13090019CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6 RESULTS WAY
CONTRACTOR: REDWOOD ELECTRIC
PERMIT NO: 13090019
GROUP INC
OWNER'S NAME: ECI TWO RESULTS LLC
2775 NORTHWESTERN PKWY
DATE ISSUED: 09/05/2013
OWNER'S PHONE: 4089745662
SANTA CLARA, CA 95051
PHONE NO: 6503695555
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C-16 Lic.11 ��
INSTALL 5 (N) BOLLARD MOUNTED EV CHARGING
Contractor [e4 fi�_ate
STATIONS
TO B6 GARAGE TO BE POWERED FROM (N) 400 AMP
I hereby affirm that I am licensed under the provisions of Chapter 9
PANEL
(commencing with Section 7000) of Division 3 of the Business & Professions
(P12) W/(N) TRANSFORMERS (T12)J'
Code and that my license is in full force and effect.
"7
K�
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: $83000
performance of the work for which this permit is issued.
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
APN Number: 35720041.6
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 and state laws relating
WITHIN 180 DAYS OF P T 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 ST ED 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
I
granting of this permit. Additionally, the applicant understands and will comply
ed Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. 1
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, 1 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,
wil I 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
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. I will
1 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
1 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, S tions 25505 3, i d 25
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date•
permit is issued.
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. 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
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION (�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 V
(408) 777-3228 • FAX (408) 777-3333 • building(abcupetno.org
PROTECT ADDRESS� v
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ADEVELOPER ❑ TENANT
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USE OF ❑ SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE: ❑ Commercial
URBAN INTERFACE AREA [IYes 0
FLOOD ZONE E-1YesNO
❑ SOLAR PANELS
ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FDR SOLAR PANELS: NUMBER OF PANELS/UNITS: N KILOWATTS:
TOTAL VAL ION
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DESCRIPTION OF WORK
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LVED
By my signature below, I certify to each of the following: I am the property owner or authorized agent t n t e pro rty alf. I have read this
application and the information I have provided is correct. 1 have read the Description of Work and v it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cor{str 1 autho i repr a{'ves of Cupertin o enter the above -i entifie property for inspection purposes.
Signature of Applicant/Agent: Date: S
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
OVER-THE-COUNTER
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PVApp_2012.doc revised 06/20112
CITY OF CUPERTINO
FM_71 FEE ESTIMATOR - BUILDING DIVISION
1AADDRESS:
6 RESULTS WAY
DATE: 09/05/2013
REVIEWED BY: MELISSA
APN: 357 20 041
BP#: 3
'VALUATION: 1$83,000
%PERMIT TYPE: Building Permit
PLAN CHECk TYPE: Alteration / Addition / Repair
PRIMARY Commercial BuildingT
USE:
O, 07
PENTAMATION SOLAR -COMM
PERMIT TYPE:
WORK
INSTALL 5 N BOLLARD MOUNTED EV CHARGING STATIONS TO B6 GARAGE TO BE
SCOPE
POWERED FROM (N) 400 AMP PANEL (P12) W/(N) TRANSFORMERS (T12)
LR", /1. Plan, ('/w(k
k
l frr'/I I "! rrrz ; I 7-,,,:
0"bh r W c'2. h/v"
1'lzrorrh, I'/(/ a l_`h(� ch
t'hozI/' I`"i rna F, v.
Odw'-I'Iunzlz h"3p
Elec. Plan Check 10.0 1 hrs $0.001
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 1 0.0 1 hrs $47.00
C he( fw'p /" v
NOTE: This estimate does not inelude fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt otr 1 Thoco fooc aro hacod nn tho nroliminary infarmntian nvailahlo and tyro nnly an octimala_ Cnntart tho Dont for advIn'l info_
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$530.00
Alternative Energy System
ICHRGSTA EV Charging Station
Suppl. PC Fee: Q Reg. Q OT
O, 07
hrs
$0.00
PME Plan Check:
$0.00
F 1
$174.00
Electrical
IBREMPOWER Transformers
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
0.0
1 hrs
$0.00
400 amps Electrical \a
$70.00 IBELEC1000 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
f.on"ri'f' Icnoan a.l:
T7
Administrative Fee: 1ADMIN
$44.00
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Pla.nninp Fee:$0.00
Select a Non -Residential
Building or Structure
0
Travel Documentation Fee: ITRA VDOC
$47.00
Strong Motion Fee: IBSEISWCO
$17.43
Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC
$4.00
[TI#TtTAL;:=
$159.43
$774.00
; TOTAL FEE:
$933.43
Revised: 07/01/2013
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: C Kks-0
SUBCONTRACTOR
PERMIT # Q
OO
OWNER'SNAME: ' L'
Cabinets & Millwork
PHONE # O ,
.,. . A.
GENERAL CONTRACTOR:
&, 1n< -ti
BUSINESS LICENSE #
. lI e) g
ADDRESS:,a'7 " t
Electrical
CITY/ZIPCODE:
0
*Our municipal code requires all businesses working the city to have a City of Cupertino business tic A se.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) 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
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
Date