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B-2016-1405CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1405 10110 CALIFORNIA OAK WAY CUPERTINO, CA 95014 (342 12 030) TOTAL ENVIRONMENTAL & POWER SYSTEMS INC CONCORD, CA 94520 OWNER'S NAME: PACIFIC GAS AND ELECTRIC CO DATE ISSUED: 08/24/2016 OWNER'S PHONE: 415-740-9974 PHONE NO: (925) 681-2238 LICENSED CONTRACTOR'S DECLARATION BUILDING i PERNM INFO: License Class B C10 C20 Lic. #817449 Contractor TOTAL ENVIRONMENTAL & POWER SYSTEMS INCDate X BLDG —ELECT _PLUMB 02/28/2017 _ MECH _;RESIDENTIAL X COMMERCIAL 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 JOB DESCRIPTION; license is in full force and effect. T: MOBILE -:ADD (N) FUEL CELL CABINET TO (E) FREE STANDING CELL SITE 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 ection 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $2600.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number; Occupancy Type: information is correct. t agree to comply with all city and county ordinances 342 12 030 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which WITHIN 180 DAY RMIT ISSUANCE OR may accrue against said. City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point 180 DAY CTION. source regulations per the Cupertino Municipal Code, Section 9.18. Issued by: MELISSA NAMES Signature Date 08/24/2016 Date: 08/24/2016 -BUILDER DECLARAT I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant; 2. I, as owner of the property, am exclusively contracting with licensed Date: 08/24/201 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material, Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the all' contaminants as defined by the Bay Area Air Quality Management District I w� maintain. compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of p $ the il3ealth &Safety Code, Sections 25505, 25533, and 25534.. 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 Owner or au):horized agent: '- be deemed revoked. Date: 08/24/2016 = APPLICANT CERTIFICATION I certify that I_have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understan&my plans shall be used as public records. Code, Section 9.18. Licensed Professional ._ Signature Date 08/24/2018 __ i. PERT- i i+ O NRw C.t1NRTRITrTTnm CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT' DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 , (408)777-3228FAX (408) 777-3333 • buildinq a@cuper hio.or^ FA7 Annrr-MMT M A T'rVDA [`inT.7 /mT n Y�rnrnnot (Y PROJECT ADDRESS APN # OWNERNAME PHONE pEe STREETADDRESS {(/I f { �/\ CITY, STATE 7[Pit- (sem[/ CONTACT NAME �" PHONE `% IE-MAIL ''fin Lbovi; G� ZPI STREET ADDRESS _ � CITY, STATE. ZIP VAX Y3��'-iSC'� � ., p CI OWNER ❑: OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR CONTRACTOR AGENT ARCHITECT D ENGINEER ❑ DEVELOPER D TENANT CONTRACTOR NAME• r LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME I E-MAIL FAX STREET ADDRESS CITY., STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE GG_�" NS7 BB � � � � [' Ss BUS. LIC # COMPANY NAME E-MAIL `� /f FAX . STREET ADDRESSCITY. STATE, ZIP SA- �ss.'.`.t�' PHO f DESCRIIKfION OF—WORK_y ) ='` cry-, QIPv, EXISTING USE - PROPOSED USE - CONSTR. TYPE A STORIES USE '', TYPE OCC. SQ.FT. VALUATION ($) L•'XISTG NEW FLOOR DEMO TOTAL AREA. AREA AREA NETAIWA - BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECKAREA 'TOTAL DECK/PORCH AREA - GARAGE AREA: D DETACH - ] ATTACH 1lDWELL ING.UNITS: ISA SECOND UNIT E3YES SPCONDSTORY [JYES - BEINGADDFD? E]NO ADDITION? NO PRL -APPLICATION []YES IF YES, PROVIDE COPY OF IS TIM BLDG AN DYE S TOTAL ALUATION: PLANNINGAPPL# ONO PLANNING APPROVALLGTrER EICHI.ERIIOML? NO By my signature below, I certify to each of the following: I ain the property owner c Lruthol-tee cn to act on the property owner's behalf. 1 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 Iyktkeie representatives of Cupertino to enter the above -identified property for inspection purposes. �construction. Signature of Applicant/Agent: Date: .SUPPLEMENTAL INFORMATION REQUIRED �. PLAFi_CHFCKTYPE ,.:: -- .._`... 120UTIttiGSLIP p avl a HE t ouNrui; ❑ aMDrnIGrLAN RFVIE t = _ New 5FD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is requited prior to issuance of building - permit for new building, ' Eeexess, l7 I'LA�i�1�1G 1 [ A� x1yiEH Commercial Bldgs: Provide a completed Hazardous Materials Disclosure =' EI -sIA-,�InalD - l] I�CtItL�cesoelr5 _ i'orin if any Hazardous Materials are being used as part of tNs project. _ )] CI LAxGE - FICiE BERT _ Copy of Planning Approval Letter or Meeting with Planning prior to ©:�A1VLT'ARYSEwE1I-DISYIiCT submittal of Building Per nit application.- _: B1dgApp 2011.doc revised 06/21111 rox CONSTRUCTION PERMIT APPLICATION Ar COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.or- ❑ NEW CONSTRUCTION ® ADDITION r3 - ?W 6- (Y65 ❑ ALTERATION / Ti ❑ REVISION / DEFERRED URIUiNAL PERMIT # PROJECTADORESS D Char L �� w AID# ` � 2 I �J �f C2 / ((� d I d�(� > OWNER NAME P C PHONE f s'- 7 7'� E-MAIL fie+» �4 Rai. r Q FAX STREET ADDRESS /.I-�'CITY, STATE ZIa G �L _ CONTACT NAME PHONE E-MAIL p I STREET ADDRESS P G`(®O 6t. ?a�S CITY, STATE, ZIP tS C (S cry a FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 0 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. L1C # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHI"fCCT/ENGINEER NAMG >u C+f'r . ct� LICENSE MBER 0� BUS. LICK COMPANY NAME E-MAIL�t FAX STREET ADDRESS CITY, STATE, ZIP `�.Flo` PHO �„'® 255' Sits I�'= DESCRIPTION OF WORK �,ELlr !J C�) c�-1� Tp `Two EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE OCC. $Q.FT. VALUATION ($) EXISTO NEW FLOOR DEMO TOTAL AREA AREA AREA NE'I'AREA BATHROOM - KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DLCKAREA TOTAL DECK/i'ORCH AREA GARAGE AREA: ❑DGrACH ❑ ATTACH tt DWELLINGUNITS- UNIT ❑YES IS ABEING SDCITION? RY ❑YES ADDED? BRING ADDED? ENO ADDITION? ENO PRE-APPLICKHON ❑YES IF YES, PROVIDE COPY OF 1STHE BLDG AN ❑YES ENE TOTAL LUATION: PLANNINGAPPL# ENO PLANNING APPROVAL LE"FIER EICIILER HOME? ENO •,,, By my signature below, I certify to each of the following: I am the property owner o antlioeize n 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 aoearate. I agree to comply withal] applicable local ordinances and state laws relating to building constivcµtion_. I�)+fke c representatives of Cupertino to enter the above- identified property for inspection purposes. Signatureof Applicant/Agent r—F— Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ -: BUILDING PLAN REVIEW _ 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 P Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD r ❑'. PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑.LARGE ❑FtRE DEFT ' _ Copy of Planning Approval Letter or Meeting with Planning prior to p. ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. mAJoB ❑' ENVIRONMENTAL BEALL M1, M BldgApp_2011.doc revised 06121111