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14120010CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19925 STEVENS CREEK BLVD CONTRACTOR: SPRIG ELECTRIC PERMIT NO: 14120010 OWNER'S NAME: STEVENS CREEK INVRS LLC 1860 S 10TH ST DATE ISSUED: 01/15/2015 OWNER'S PHONE: 4084990223 SAN JOSE, CA 95112 PHONE NO: (408)298-3134 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ Z APPLE - T. 1. FOR ADD 7 (N) EV CHARGERS 7.2 KW License Class _ Li... # REVISION #1 CIVIL PLANS FOR RESTRIPPING (E) C %Date L� Contractorf I hereby affirm that I ad licensed under the provision 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: $115000 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: 31621089.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS IT 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 INSPE ON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the _ FR�TLLED granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. % J —%ate SignatureTA-1"'7 -" 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) 1, 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, 25533, and 25534. I 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(a) 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, Sectio s 5505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: a. 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, 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19925 STEVENS CREEK BLVD CONTRACTOR: SPRIG ELECTRIC PERMIT NO: 14120010 OWNER'S NAME: STEVENS CREEK INVRS LLC 1860 S 10TH ST DATE ISSUED: 01/15/2015 OWNER'S PHONE: 4084990223 SAN .IOSE, CA 95112 PHONE NO: (408)298-3134 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] APPLE - T. I. FOR ADD 7 (N) EV CHARGERS "7 Ko G t o �Q License Class Lic.# ,L Contractor c Date 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: $115000 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: 31621089.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 DA 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 FHrST 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: ' ! S • / J with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. G� 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 MATERI.ALS 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 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(a) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 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, Sec 'o s 25505, 25533, and 25534. 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 l 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 CONTRACTOR / SUBCONTRACTOR 11ST Building Department CritV Of'Cuhcrtino I ()300 Torre Avenue Cupertino. ('A 95014-3255 Telephone: 408-777-3?? t1' t:ax: 08-777-3333 JOB A17DR13'ss:__ OWNER'S NMOL,: NJOuf�:� ((QLE �N [ RAC' OR �� BtJSINESS LICENSF' _ v L _e !E�-T`t __________ _._._ -- %1f)f.)[ZI�SS: / X60 ..._S Lt7�• � S I 1 Z *Our municipal code requires all businesses working in the city to have a City or Cupertino business license. NO RL11,I)ING FINAL OR FINAL 0(' _LjMN('Y INSPECTION(S) WILL BE SCI-ItAXiLED L'ti'l'll, THE GENERAL CON't'RAC OR AND ALL SUBCONTRACTORS A(:'I'ORS HAVE ()I3'rAINED :A CIT ()F CL!PE.RTINO BUSINESS l..l(_:ii;NSE. I am not using any subcontractors: ------------------------ --- __--- — signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAi1� E BUSINESS IACE'NSE tt I Cabinets & Millwork � Cement F1111shin" Eleetrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Gass / Glazing _ -- Heating Insulation Landscaping j Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet IA'ietal Sheet Rock The -------------- 3 lZ b l S _. ___ _-_----- —-------- Orin / t� acto � gnature 1)a e CITY OF CUPERTINO FF -M-7 FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 19925 scb DATE: 03/0212015 REVIEWED BY: Mendez MISC ITEMS APN: BP#: EVALUATION: 1$19,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 GENRES PERMIT TYPE: WORK revision #1 civil plans for restri in a accessible stalls SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ otr_ 1_ Thoco foot aro hacod an tho nroliminary infnrmatinn availahle and aro nnly an owimalo. Contart the Dont fnr addn'1 info. FEE ITEMS wee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 1 hours Plan Check, Hourly $143.00 ISTPrNcx Suppl. PC Fee: Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Select a Non -Residential Building or Structure 0 Work Without Permit? Yes 0 No $0.00 Advanced Planning Fee; $0.00 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: 1BSEISMICR $2.47 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $3.47 $143.00 TOTAL FEE: 1 $146.47 Revised: 02/14/2015 CUPERTINO CONSTRUCTION PERMIT ����"INXL� COMMUNITY DEVELOPMENT DEPARTMENT • BU 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-)cupertino.or4 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI 97 REVISION / DEFERRED ORIGINAL PERMIT # Jt�/ z✓ PROJECT ADDRESS (jl v "I APN # OVJNERNAME PHONE E-MAIL STREETADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREETADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWN'ERAGEN'T ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME,^ �� FAX LICENSE NUA4BER LICENSE TYPE BUS. LIC k 1 ! COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORKCA V r I ` EXISTING USE PROPOSED USE CONSTR. 7.YPE ISTORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH k DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED Y TOTAL VALUATION: PLAWNGAPPLN ❑NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO -WO aninas,. 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 it is accurate. I agree to comply with all applicable local ordinances and state laws relatinAt9obuilding constructio I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ^ Date: 3/5/1 SUPPLEMENTAL INFORMATION REQUIRED PLANT cHEclz> iionTiNcs%Ir `ovsRTH>rCOIJ`rER BIJIIDINCPLANRE\SE1v £ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition is required to issuance of building permit prior permit for new building. ❑ EJ�PRESS s L7 PLAA �rnGPLA1\ R&VIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srA1,vARD a ❑ r17BI IcwoRKs forth if any Hazardous Materials are being used as part of this project. , ❑ i ; ❑ BIItE LARGE, x REPT � _ Copy of Planning Approval Letter or Meeting with Planning prior to 0 ❑ SAI�ITARYSEq'ERDiSTRICT -. submittal of 3uilding Permit application.„ 11fAJOR 3 . ❑ ";ENVIRON'TIENTAL'FiEALTA ;_ BldgApp_2011.doc revised 06121/11 CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION �v �O COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ` (408) 777-3228 • FAX (408) 777-3333 • building(o1cuperino.orq ` AE PROJECT ADDRESS "') C PN k I,6 - -z-I O� OWNERNAME . f� �PHONE,07 �( E-M,�IL -�' STREET .ADDRESS I �. TC -7 f, V CITY, ST E IP FAX CONTACT NAME/� PHONE /'�7 7�D E-MAIL v,a kP e f STREETADDRESS I jr\[O � (' ) CITY, STATE, ZIP (� A-V S<(A ` FAX El OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ,CONTRACTOR 1:1 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I I � �+ LICENSE NUMBER � LICENSE TYPE BUS. LIC # COMPANY NAME O E-MAILA ' �_1..9 r l "���C FAX STREET ADDRESS CITY, STATE, ZIP PHONE 1 o O ARCHITECT/ENGINEER NAME't'= j A r e '1T�''l(1-` � ENSE NUMBER BUS. LIC # COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑]S,FD Or Duplex ❑ Multi -Family STRUCTURE: L`l�-Ommercia] PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes [INO 7 PROJECT IN FLOOD ZONE El ❑ NO ❑ SOLAR PANELS �k LECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATI0 (p ` DESCRIPTION OF WORK �i I By my signature below, I certify to each of the following: I am the property owner or authorized agent to ac on th property er's alf I have read this application and the information I ave provided is correct. I have read the Description of Work and verify it is accurate. I a comply with all applicable local ordinances and state laws relatin `building construction. I authorize representatives of Cu ert o -to enter th a ve-identified pro[:4 for inspection purposes. Signature of Applicant/Agent: Date: 2� �: SUPPLEMENTAL INFORMATION REQUIRED s',oFcEUSE ONLY OVER-THE-COUNTER � ' ❑ STANDARD,; U Z ` Q LARGE MAJOR - PVApp_2011.doc revised 03/16/11 ii V CITY OF CUPERTINO FM -7, FEE ESTIMATOR - BUILDING DIVISION iaADDRESS: 19925 STEVENS CREEK BLVD DATE: 12/02/2014 REVIEWED BY: MELISSA APN: 316 21 089 BP#:`VALUATION: 1$115,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building =# $763.00 PENTAMATION PERMIT TYPE: SOLAR -COMM WORK APPLE - T. I. FOR ADD 7 N EV CHARGERS SCOPE hrs 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 only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fce Resolution 11-053E— tT'1,13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $763.00 Alternative Energy System ICHRGSTA7 EV Charging Station Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? © Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) Strom Motion Fee: IBSEISMICO $32.20 Select an Administrative ]tem Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $37.201 $763.00 TOTAL FEE: $800.20 Revised: 10/01/2014