Loading...
15090004S cq,n- CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19550 VALLCO PKWY CONTRACTOR: POWER PLUS PERMIT NO: 15090004 SOLUTIONS CORP OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 1210 RED GUM AVE DATE ISSUED: 09/01/2015 OWNER'S PHONE: 9165031073 ANAHEIM, CA 92806 PHONE NO: (714) 765-7551 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL INSTALLATION OF (2) TEMP POWER SERVICE PANELS q License Class G I0 Lic. # / 110 7 ( (200 Contractor. pk-Ou)- �I �`l Date_J:/l / AMP EA.). 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 Sq. Ft Floor Area: Valuation: $2000 perf ante of the work for which this permit is issued. h and will maintain Worker's Compensation Insurance, as provided for by tin 3700 of the Labor Code, for the performance of the work for which this APN Number: 31620085.19550 Occupancy 'type: rm t is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the? / J ���� 'II Issued by: / ��� LLL/! G Date: L � granting of this permit. Additionally, the applicant understands an comply v with all non -point source regulations per the Cupertino M Code, Section 9.18. RE -ROOFS: Signature Date—c7,/[// 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. ❑ OWNER-BUI R DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and Section 3700 of the Labor Code, for the performance of the work for which this �Date: Owner or authorized agent: / permit is issued.p 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 =C%NQ-rV1T=CTG Compensation laws of California. If, after making this certificate of exemption, I AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance o1' forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date ___ CITY OF CUPERTINO 5-N FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 19550 Vallco Parkway DATE: 09/01/2015 REVIEWED BY: Sean UNITS APN: BP#: *VALUATION: 1$2,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Amps PENTAMATION 1 CEAP14 PERMIT TYPE: WORK Installation of 2 temp power service panels 200 amp ea.). SCOPE Suppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check QTY UNITS BP FEES Elec. Permit Fee: I EPERMIT Temporary Power 1ECT<200 Other Elec. Insp.Es�$48.00 200 Amps $48 Temporary Power 1ECT<200 Suppl. Insp Fee 200 Amps $48 PME Unit Fee: $96.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: (ADMIN $45.00 Work Without Permit? Q Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $96.00 Strong Motion Fee: 1BSEISMICO 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 only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) Mech. Plan Check Plumb. Plan Check Elec. Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: I EPERMIT Other Mech. Insp. Other Plumb Insp. Other Elec. Insp.Es�$48.00 Afech. hasp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: 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 only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $96.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: (ADMIN $45.00 Work Without Permit? Q Yes (F) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICO $0.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $238.561 $0.00 TOTAL FEE: $238.56 Revised: 07/02/2015 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ('�\) 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M'SCCUPERTiNO l�1 (408) 777-3228 • FAX (408) 777-3333 • building0cuoertino.ora fD/}Q� J ✓ (% `7` PLUMBING ❑ MECHANICALELECTRICAL MISCELLANEOUS PROJECT ADDRESS 1 1 �So I1�/ I 7 V (PHONE APNa I/� •D� ✓` ONAME WNER ItJ 11'. CJ��'71A)0 466R -CCA -16-G4 c / s© /�J 7 E: -MAIL STREET ADDRES5 2 Z ,F,jp N11 -L 9-9 S'%E- 7-4 CITY, STATE, ZIP - /O S 14CA14-0 P/t-f-r— - `I FAX CONTACT NAME .IEEE RAINEY STREET ADDRESS 1069 EDGEMERE LANE PHONE51E-MAIL 0-427-4260 jeffrey.rainey@aft.net FAX510-783-1041 CITY, STATE, ZIP HAYWARD, CA 945454 1 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR R CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TI'\a\ I CONTRACTOR NAME LICENSE NUMBER71O 5 / L CENSE TYPE GID BUS. LIC # COMPANY NAME P 0L-i26.Pv9,q1.7 E -M 1L 54,za Ice I; cb FAX STREET ADDRESS y D 0 - CQfA X) F � CITY STATE, IP r ,1 G / C /# � / PHONE / 5d 10,7 3 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ `-�' EICHLER HOME" [� - DESCRIPTION OF WORK rroji- ZA 2-40 2. -70M O /ems ctD 79-dL-7 "0 ,J TOTAL VALUATION: Cx'.�� RECEIVED BY: 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 itis accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino above -identified pro rty for inspection purposes. Signature of Applicant/Agent: Date: MENTAL INFORMATIO UIRED OFFICE USE ONLY prW t" 1 OVER-THE-COUNTER ❑ EXPRESS a ❑ STANDARD U z ❑ LARGE ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 k vAr I k 040 �0 J 1 � � COMMUNITY DEVELOPMENT DEPARTMENT C3 BUILDING DIVISION - CUPERTINO / APPROVED la This set of plans and specifications MUST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate therefrom, without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City O dinance or State Law. BY DAT= ' PERMIT NO. �9 �o kN '_'.; . RECEIVED SEP p 1 2015 BY OFFICE COPY 1455 Vallc.� �Kwy G.Pe✓�,no -!O�M/40 T4c-LoPi-5 V 05P 6) 0 tof 1101q04 ul 6D�,—st-f - & co(�-- 0IRI ��i sso v a,l l c.� �P�-W y � �e�-�rl 0 RECEIVED SEP 01 2015 BY ASSESSOR COPY