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13030067CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR: DORMAN ELECTRIC, INC PERMIT NO: 13030067 OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 2261 FAIRVALLEY CT DATE ISSUED: 03/(3/2013 OWNER'S PHONE: 4086602825 SAN JOSE, CA 95125 PHONE NO: (408) 266-0469 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class -'/0 Lic. # 9 3 2�f INSTALL 14 (N) OUTLET RECEPTACLES IN IST FLR . OFFICE AREA & LOBBY. INSTALL CORD DROPS IN Contractor0/L`%t 1�1 Date/ - SERVER I hereby affirm that I am licensed under the provisions of Chapter 9 ROOM. INSTALL (N) 50AMP SUB PANEL (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: $10000 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 APN Number: 36901028.00 Occupancy Type: permit 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 state laws relating to building construction, and hereby authorize representes o this city to enter WITHIN 180 D ERMIT ISSUANCE OR upon the above mentioned property for ' p tion poses. e) agree to save 180 DAY OM ALLED INSPECTION. indemnify and keep har less the C' of C pert against abilities, judgments,'° id alle ae int cant u'tyerstands and w llocom I g g pY, comply granting g of thissts, and per w Aiguyla'lio Issu v with all non poin r p Cupe no Municipal Code, Section „ 9.18...""", r° � ? - �3 RE -ROOFS: Signature Date 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 -BUILDER 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 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533and 25534. 11 I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Chap 9.1 and the declarations: Health & Safety Code, Section 25532(a) should or r han a haz dons I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use a uipm or vices ich a it hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Air unli ana ent District I performance of the work for which this permit is issued. will maintain compliance with the ino ni ' od hapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Secti 2 O5, 2 33 55 l Section 3700 of the Labor Code, for the performance of the work for which this � � f 3 -� / permit is issued. Owner or authorized agent: Date: 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 CONSTRUCTION LENDING 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 of 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. l 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, ARCHITECT'S DECLARATION 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 CU'ERTINO CONSTRUCTION PERMIT APPLICATION Q� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(a)cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECTADDRESS Yo C, APN# a O ER ME &MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME / PHONEl�� ✓J p 0 (3 E MA `–C�� ST ET DD 2� I �>c�c€� C Y, STATE, ZIP / Esc Sits F 95 �O 7G ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHRECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONT&ACTQR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # l / COMPA AME �� C Ji _MAIL FAX STREET ADDRESS 2 2-6 1 � C. CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC q COMPANY NAME E-MAIL FAX STREET ADDRESS G�7 _JJ/„ CITY, STATE, ZIP PHONE DESCRIPTION OF WORK— /�e )C IC 1 / 6� 1771 l/� �J �/v y/l�ii�C ! 6 /73 t NY 5' Lo C' Aw J oF�iu�'/ /�srr►��11P2b z. . tbp,.oPS �,j r St1724/11,TL o� . �.cl S 0a C 7e�A V g'd 1.5Ji9j0,4A1UZ 7a GJC ,ST. /,/C- a"il EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE I TYPE OCC. SQ.FC. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJ DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND ST YES BEING ADDED? ❑ NO ADDITIO y ❑ PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF Is .'ESLD ❑YE9' D TOTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LER CHLERI Q„ '""""'"'""'"""_ /Q ���„ 17 By my signature below, I certify to each of the oW, la e wner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provid et. escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build c"' c ' ho re Ives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFOtIAT17 REQUIRED PLAN CHECKTYPE ROUTING SLIP OVER-THE-COUNTER UILDING PIAN 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 Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLICWORKS farm if any Hazardous Materials are being used as part of this project. M LARGE ,1FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR ``❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FM -7 FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE 20400 STEVENS CREEK BLVD DATE: 03/13/2013 REVIEWED BY: MELISSA I'laADDRESS: APN: 369 01 028 BP#: *VALUATION: $10,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: # PENTAMATION 10EAP1 i PERMIT TYPE: WORK REPLACE 15 E PARABOLIC LIGHT FIXTURES WITH DIRECT/INDIRECT LIGHT FIXTURES. SCOPE INSTALL 14 (N) OUTLET RECEPTACLES IN 1ST FLR OFFICE AREA & LOBBY. INSTALL CORD APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 15 # $67 Recep/Switch/Outlets 1BREMRECEP ./1spFee 14 # $45 Services 1BELEC200 PME Permit Fee: 50 Amps $45 Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: 1TRAVDOC $157.00 Strong, Motion Fee: IBSEISMICO I,'e?-�ur1 l'<�r: 0(1vvv t(',-rh. /o yp 14, l,. In /1, P"(' ' Phonh. C"/(m t '/we / /'lnrrth. CTer 7itt f'� e ("114w�'� 11mol) !wisp. Elec. Plan Check 10.0 1 hrs $0.001 Elec. Permit Fee: IEPERMIT Other Elec. Insp.1.0 hrs $45.00 Elec. Insp. Fee: IELECINSP $133.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ etc )_ Thovo fees are hated an the nrelindnary information availahle and are only an estimate. Contact the Dent for addh 7 info. FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Cdrcc4 /r cc. ��t� lrle PC Fee PME Plan Check: $0.00 ./1spFee PME Unit Fee: $157.00 PME Permit Fee: $178.00 C(Jn swiX i,io's Tf7X Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: 1TRAVDOC $45.00 Strong, Motion Fee: IBSEISMICO $2.10 Select an Administrative Item BldgStds Commission Fee: IBCBSC $1.00 ,. S $425.10 $0.00 ` T©TAL FEET; $425.10 Revised: 01/01/2013 �y CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: -.�-ae(ao ;�'- r. 1 PERMIT # l zj o 3 o o 4 7 OWNER'S DAME: 6�00,=-AT7AJp PHONE # 1K05--5-9'5(-0t3-2-- f»f-�'5(•OI -2— GENERAL GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: Z ,m CIT CODE: ¢-. 9% Z *Our municipal code requires all businesses working NO BUILDING FINAL OR FINAL 01 GENERAL CONTRACTOR AND ALL BUSINESS LICENSE. I am not using any subcontractors: city to Signature a�ity of Cupertino business license. 0) WILL BE SCHEDULED UNTIL THE ,VE OBTAINED A CITY OF CUPERTINO Please check applicable subcontractors and complete the following information: 3-13-1 Date s/ 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 f Roofing Septic Tank Sheet Metal Sheet k` Tile ner ,contractor 9iipature 3 -13-13 Date