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15090059CITY OF CUPERTINO BUILDING PERMIT W1 LDING ADDRESS: 19550 VALLCO PKWY CONTRACTOR: DEVCON PERMIT NO: 15090059 CONSTRUCTION INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR OWNER'S PHONE: 9165031073 ❑ LICENSED CONTRACTOR'S DECLARATION License Class �q Lic. " (e) Contractor�IYU. Date — I v 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: t. 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 rformance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this 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 to building construction, and hereby authorize representatives of this city to enter 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 the granting ofiMX pe A pally, the applicant understands and will comply with all no rce egulations er the Cupertino Municip(all Code, Section 9.18. Sign Date'1 �l— !V ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. 2. 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 permit is issued. s 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 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 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 comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 690 GIBRALTAR DR J DATE ISSUED: 09/11/2015 MILPITAS, CA 95035 1 PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ TRAFFIC SIGNAL CONTROL BOX METER RELEASE AT THE INTERSECTION OF VALLCO AND FINCH - REFERENCE APPROVED APPLE MITIGATION PLANS (LM) PAGE T-7. Sq. Ft Floor Area: I Valuation: $5000 APN Number: Occupancy Type: 34ao//& PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by:. q/✓ �! Date: //-/.5 RE -ROOFS: 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. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the HeaA& Safety e, ons 25505, 25533, and 25534. agent: „ ( 1 ( CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed III CUPERTINO ��GTi2/tfJL R1 NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 I� (408) 777-3228 •FAX (408) 777-3333 • buifdino(8cupertino.oro �� Q✓ ❑ ADDITION ❑ ALTERATION/TI ❑ RT;V€S'I0N/DFFr--RRFr) C)RIC;ENAI PFPkAITB PROJECT ADDRESS APN k _ 19550 A Vallco Parkway uir�+eo nre sat. "/�/ Tf2C.E/ �/P�i¢i�n/o A Ptto.: S� 3 /07 -MAIL. rr�n�,-.....�.,.•..�. a�j'b /Vi% /Ly CITY. STATE. LIP / FAX Jeri/i o�y ' /yJ�jVLG /�iq��ew I CONTACT NAME PHONE E-MAIL Sarah Nelson 323.919.4460 s.nelson@ccm.to STREET ADDRESS CITY,SrATE, ZIP FAX 1 Infinite Loop MS-21-1AC2 Cupertino, CA 95014 ❑ OWNER ❑ OWNER-BUILDFR ® OWNHRAGEN'r ❑ CONTRACTOR ❑CONTRAC-I"ORAGEN1 ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT t'ONTRACTOR NAME Devcon Construction Incorporated LICENSE NUMBER CA Lic $99163 LIC7:NSE "TYPE BUS. LIC.". COMPANY NAME Devcon Construction Incorporated E-MAIL tcleveland@Devcon-const.com FAX STREET ADDRESS CITY, STATE, LIP PRONE 690 Gibraltar Dr Milpitas, CA 95035 408.636.0900 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC x Stephen Yazalina SBE# 19730 COMPANY NAME, E-MAIL FAX Sandis syaz@sandis.net S I REI: r ADDRESS CITY. STATE, ZIP PHONE 1700 Winchester Blvd Suite 200 Campbell, CA 95006 408.636.0900 DESCRIP'T'ION OF WORK Traffic Signal Control box Meter Release at the intersection of Vallco and Finch - reference approved Apple Mitigation Plans (L -M) pa e T-7 EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES N/A 1151 TYPE OCC. SQ.FI', VALUATION (S) FXISTO KNEW FLOOR DEMO TOTAL. AREA AREA ARCA NET AREA Electrical Met , -r $5000 IIAIHROOM KI'FCHLN OTHER REMODFI. AREA REMODEt, AREA REMODEL. AREA PORCH AREA DECK AREA TOTAL DECK:PORCH AREA GARAGE:ARFrV. DETACH ❑ ATT.ACH M DWELLING UNITS. IS A SECOND "IT ❑YES SECOVD STORY YE:s BEING ADDED? ®NO ADDITION? ®NO PRG -APPLICATION ❑ YF,S IF YES, PROVIDE COPY OF IS TILE IRLDG AN to YES RECEIVED n PLANNING APPL4 ONO PLANNING APPROVAL LEITER EICHLER BONIE' ®NO ��ATION. By my signature below, I certify to each of the following: IRM the property owner or authorized agentto act on the property owner's behalf. 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 buildin onstructlon. I authorize representatives of Cupertino to enter the above-idimtiflyd property for inspection purposes. Signature of ApplicanUAgcnt: Date: ,�..... SUPPLEMFNTAL INFORMATION REQUIRED P€. AN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER rvTER Bulr utNs PLAN R£vtew New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s), Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLICWORKS form if any Hazardous Materials are being used as part or this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ submittal of Building Permit application. MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_201Ldoc revised 06/2b11 CITY OF CUPERTINO ill FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE 19550 A Vallco Parkway DATE: 09/10/2015 REVIEWED BY: Sean ImlADDRESS: APN: BP#: *VALUATION: 1$5,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Amps PENTAMATION 1 CEAP2 PERMIT TYPE: WORK Traffic signal control box meter release at the intersection of Vallco and Finch - reference approved SCOPE Apple Mitigation Plans (L -M) Page T-7. APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check QTY UNITS BP FEES Elec. Permit Fee: 1 EPERMIT Services 1 ECT<200 Other Elec. Insp.0.0 hrs $48.00 100 Amps $48 Permit Fee: Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: TravelDocumentation Fee: ITRAVDOC 1 $48.00 Strong Motion Fee: IBSEISMICO 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 Dreliminary information available and are only an estimate. Contact the Dent for adds'/ into. FEE ITEMS (Fee Resolution 11-053 Ef 7/1/13) Altech. Plan Check Plumb. Plan Check Elec. Plan Check 0.0 hrs $0.00 x—f ch. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: 1 EPERMIT Other Afech. Insp. Other Plumb Insp.Li Other Elec. Insp.0.0 hrs $48.00 Mech. Insp. Fee: Plumb. Insp. Fee: E/ec. htsp. Fee: 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 Dreliminary information available and are only an estimate. Contact the Dent for adds'/ into. FEE ITEMS (Fee Resolution 11-053 Ef 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fees.- ees:Travel TravelDocumentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $1.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS': $191.401 $0.00 TOTAL FEE:" $191.40 Revised: 07/02/2015