14020048 CITY OF CUPERTINO BUILDING PERMIT j
BUILDING ADDRESS: 10140 N TANTAU AVE CONTRACTOR:SPRIG ELECTRIC PERMIT NO: 14020048
i
OWNER'S NANIE: CUPERTINO GATEWAY PARTNERS LLC 1860 S IOTH ST DATE ISSUED:02/06/2014
OWNER'S PHONE: 6506901660 SAN JOSE,CA 95112 PHONE NO:(408)298-3134
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
��� �� APPLE-INSTALLATION OF(1)NEW PANEL 225 AMP
License Class C 0 Lic.4 ,AND 15 CORD DROPS
Contractor � � i. L Date l y
I hereby affirm that I am licensed under the provisions of Chapter 9
j (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:$12000
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:31619061.10100 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 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 F M CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ^
costs,and expenses w ich may a e gainst said City in consequence of the
granting of this per Add
i' nally he applicant understands and will comply Issued by: Dat
with all non-poin urce r ulatio. per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date Al I roofs shal I 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 I 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
t,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.7044,13usiness&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(x)should I store or handle hazardous
i 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use eq ipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the B Area uality Management District I
performance of the work for which this permit is issued. will maintain compliance with the erti M nicipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 505 5 and 25534. (�
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ' Date:Z '6 7
permit is issued.
i
1 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,1 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 1 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 a
MEP
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COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (�
CUPERTINO (408)777-3228• FAX(408)777-3333•building0kupertino.org MISC
❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 10100 Tantau Ave APN/9 316-s
l q &/
1V`
OWNERNAME Apple P _ �1i1 0
STREET ADDRESS j 10100 Tantau Ave CITY,STATE,ZIP L l.�w FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS '�, CITY,STATE, ZIP FAX
❑01VN•ER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME Sprig Electric LICENSE NUMBER 296728 LICENSETYPEC_10 BUS.LIC# 219724
COMPANY NAME Sprig Electric E-MAIL timd@sprigelectric.com FAX
STREET ADDRESS 1860 S. 10th Street CITY,sTATE,ZIP S.J. CA 95113 PHONE 408-298-3134
I. _
ARCHITECT/ENGIN NAME N/A LICENSE NUMBER BUS.LIC 9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑41J or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME'? ❑ NO
DESCRIPTION OF WORK
Installation of (1) new panel and (15) cord drops
TOTAL VALUATION: $12,000 RECEIVED BY: —� —�
By my signature below,I certify to each of t ollow' g: I the property owner or authorized agent to act on the property owner's behalf. l have read this
application and the information[have ed is rrec have read the Description of Work and verify It is accurate. I agree to comply with all applicable local
PP P P P Y PP
ordinances and state laws relating b ' e g c stru ' n. I authorize representatives of Cupertino to enter the:rb -identified pro erty for inspection purposes.
Signature of Applicant(Ag44 Date:
'�UPPLEMWOAXIL INFORMATION REQUIRED OFFICE USE ONLY
w Cl OVER-THE-COUNTER
a
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F' ❑ EXPRESS
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x
❑ S'T'ANDARD
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❑ MAJOR
MEPMiscApp_201 1.doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10100 Tantau Ave DATE: 02/06/2014 REVIEWED BY: Mendez
APN: BP#: 7 0oZ p� 'VALUATION: 1$12,000
FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY --7Commercial Building PENTAMATION 10EAP2
USE: PERMIT TYPE:
WORK apple- installation of 1 new panel 225 am
SCOPE and (15) cord drops i
i
Elec.Plan Check 0.0 hrs $0.00
r
Elec.Permit Fee: IEPERMIT
Other Elec.Insp. 0.0 hrs L $47.00 I
f
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 prelimina information available and are only an estimate. Contact the De t or addn'l info. "
FEE ITEMS (Fee Resolution 11-053 El: ?1 l/l3) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 225 amps Electrical
Su 1. PC Fee: Re OT 0.0 hrs
pp Q g. Q $0.00 $70.00 IBELECI000 Services i
PME Plan Check: $0.00 15 Electrical
Permit Fee: $0.00 $47.00 ]BREMRECEP Recep/Switch/Outlets
Suppl. Insp. Feer Reg. 0 OT Q.Qhrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Administrative Fee: ]ADMIN $44.00
Work Without Permit? ® Yes ) No $0.00 E)
Advanced_Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure o
i
Stroij�Motion Fee: IBSEISMICO $2.52 Select an Administrative Item
Bldg Stds CommissionFee: ]BCBSC $1.00
SUBTOTALS: $141.52 $117.00 TOTAL FEE: $258.52
Revised: 01/15/2014
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