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B-2016-2196 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2196 10100 N STELLING RD CUPERTINO,CA 95014-5799(326 31 019) GENERALLIGHTING SERVICE INC SAN JOSE,CA 95110 OWNER'S NAME: ABUNDANT LIFE ASSEMBLY OF GOD DATE ISSUED:06/30/2016 OWNER'SPHONE:408-252-2668 PHONE NO:(408)298-6670 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-1 Lic.#466869 Contractor GENERAL LIGHTING SERVICE INC Date 12/31/2016 X BLDG X ELECT —PLUMB _ I hereby affirm.that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: ADD(9)NEW PARKING LOT LIGHTS TO CHURCH PARKING LOT- I hereby affirm under penalty of perjury one of the following two declarations: ABUNDANT LIFE ASSEMBLY OF GOD 1. I have andwill 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. Sq.Ft Floor Area: Valuation:$31000.00 APPLICANT CERTIFICATION 1 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 31.019 A(Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertisamniisial Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature9,�,�_Date0-1.6 Issued by:SEAN HATCH ',/ Date:06/30/2016 *9l if f OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material eing installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signaturp,ofApplicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:6-3D-16 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. HAZARDOUS MATERIALS DISC UR z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements in der Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal C de,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I sto a or handle hazardous 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 material. Additionally,should I use equipment or de which emit hazardous air contaminants as defined by the Bay Area Air Qual ty ty Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municip Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod ctions 25L05,,2 533,and 2553-4. Labor Code,I must forthwith comply with such provisions or this permit shall 7iw4_� be deemed revoked. Owner or authorized agent,, 1 APPLICANT CERTIFICATION Date:6-3-116 7 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING A .N Y correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency fort performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Giv C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs;and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands ON and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S L TI I understand my plans shall be used as as public recorc s. Code,Section 9.18. Licensed Signature Date 300-116 Professional Building Department City Of Cupertino 1030 Torre Avenue Cupertino,QA 95014-3255 Telephone 408-777-3228 CUPERTINO Fax 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 0610 40 PERMIT# r OWNER'S NAME: Zjpett& PHONE# '2 — GENERAL CONTRACTOR: Ce BUSINESS LICENSE# � ADDRESS: q 7 5— ' 9S-I10 CITY/ZIPCODE: a `JT'dl *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. _ -44 I am not using any subcontractors: 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 Sgnat re Dat CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(okupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISIQN / DEFERRED ORIGINAL PERMIT # :W] PROJECTADDRESS 10100 N Stelling Rd sa AIN0 '' 2Lc- e5l OWNER NAME Abundant Life Assembly of God PHONE 408-252-2668 E-MAIL STREETADDRESS 10100 N Stelling Rd CITY, STATE, ZIP Cupertino, CA 95014 FAX CONTACT NAME David Richie PHONE (408) 210-1420 E-MADL david@svpinc.com STREETADDRESS 1530 Oakland Rd # 140 CITY, STATE, ZIP San Jose, CA 95112 FAX ❑ OWNER ❑ OWNER-BUILDRR ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrFcT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME General Lighting Service, Inc LICENSE NUMBER 466869 LICENSETYPE C-10 BUS. LIC# 22559 cOMPANYNAME General Lighting Service, Inc E-MAM ben@gls-ine.net FAX STREET ADDRESS 975 Chestnut Street cITY,sTATE,zIP San Jose, CA 95110 PHONE 650-400-9891 ARCIHTECUIRIGHMERNAME Same as above LICENSENUMBER BUS. LIC# COMPANY NAME E-MAH. FAX STREETADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Add (9) new parking lot lights to an existing church parking lot EXISTING USE PROPOSED USE CONSTR.TYPB #STORES I USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA RBMODELAREA PORCH AREA DECXAREA TOTALDECKIPORCHARUA GARAGEARBA: DETACH I ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEMGADDED? [-]NO ADDITION? []NO PRE -APPLICATION []YES IFYES,PROVEMOOPYOF IS THE BLDG AN [I YES CH TI VALUATION: PLANN[NGAPPL# []NO PLANNDIGAPPROVALLHTTER EICHLERHOME? ❑NO p JkL 4{�'1_II'^co By my signature below, I certify to each of the following: I am the property owner or authorized agent to 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 building construction. II authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for El OVER-THE-COUNTER y/ �M W tlI7H.DING PLAN REVIEW f V existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS �i (' VPLANNING PLAN REVMW'E t _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ submittal of Building Permit application. SANITARY SEWER DISTRICT ❑ ENVmONMENTALHEALTH BldgApp_2011.doc revised 06121111