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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 ►.