15100144L CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 16 RESULTS WAY
CONTRACTOR: SPRIG ELECTRIC
PERMIT NO: 15100144
OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET f60 10TH ST DATE ISSUED: 10/19/2015
OWNER'S PHONE: 6503808624 OSE, CA 95112 PHONE NO: (408)298-3134
LICENSED CONTRACTOR'S DECLARATION
License Class [ Lic. # a�
Contractor l,Date
I hereby affirm that I tm 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:
1. 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.
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 -poi t source regulations per the Cupertino Municipal Code, Section 9.18.
3i
Signature M,h V b -: ---- Date Ili It
11 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
i. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three 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.
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.
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
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
ADD ELECTRICAL SUB -PANEL ON 2ND FLOOR (150 AMP);
ADD ELECTRICAL METER IN MAIN SWITCH BOARD (MSB)
Sq. Ft Floor Area: t Valuation: $15000
APN Number: 35720041.16 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued
QQ ��
Date: 4
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 Applicant:
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
Health & Safety Code, Sections 25505, 25533, and 25534.
Ow rauthorrz agent:Y lam.ss
a _ Date:t__r,
t 6
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 Professional
CUPERTINO
❑ PLUN
PROJECT ADDRESS
OWNER NAME
STREET ADDRESS a
CONTACT NAME
STREET ADDRESS
GENERAL PERMIT APPLICATION M E F)
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building6l?cupertino org
M i
�5rvONL/
'NCr ❑ MECHANICAL
�� XELECTRICAL ❑MISCELLANEOUS
PE,
1- APN# 35
- A
PHONE 66_0_ -362,41
ir E-MAIL
¢ T q
CITY, STATE, ZIP r e FAX
PHONE.
E-MAIL 9g} y } P
,✓ < x ti e� �' f' L „f�T 9 Y� 'al P per,
4 A,..a
CITY, STATE, ZIP
FAgC"
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER TA EN
CONTRACTOR NAME a
i -i r LICENSE NUMBER LICENSE TY41BUS. LLC #COMPANY NAME , '1f 1i 4 EMAILla'va%� ! STREET ADDRESS _ .,?
CITY, STATE, ZIP NE
ARCHITBCT/ENGINEERNAME p �a
LICENSE NUMBER BUS. LIC #
COMPANY NAME -
E-MAIL
FAX
STREET ADDRESS
El OVER-TEI&COUNTER
pW
H
❑ EXPRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX
BUILDING: COMMERCIAL
❑ MULTT-FAMILY
PROJECT IN WTLDLAND-
❑YES PROJECT IN YES
IS THE BLDG AN
-.
URBAN INTERFACE AREA
' NO FLOOD ZONE NO
EiCHLER HOME'?
DESCRIPTION OF WORK
fYA
Ado( tu #
ar t 'A
A /I ,
TOTAL VALUATION: l" ,
- 3 P°j RECEIVED BY:
By my Signature below, I certify to each Of the following: I am the property owner or authorized agent to act on thero
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. pI agree to complyalf with all applicable local
ordinances and state laws relatiin 'building construction. I authorize representatives of Cupertino to e
I mer the above -identified property for inspection purposes.
Signature of Applicant/Agem— CA
Date: a.
SUPPLEMENTAL INFORMATION RE0I IIRFIn b
OFFICE USE ONLY
El OVER-TEI&COUNTER
pW
H
❑ EXPRESS
x
0 STANDARD
v ,
7.
..
=EILARIE
W
MAJOR
YES
NO
MEPMiscApp 2011 _doe revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 16 Result Way DATE: 10/19/2016 REVIEWED BY: Phuong
APN: 357-20-041 BP#: 'VALUATION: 1$15,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY Commercial Building Civil / Religious activities PENTAMATION 1 CEAP2
USE: in BQ zone? Yes E) No PERMIT TYPE:
WORK I Add electrical sub -panel on 2nd floor 150 amp); add electrical meter in Main Switch Board MSB
SCOPE
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dicfrirt otr 1 Thoca foac — A—d n- fh. nrnii-li-nrl i-fnr-xnfin- nunilnkia null nro n -hr n- aefim"fa /'n-tnrf fho Dont for 17dd I info_
FEE ITEMS (Fee Resolution 11-053 Eff. 7111131
Heck I' urt Check
Philnb. Man (; aecvL
Elec. Plan Check 0.0 hrs $0.00
/ech Perniii 1 cee:
Fh.rib. Permit lee:
Elec. Permit Fee: IEPERMIT
ower Ilech. 11,18p,
Other Plzunb Iris:>.
Other Elec. Insp. Fo.0 hrs $48.00
AA?C h. hisp, Fee:
1 r!tnr,. ?;^sa Fee:
Ins!). Hee:
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dicfrirt otr 1 Thoca foac — A—d n- fh. nrnii-li-nrl i-fnr-xnfin- nunilnkia null nro n -hr n- aefim"fa /'n-tnrf fho Dont for 17dd I info_
FEE ITEMS (Fee Resolution 11-053 Eff. 7111131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
150 amps
$48.00
Electrical
IBELEC200 I Services
Suppl. PC Fee: 0 Reg. 0 OT
0,0
Thrs
$0.00
PME Plan Check:
$0.00
1
$179.00
Electrical
IBREMPOWER Other Power Devices
Permit Fee:
$0.00
Suppl. Insp. Fee -.(D Reg. 0 OT
0 0
his
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction Tax: IBCONSTAXC
$0.00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.Q0
Select a Non -Residential
Building or Structure
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICO
$4.2
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SI18TQfiALs
$146.20
$227.00
fiaTAL F1E:
$373.20
e
Revised: 10/0112015
►.