15080214CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: ABM ELECTRICAL PERMIT NO: 15080214
SOLUTIONS
OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC 16940 KOLL CENTER PKWY STE 100 1 DATE ISSUED: 08/31/2015
OWNER'S PHONE: 4083431088 . ' I PLEASANTON, CA 94566 1 PHONE NO: (510) 932 -2275 1
❑ LICENSED CONTRACTOR'S -DECLARATION
License Class c- Lic. # q6 / 7 � 7 L
Contractor A'Q M Date �I�I
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
erformance of the work for which this permit is issued.
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 -point source r ulations per the Cupertino Municipal Code, Section
9.18.
Signature Date . �/. A
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
1, 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:
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, l 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, 1
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
1 certify that I have read this application and state that the above information is
correct. 1 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 EJ COMMERCIAL E]
INSTALLATION OF (2) L3 AND (1) L2 EV CHARGING
STATIONS IN PARKING STRUCTURE AT MAIN STREET.
Sq. Ft Floor Area: Valuation: $52000
APN Number: 31620108.19800 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: ZL/7` Date: e
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 2550_) 25533, and 25534.
Owner or authorized agent: r- Date:
• %'f
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profess
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: ABM ELECTRICAL PERMIT NO: 15080214
SOLUTIONS
OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC 16940 KOLL CENTER PKWY STE 100 1 DATE ISSUED: 08/31/2015 1
OWNER'S PHONE: 4083431088 1 PLEASANTON, CA 94566 1 PHONE NO: (5I0) 932 -2275
❑ LICENSED CONTRACTOR'S DECLARATION
License Class��) V Lic. #
Contractor ) 1 E N Date [� 1<'
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. 1 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. 1 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 authori c representatives of this city to enter
upon the above mentioned property for in ction purposes. (We) agree to save
indemnify and keep less tCiupertino against liabilities, judgments,
costs, and expense ich maaid City in consequence of the
granting ofth.i it. Ad tcant understands and will comply with
all non -poin rce regul no Municipal Code Section 9.18,
Signat Date to 2,10y
❑ OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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. 1, 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. 1 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.
a. 1 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 Califomia. 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 shal I 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.I8.
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALLATION OF (2) L3 & (1) L2 EV CHARGING
STATIONS IN PARKING STRUCTURE AT ROSEBOWL(134.2
KW).
Revision #1 - Add (N) charging station to van accessible parking spot - ISSUED 10/28/15
Sq. Ft Floor Area: Valuation: $52000
APN Number: 31620108.19800 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D YS FjROMj��LAST CALLED INSP �CQT�O/jN.
Issued by: e 1 ""�'��`�""^ Date: O 1013 (JN
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. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Sectio 5532(a) should I store or handle hazardous material.
Additionally, sho I use a uipment or devices which emit hazardous air
contaminants as fined the Bay Area Air Quality Management District I will
maintain com nee w' he Cupertino Municipal Code, Chapter 9.12 and the
Health & S Cod ctions 25505, 25533, and 25534.
Date: ze- / v
CONSTRUCTION LENDING AGENCY
1 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
CUPERT[ NO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildina(a.cuDertino.org J L S j 1 I
PROJECT ADDRESS l p o o V A't r U 1�9 l. (�
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STREET ADDRESS Moo 0 oo W/ v p'tw I Crrryi fLA E ZIP v o FAX
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STRE�T�D SS j'��1%/7�`1/��t1l�d�1 ppk
CITY TA�e Zjp_ - /B ��7 �7 U�
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FAX
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❑ OuW=R ❑ ON WER- B(b'LTDEER ❑ 01A1N= RAGE)v'T CONTRACTOR
CO,'TR4CTQRNA74E LICtBER�
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BUS. LIC R
COMPANY NAME � -e f�� s
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E -M.AIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑SFD or Duplex ;2multi- Family
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE: eCOmmercial
URBAN INTERFACE AREA ❑ Yes NO
FLOOD ZONE ❑ Yes 1"0
❑ SOLAR PANELS
� STATION
❑ SOLAR WATER I EATINTTG
❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION: �Z VO
FJ
DESCRIPTION OF WOR} A � S4 / / 1 r ! j ( An ` � A � /4 � Ct �s O
.. • ,
.RECEIVED BY `� u�?2.2„-
y; 6 k
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 corect. I have read the Description ofWork and verity it is accurate. I agree to comply with all applicable local
ordinances and state la \vs relating to building co authorize representatives of Cupertino to enter the above- idennt�ified property for inspection purposes.
Signature of Applicznt/Azent: Date:? "
SUPPLEI`6ENTAL INTFOR?`QATION REQUIRED
5`
PI!4pp_2011.doe revised 03116111
Wo"
CONSTRUCTION PERMIT APPLICATION IL �.
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 up
CUPERTINO (408) 777 -3228 • FAX (408) 777 -3333 • buildina(a,cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI V REVISION / DEFERRED ORIGINAL PERMIT
PROIcCf ADDR>� � t' W
APN R
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13 o\%gTR ❑. OWNER - BUILDER - ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ,ac=cT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
C0 ' ME L" %T%7/, %E / L1C S ;170
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ARCHUECVENGIIV NEERNA.ME LICESENUMBER
BUS.LICR
COMPANY NA-Ma
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FAX
STREET ADDRESS
CITY, STATE; ZIP
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DESCRIPTION OF WORK 1b V'w W {� II A cS S�V1b .
Spot
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EXISTING USE PROPOSED USE CONSTR TYPE 4 STORIES
USE
TYPE f
I
OCC. j
I
SQ.FT.
VALUATION (S)
FDaSTG
NEW FLOOR
DE1.4O
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK TORCII AREA
GARAGE AREA: LJDETACH
--
❑ ATTACH
n DWELLING UNITS: IS A SECOND UNrr ❑ YES
SECOND STORY []YES
BEING ADDED? NO
ADDITION? NO
PRE - .APPLICATION ❑ YES IF YES, PROVIDE COPY OF
15 THE BLDG AN YESiE
TOTAL VAL ATION:
PLANNTI.G.APPLR ❑NO PLANT'7I�GAPPROVAL LETTE.
EICHLERHOME? ❑1.0
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By my signature below, I certify to each of the fo ving: I am the prop owner or authorized agent to act on the propel owner's behalf. I hav read this
application and the information I have provi correct, have re .e Description of Work and verify it is accurate. I agree to comply wr t all pplicable local
laws bu ' ' 'of
ordinances and state relating to constructi author representatives Cupertino to enter the a v -id t fi t p!e r inspection purposes,
��1
Signature of Applicant/Agent: Date: `
SUPPLEMS11TAL INTFORAZATION RE IRED
� ; _ otizznc �Lle __=
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
�o EIZ ralicoti�rl lz
T4IIII.DL'SGPLANREVIE�Y
permit for new building.
4N1LnGpL4? 9 v Jz> �TEF 3
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
l� T nDAxn
;0 pLEI C�oRrts Y
_
form if any Hazardous Materials are being used as part of this project.;
r�I4RG2
L7 FSREDEPT -
_ Copy of Planning Approval Letter or Meeting with Planning prior to
a
submittal of Building Permit application,7oRz
saa�T?�x� sEnERDlsrxicr f
B1dg,4pp_2011.doc revised 06121111
FM_7 CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
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 vreliminary information available and are onlv an estimate. Contact the Deat for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Lfl,' 7i1113�
ADDRESS: 19800 VALLCO PARKWAY
DATE: 08/31/2015
REVIEWED BY: SEAN
[ttech. I'r�rrrri: f-,ee:
APN:
BP #:�
*VALUATION: $52,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? 0 Yes (F) No
PENTAMATION
PERMIT TYPE: SOLAR-COMM
WORK
INSTALLATION OF 2 L3 AND 1 L2 EV CHARGING STATIONS.
SCOPE
Suppl. Insp. Fee:Q Reg. Q OT
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 vreliminary information available and are onlv an estimate. Contact the Deat for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Lfl,' 7i1113�
ie<llh. Flom Chick
Plrrnrh. Plcrn Cher.A.
Elec, Plan Check
[ttech. I'r�rrrri: f-,ee:
Plurnh. Permit Fcce,:
Islee. Pere it Fee'
Other n(e"Ir. 1rrvp
Other Phonb Imp.
Other El". hup. Lj
)tech, Laso. Fee':
I' %rear. h?.sv. Fees:
0e:c. l l o. ilc,:
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 vreliminary information available and are onlv an estimate. Contact the Deat for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Lfl,' 7i1113�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 # Alternative Energy System
$327.00 ICHRGSTA EV Charging Station
Suppl. PC Fee: 0 Reg. OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
kmo
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
Ae'.1ininistrwive Fee:
0
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Plannin Fee:
$0.00
Select allon- Residential
Building or Structure 0
1'ravel Doetanenlaiion Fees:
Strong Motion Fee: 1BSEISMICO
$14.56
Select an Administrative Item
Bldy Stds Commission Fee: IBCBSC
$3.00
SVBTQTALS:
$17.56
$327.00 TOTAL FEE:
$344.56
Revised: 07/02/2015
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
i9s,
ADDRESS: 198000 Vallco Parkway
DATE: 10/28/2015
REVIEWED BY: PAUL
d/eclr. Permit Fee:
APN: 316 20 108
BP#:
"VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? Yes � No
PENTAMATION
1GENCOM
PERMIT TYPE:
WORK
Revision #1 - Add N charging station to van accessible parking sot
SCOPE
Suppl. Insp. Fee:(!) Reg. ® OT
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 preliminary information available and are onlv an estimate. Contact the Dent for addn'I info.
FEE ITEMS (Fee Resolution 11 -053 Eff, 711113)
aleclt. ,Pleat (.` /reek
Numb, Nat? ( " /tec•k
l? /ee,. Plan CFte<:k
d/eclr. Permit Fee:
Plumb. PerniirFee:
Glee. Permit Fee:
Olher,llec/c. 1ns'p.
Other Plumh./usp.
Other Elee. hap.
Afech. /nyp7 /'c'e:
I Plumb. insp. Fee:
/aec. Insp. Vee:
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 preliminary information available and are onlv an estimate. Contact the Dent for addn'I info.
FEE ITEMS (Fee Resolution 11 -053 Eff, 711113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes (!) No
$0.00
0 hours Plan Check, Hourly
$143.00 1STPLNCK
Suppl. PC Fee: (j) Reg. () OT
0,0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:(!) Reg. ® OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCoNSTAXC
$0.00
AdminisireVive F'ee:
0
G
Work Without Permit? Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
�
Travel Docutneriluliotr Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
Blda Stds Commission Fee:
$0.00
SUBTOTALS: 1
$0.001
$143.00 TOTAL FEE:
$143.00
Revised: 10/0112015
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Tone Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408- 777 -3333
JOB ADDRESS: PF800 V, Il ( 6 P,2KW .
PERMIT #
OWNER'S NAME:
PHONE # '57e q -C Z ZZ -K-
GENERAL CONTRACTOR: kg M
BUSINESS LICENSE #
ADDRESS: /6AV 0011(-M +Q/ oPOCL0 • STS /06
CITY /ZIPCODE: Pj eACAN1 ,r,,1 CA
*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.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
2- . 3/' /S--
Date
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 Signature
2- . 3/' /S--
Date