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14020116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20955 STEVENS CREEK BLVD CONTRACTOR: 50LAIt-"S PERMITNO: 14020116 OWNER'S NAME: WEISS PAUL E AND BARBARA H TRUSTEE DATE ISSUED:02/25/2014 OWNER'S PHONE: PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL q4S WHOLE FOODS- INSTALL 4 EVC STATIONS LOCATED ON License Class G—� Lic.# i' SIDE OF PARKING LOT 150KW Contractor 5© 1 tx r v`-,5 (3-r Date ' T 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$70000 ave 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:32631022.00 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 and state laws relating WITHIN Igo -fi-9F 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 I D 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 p y 71SSUd by: a e: with all non-point rce re"dations per the Cupertino Municipal Coide,Section 9.18. _7 I; -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. ❑ O i EJ BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contraetor'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. 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(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,See ' ns 25 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this ,, penmit is issued. Owner or authorized agent: Dat 1 certify that in the performance of the work for which this permit is issued,1 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 .l 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 1 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 ALTERNATIVE ENERGY PERMIT APPLICATION V__ COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION AuA 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 nQ\1 11 MAN r CUPERTINO (408) 777-3228• FAX (408)777-3333• buildingancupertino.org b// PROJECT ADDRESS j��L^ , t C^L.� M`VD. APN k n 3/ OWN'ERNAME o I�� PHONErI f 3,, 717 3 7 E-MAIL STREET ADDRESS C/ CITY, STATE`,ZIP! FAX CONTACT NAME 5ft7vt S- A-T ,�N O� PHONE E-MAIL STREET ADDRESS CITY.STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (::.a n LICEIJSE NUMBER 06'a-ys LICENSEC E ��T• BUS.LIC k C - 1_0 COMPANY NAME - c ^O� I E-MAIL ` ` FAX vtJ ` SN04JOPnr�SoS�Wi�'� STREET4DDRESS �� `Qo1AS A CtV� CjlY,STA E ZIP PHONE ARCHITECT/ENGWEER NAME LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No ❑ SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FDR SO1.IR PANELS: NUMBER OF PANELS/UNITS: k KILOWATTS: 15 D 14tt; TOTAL VALUATI7O ^WW� n ^ DESCRIPTION OF WORK �o�� C?LC2'Cn.l� � �-{•1C(..�' Ct�pRCi)N S7'�'I1or�.1�. o rim ��wruRc 'Dc FC RECEIVED BY: By my signature below,I certify to each ofthe following: I am the property owner or authorized agent to act on the property owner' ehalf I have read this application and the information 1 have provided is co ect, 1 have read the Description of Work and verify it is accurate. I agree to om with all applicable local ordinances and state laws relating to buil g cons)io uthoriz epresentatives of Cupertino to enter the above-identified e ty for inspection purposes. Signature of Applicant/Agent: Vv 4 ---� Date: .. SUPPLJEN L INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER G r E ❑ EXPRESS U ❑ STANDARD d' E01 LARGE m . 0 MAJOR PVApp_2012.doc revised 06/20/12 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20955 STEVENS CREEK BLVD DATE: 02/26/2014 REVIEWED BY: COUNTER APN: BP#: 14020116 'VALUATION: 1$70,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: SOLAR COM WORK INSTALL 4 EVC STATIONS FOR WHOLE FOODS LOCATED ON SIDE OF PARKING LOT 150 KW SCOPE NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Efl.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F___47 # Alternative Energy System Suppl, PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 $424.00 1CHRGSTA EV Charging Station PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. Q OT 10.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ldfmnrstr,ftilr i rr Q Work Without Permit? 0 Yes (j) No $0.00 ) Advanced Plannin Fee: $0.00 Select a Non-Residential Building or Structure i Strong Motion Fee: 113SE1SMICO $14.70 Select an Administrative Item BldgStds Commission Fee: 1BCl3SC $3.00 SUBTOTALS: $17.70 $424.00 TOTAL FEE: $441.70 Revised: 01/15/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ?-0415.5- 57C-13 PERMIT# ` D Z Ol 16 OWNER'S NAME: /fVL. e—rl Ste' PHONE# Yl�5-- 3 D 3,-- 3�L GENERAL CONTRACTOR: oL1t7Z S (�Plf BUSINESS LICENSE# ADDRESS: Sq-o(:, uL3A Avt CITY/ZIPCODE: tkN,,6, k•,+ fat. 12M-1 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) 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: V 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 Ilk LL----- 2,.-)-�r I Ow r/ ntractor Signature Date BIGGS CAROOSA ASSOCIATES INC STRUCTURAL ENGINEERS BB5 The Alameda DU RECEIVED ECEIV r�F-y San Jose, CA 95 9 2B-3133 i�SF��' Telephone 408-296-5515 Facsimile 406-296-81 14 APR 6 2��4 April 11, 2014 2014096 MJR Electric, Inc. 3Y P.O. Box 668 Morgan Hill, CA 95038 Attention: Mr. Michael Rauschnot Subject: Special Inspections and Materials Testing—Final Report Whole Foods—eVgo Installation 20955 Stevens Creek Boulevard Cupertino, CA Permit No. 14020116 Gentlemen: In accordance with Section 1704.2 of the California Building Code and as specified in the structural contract drawings, Biggs Cardosa Associates, Inc. has performed the following special inspections. Expansion anchor installation and testing The completed inspections were performed under the supervision of the undersigned Registered Engineer. Based both upon inspections performed and our substantiating reports, it is our professional judgement that, to the best of our knowledge,the inspected work was performed in accordance with the applicable workmanship provisions of the California Building Code and the approved plans and specifications. Should you have any questions, please do not hesitate to call. Sincerely, Qq(f ESSIONq� BIGGS CARDOSA �� F CA,Q� F ASSOCIATES, INC. LQ No. S2279 Mark A. Cardosa * Exp. 3/31/16 Vice PresidentSTRUCTVRP��P OF cc: Building Division, City of Cupertino M12014\096\Insp\Sp Insp Final Ur Whole Foods eVgo.doc BIGGB BA A SOCA ESOINC CEIVED STRUCTURAL ENGINEERS (0 APR APR 16 2014 JOB #. /�D 865 The Alameda Page IOf I San Jose, CA 95126-3133 Telephone 408-296-5515 BY Facsimile 408-296-81 14 SPECIAL INSPECTION DAILY REPORT Project Name: W bc.E-I�00oJ - E✓&o Date: /o, Zo Project Address: Z04 of al&FN r CeER I?Voo Time Arrived: C4 Time Departed: Location of Inspection: l B Jrr— Inspections made: 1AW4t,G1fr,o,V 00E -1/8 t4S ff&ri ND_Tt- 4rw dt4=4-0t tA+� Cs► f. ' veQ�r-A-n ver# CJF PM R VA f rr v"'r iAAr4tTZ1Z ]"Jy t � ?�FlG c..BJ !�7e /Yl•4n/y� Samples Taken: Items Complete: _AA4iF/ Al h A90r ��l—31 'ViAOrT� Deficiencies/Items Pending: Comments: A/yC,dZ To the best of my knowledge, the work completed or in progress for this report was done in general conformance with the intent of the approved design documents and specifications and applicable workmanship provisions of the C.B.C. except as noted above. INSPECTOR: '`