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14040163 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21979 SAN FERNANDO AVE CONTRACTOR:ELCOR ELECTRIC, PERMIT NO: 14040163 INC. OWNER'S NAME: CITY OF CUPERTINO 3310 BASSETT ST DATE ISSUED:04/23/2014 OWNER'S PHONE: 4087773140 SANTA CLARA, CA 95054 PHONE NO:(408)986-1320 ❑ LICENSED CONTRACTOR'S DECLARATION r F ;- 5-00 Z 2�j BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L—10 Lic.# r— F_ !I MECH RESIDENTIAL COMMERCIAL Contractor FLCO e EtE�—Tr? I C �r Date `I 123/�'/ JOB DESCRIPTION:INSTALL NEW STEP DOWN TRANSFORMER&2 NF,W POOL, I hereby affirm that I am licensed under the provisions of Chapter 9 LIGHTS (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: 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000 JU 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:35710008.00 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 TMcorrect. 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 ` l Date: granting of this permit. Additionally,the applicant understands and will comply Issued by: �� it- with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 23 (`Y 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 I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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). 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(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,Se 'ons 25505,255,34,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Cf Z3 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 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPER'I'INO, CA 95014-3255 MIS GUPERTINO (408)777-3228•FAX(408)777-3333•building(a)cupertino.org %0 IC ❑PLUMBING ❑MECHANICAL ®ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS rQ� APN# 35� — /0 Fernando Avenue "' -- (J OWNER NAME �/�^�/_nN PHONE 3Q� E-MAIL Cit of/Cu ertino — C �/�/ 408-777-�2$ buildin cu ertino.or STREET ADDRESS ! �(Z. �� ITY, STATE,ZIP FAX Cupertino, CA 95014 408-777-3333 CONTACT NAME PHONE E-MAIL Travis Gamble 408-986-1320 3007 t amble elcorelectric.corn STREET ADDRESS CITY,STATE,ZIP FAX 3310 Bassett Street Santa Clara CA 95054 408-986-1324 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR N CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS LIC# Elcor Electric 500228 C-10 24701 COMPANY NAME E-MAIL FAX Blackber Farms/City of Cupertino buildingocupertino .corn 408-777-3333//// STREET ADDRESS CITY,STATE,ZIP PHONE yo 21975 San Fernando Ave/10300 Torre Ave Cupertino, CA 95014 408-777- ARCHITECT,ENGrNEER NAME LICENSE NUMBER BUS LIC ft Travis Gamble 50028 24701 COMPANY NAME E-MAIL FAX Elcor Electric tizamble@elcorelectric.com 408-986-1324 STREET ADDRESS CITY,STATE,ZIP PHONE 3310 Bassett Street Santa Clara CA 95054 408-986-1320 USE OF ❑SEE)or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING a COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME' ® NO DESCRIPTION OF WORK Install N step down transformer and two Npool lights. TOTAL VALUATION 45,j=.00 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 it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build`incons uction. I horize re ese atives of Cupertino to enter the abovee-identified /property for inspection purposes. Signature of Applicant/Agent / Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY pwp OVER-THE-COUNTER E ❑ EXPRESS U s� ❑ STANDARD U < ❑ LARGE a ❑ MAJOR MEPMisc,4pp 2011.doc revised 06-21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21970 San Fernando Ave DATE: 04/23/2014 REVIEWED BY: Sean APN: BP#: Z tfj 01&3 "VALUATION: 1$5,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARY Commercial Building PENTAMATION 10EAP11 USE: PERMIT TYPE: WORK Install N step down transformer and two npool lights. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 2 # $70 Appliances 1ECOMAPP 1 # $47 TOTALS: $117.00 Elec.Plan Check 0.0 1 hrs $0.00 fwzl+ ;'��'rryr� . F'r.,, . i'c; nr`i<<.. Elec.Permit Fee: IEPERMIT ETOther Elec.Insp. 0.0 hrs $47.00 NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District etc. . Theseees are based on the relimin information available and are onlyan estimate. Contact the Det or addn'l info, FEE ITEMS (Fee Resolution 11-053 Eff 7111'13FEE QTY/FEE MISC ITEMS Plat. ( lr'cik k1l(': PME Plan Check: $0.00 PME Unit Fee: $117.00 PME Permit Fee: $47.00 Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (j) No $0.00 Travel Documentation Fee: ITRA VDOC $47.00 i Strong Motion Fee: IBSEISMICO $1.05 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $257.05 $0.00 TOTAL FEE: $257.05 Revised: 04/0112014