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14080179 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19900 STEVENS CREEK BLVD CONTRACTOR:CRAIG ELECTRIC INC PERMIT NO: 14080179 OWNER'S NAME: FIRENZI ALAN L ET AL PO BOX 612768 DATE ISSUED:08/15/2014 OWNER'S PHONE: 4159397854 SAN JOSE,CA 95161-2768 PHONE NO:(408)232-9300 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E] SCANDANAVIAN DESIGN-INSTALL 4(N)OUTLET License Class_/ _ Lic.# 7&12-40 RECEPTACLES Contracto .tL%( 7,kG11 4 Date 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1040 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:36905038 00 Occupancy Type: permit is issued. 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 WITHI F IT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter ST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments costs,and expenses which may accrue against said City in consequence of Issue Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source r ulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature Date /s �� 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(See.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 50 , 3,an 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 CONSTRUCTION LENDING AGENCY 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 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 9 GENERAL PERMIT APPLICATION o O M E P Im COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 b CUPERTINO (408)777-3228•FAX(408)777-3333•buildingCc)-cupertino.org \ misc \ ❑PLUMBING MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS _ APN# f,:T ©5 _ 0 OWNERNAME '44 'P7y�S�T*'V Ad otlje 3 4MIS. y STRE ADDRESS CONTACT NAME(� PHONE Ti Y.W.-a-32 4 3 0O G�A�►Z!{s ® L'2A%(�lPoT21L• F( STREET ADDRESS CITY,STATE,ZIP F /l�fl PSRrJ 7v 9sJ3 a _ Z32- Rad 3 ❑OWNER ❑ OwNER-BUILDE=R ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSENUMBER_7GI. loO1 141 COMPANY NAME LICENSE TYPE BUS.LIC# �{^d l] E- Ap�c' FAX �(/ l�5 ! ' 2�s Cc CpN/ �ia'- 23z-5'303 STREET ADDRESS// / f1JVWW,J 4r ,# 7o CITY,STATE,ZIP �S �S/3 PHONE 7,3 7- 3CV ARCHITECT/ENGINEER NAME J V ^ LICENSE NUMBER `J�/ BUS.LIC# COMPANY NAME �( E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? NO DESCRIPTION OF WORK budegergs iqAJb eoAlAAQt-T 70 AAA K I A' /a0 Vi7_ 27 TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property o f I have r application and the information I have provided is correct. I haa read the Description of Work and verify it is accurate. I agree to comply with all applicable loc ordinances and state laws relating to bu ingon. I orize representatives of Cupertino to enter the abve-identified property for inspection purposes. Signature of Applicant/Agent: Date: 40//,r / SUPPLEMENTAL INFO TION REQUIRED OFFICE USE ONLY WW VMTHE-COUNTER t" ❑ EXPRESS z ❑ STANDARD rZ7 ❑ LARGE a ❑ MAJOR MEPM1scApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR BUILDING DIVISION ADDRESS: 19900 STEVENS CREEK BLVD DATE: 08/15/2014 REVIEWED BY: MELISSA A7PN: 05 038 BP#: *VALUATION: $1,040 KPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION 10EAP10 USE: Commercial Building PERMIT TYPE: i WORK SCANDANAVIAN DESIGN - INSTALL 4 N !OUTLET RECEPTACLES SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Recep/Switch/Outlets 1BREMRECEP 4 # $48 TOTALS: $48.00 „ lrr�nh. Plus°r{.'itrrca Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT C?riaer 1'a`un211 lrrsp. El Other Elec.Insp. 0.0 hrs $48.00 x i-s,t: //2?7Jd��. /!z1'J7. /'4'!': r NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7./1/13) FEE QTY/FEE MISC ITEMS PC FCC PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Fic k`< 7tG^c'c.'r jaf"-"ni,-I Fees: Travel Documentation Fee: ITRA VDOC $48.00 A Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item Bldy, Stds Commission Fee: IBCBSC $1.00 �� RIALS ' $190.50 $0.00 TOTAL FEE: $190.50 fY t B c Revised: 07/10/2014 4 7111711171, 77117711T771 I //Z( €-bl A131 .000 UG 151 ` 1 i Or 410 € ff l I ` I CUPERTINO 1 € Building Department AUG 15 2014 I REVIEWED t-OR CODE COMPLIANCE Gly 71/,(e0 Reviewed By. J�- - COMMUNITY DEVELOPMENT DEAR �r BUILDING DIVISION-CUPEftTIN i APPROVED This set of plans and specifications MUST be k the - .,� / ., job site during construction. It is unlawful to a any �`IUt�J a - .•�� - ThaffWOF-aifera-tions on same, or to dei e therefrom, without approval from the Buildinj ff al. of T nev€oi n of any p o'v€sio nance.or State �� - PERWT,NO. O!