrruh Lilz Ise: NOTE:This estimate does not include fees due to other Departments(ke.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn 7 in o. FEE ITEMS ((5ee Resolution 11-053 E . 7f /f 1/13) FEE QTY/FEE MISC ITEMS Plan Ckwcl,;Fee: S7q '/. PC P CC, PME Plan Check: $0.00 PME Unit Fee: $47.00 PME Permit Fee: $47.00 Cc1)tso—ziction Tax: Administrative Fee: ]ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 �ct,cearc'e�cl f'tctrFrrrrrtr fc�es: Travel Documentation Feer ITRAVDOC $47.00 A Strong-Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $186.50 $0.00 TOTAL FEE: $186.50 Revised: 01/15/2014 Building Department City Of Cupertino 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: 055 C-iaS c a r1 e- Dr- PERMIT# '- U /f OWNER'S NAME: PHONE# 1,1 je J/' d f GENERAL CONTRACTOR: BUSINESS.LICENSE# ADDRESS: ) ^ 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) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A-CITY OF CUPERTINO BUSINESS LICENSE. I am not using an subcontractors: Y Signature Date Please check applicable subcontractors and complete the following information: 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 Owner/Contractor Signature Date