B-2017-1539 •
•
CITY OF CUPERTINO BUILDING PERMIT•
BUILDING ADDRESS: ' CONTRACTOR: PERMIT NO:B-2017-1539
19500 VALLCO PKWY CUPERTINO,CA 95014(316 20 999) MASON
CONSTRUCTION INC
DENVER,CO 80206
OWNER'S NAME: (Main Street Cupertino Aggregator LLC) DATE ISSUED: 10/20/2017
OWNER'S PHONE: PHONE NO:(303)907-6774
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#512845
Contractor MASON CONSTRUCTION INC Date 06/30/2019 X BLDG X ELECT _PLUMB
MECH_RESIDENTIAL X COMMERCIAL
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. JOB DESCRIPTION:
MAIN STREET GARAGE-INSTALL(5)TESLA SUPERCHARGER;
I hereby affirm under penalty of perjury one of the following two declarations: (10)TESLA CHARGING POST;(1)QED SWITCH GEAR;UPGRADE
i. I have and will maintain a certificate of consent to self-insure for Worker's (I)UTILITY TRANSFORMER;INSTALL(1)QED I-LINE
Compensation,as provided for by Section 3700 of the Labor Code,for the DISTRIBUTION PANEL AND INSTALLATION OF(5)AUTO
performance of the work for which this permit is issued. TRANSFORMERS
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
permit is issued. Sq.Ft Floor Area: Valuation:$150000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 20.999 A(Tenant Improvements)
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,costs,and expenses which PERMIT EXPIRES IF WORK'IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signet Date Issued by:Kim Dunbar
Date: 10/20/2017 •
OWNER-BUILDER DECLARATION•
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: I All roofs shall be inspected prior to any roofing material being installed.If a roof is
owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
i compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec7044,Business.&Professions Code)
I,ias owner of the property am''exclusively contracting with licensed Signature of Applicant:
;contractors to construct the project(Sec.7044,Business&Professions Code). Date:
I hereby atfirin under.penalty:of perjury;one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
It. 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. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and•will maintain Workers Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
• Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit.is issued: maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
p. 1 certify that'in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall riot employ]any'person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
• Worker's Compensation,laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I becomeisubject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
I Labor Code,I must forthwith comply with such provisions or this permit shall �f
be deemed revoked. i; Owner or authorized agen
APPLICANT CERTIFICATION Date:
I certify that'l have read this application'and state that the above information is I OR I i►LE►D ► EN Y
correct.;I agree to comply with,all city and county ordinances and state laws I hereby affirm that there is:: construction lending agency for the performance
relating to building construction'and hereby authorize representatives of this city of work's for which,this permit is issued(Sec.3097,Civ C.)
'to enter:upOnk the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify;and keep harmless the City of Cupertino against liabilities, •
judgments costs,and expenses'which may accrue against said City in Lender's Address
,consequencelof the'igranting df:this permit. Additionally,the applicant understands
;and will icon'ply'withall non point's,ource regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature • Date • Licensed
Professional
N.•"ink�-• ` ' ALTERNATIVE ENERGY PERMIT APPLICATION �: i".:-.7, f,
_t, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ,
�, r. 10300 TORRE AVENUE••CUPERTINO,CA 95014-3255 ..
CUPERTINO (408)777-3228• FAX•(408)777-3333•buildina(a cupertino.orq
PROJECT ADDRESS 144510 V APN R '
•
•
49409 Stevens Creek Blvd,Cupertino,CA 95014 316 20 999
•
.OWNER NAME -`. PHONE E-MAIL ,
• Mike Rhode 408.777.3081
•
STREET ADDRESS CITY,STATE,ZIP •
FAX
• •
CONTACT NAME PHONE E-MAIL
• Zachary Whitney - • 206.204.7397 • zwhitney@gpdgroup.com •
STREET ADDRESS ' CITY,STATE,ZIP FAX .•
400 N.34th St. Seattle,WA,98103
' • 0 OWNER 0 OWNER-BUILDER OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT '0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME 4�I Cor‘sI L LICENSE NUMBE vz 0 4 S LICENSE TYPE 8 B 0
COMPANY NAME • • - E-MAIL ,/ , // ,// 1 FAX •
,/ nil<e+�0.+0o/l060//TAe r S
STREET ADDRESS CITY,STATE,ZIP PHONE
oo/(I.Co(Qe al3lvol5 / Z genue, CO 80z06 • 303-?0;t. - 64'35/
ARCHITECT/ENGINEER NAME LICENSE NUMBER 'BUS:LIC r •
- Darrin Kotecki 77119 •
' COMPANY NAME E-MAIL • FAX - '
GPD Group ' " gyanda@gpdgroup.com .
STREET ADDRESS CITY,STATE,ZIP • PHONE •
520 S. Main St. • - "Akron, OH,44311 • _ 330.572.3629
USE OF 0 SFD,or Duplex _❑ Multi-Family .PROJECT IN WILDLAND PROJECT IN •
STRUCTURE: 91,Commercial URBAN LNTERFACE AREA 0 Yes C/No •FLOOD ZONE 0 Yes V No
0 SOLAR PANELS ' V ELECTRIC VEHICLE CHARGING STATION _J 0 SOLAR WATER HEATING _ 0 OTHER: — ,
•
151 GM
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: , - KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION:
' DESCRIPTION OF WORK i
, ; Installation of(5)Tesla supercharger cabinets,(10)Tesla charging posts,(1)QED switchgear,
the urgrade of(1)utility transformer,installation-of(1)QED I-Line distribution panel,and installation of(5) ,
auto-transformers. . . .
RECEIVED B' 3 �YQ n y a
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 h is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction.
I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
• Signature of Applicant/Agent: 1__ 0- Date:
SUPPLEMENTAL INF.ORON REQUIRED
„ { ,OFFICE USE ONLY :. . .
'' ❑ O\£R THE COUNTER
1• r- +0 EXPRESS
•
❑ STANDARD
. -
.
❑ LARGE '
.❑ MAJOR ., _
. PPApp_2011.doc revised 03/16/11