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14070039 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: [0351 BUBB RD CONTRACTOR:CUPERTINO ELECTRIC PERMIT NO: 14070039 INC OWNER'S NAME: Sl 39 LLC 1132 N 7TH ST DATE ISSUED:08/08/2014 OWNER'S PHONE: 4084460700 SAN JOSE,CA 95112 PHONE NO:(408)991-1000 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] 73 r L INSTALLATION OF(2)EV CHARGING STATTIONS License Class�i Lic.# 7 � CREATING Contractor Date � (3) STANDARD EV STALLS AND I ACCESSIBLE EV STALL (4)TOTAL 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:$40000 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:35720009.10351 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is PERMIT XPIRES I WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1 DA O PERMIT ISSUA EOR 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 LAS CALLED INSP C ON. indemnify and keep harmless t City ofCupertino against liabilities judgments, costs,and expenses which m crue against said City in consequence of the granting of this ermit. A ti nally,the applicant understands and will comply Issued by: Date: / with all non i ure r lations per the Cupertino Municipal Code,Section 9.18. -,Z-/ RE-ROOFS: Signature ate 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 [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 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) 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 1 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 ea.Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cup no Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S to 5 5,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this pOwner or authorized permit is issued. agent Dat 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,1 must 1 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. 1 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.l 8. Signature Date ALTERNATIVE ENERGY PERMIT APPLICATION is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �� AE CUPERTINO (408)777-3228•FAX(408)777-3333•buildingr=upertlno.org PRor"TADDREss 10351 BUBB ROAD 'P" 357-20-009 OWNER NAME 5139 LLC/THE SOBRATO ORGANIZATION PHONE408.446.0700 E-MAIL MEET ADDRESS 10600 N. DE ANZA BLVD.#200 CITY,STATE,ZIP CUPERTINO, CA 95014 --FCONTACT NAM F.DEMETRI GONZALEZ -100 408.783.5395 E Aa DEIv1ETRl_GONZALEZ@APPLE.COM sTRE"ADDREss1 INFINITE LOOP, MS 47-18-DDC CIKY,srATE,ZIPCUPERTINO, CA 95014 FAx ❑OWNER ❑ OWNER-BUILDER ❑ OwNBR AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 0 TETIA': CONTRACTOR NANI._TBD LICENSE NUMBER j7;;Z--TYPF. H' :.IC N COMPANY NAME E-MAIL STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITFCTIENGiNEERNAMF•.MARK KNUDSEN LICENSE NUMBER 75828 Bus.LIC 0 COMPANYNAMEKIER &WRIGHT E-MAII,MKNUDSEN@KIERWRIGHT.COM FAx408727.5641 STREETADDREss3350 SCOTT BLVD.422 CITY.STATE,ZIP SANTA CLARA, CA 95054 PHONE 408.727.6665 USE OF ❑ SFD or DupleX Vltilti-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: N Commercial URBAN INTERFACE AREA ❑ Yes III No FLOODZONE ❑ Yes x No ❑SOLAR PANELS TM ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER FOR S0JAR P.aNELS: NIIMBER OF PANELS/UNITS: N KILOWATTS: TOTAL V±' ii .$40,000 DESCRIPTION OF WORK INSTALLATION OF NEW ELECTRIC VEHICLE CHARGING STATIONS, STRIPING OF STALLS AND INSTALLATION OF ASSOCIATED SIGNAGE. 3 STANDARD EV STALLS, 1 ADA EV STALL(4 TOTAL)&2 CHARGING STATIONS 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 buildcons�tion. I authorize representatives of Cupertino to enter the above-identified pro Tty for inspection purposes. Signature of ApplicandAgetu ..c�,� e -sa"AP QrjiA '2-174k, Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-TRE-COUNTER a I- ❑ EXPRESS Y U ❑ SI'AN DA RD ❑ LARGE 4 ❑ MAJOR P PApp_20 12.doc revised 06/20/12 CITY OF CUPERTINO FEE ESTIMATOR —BUILDING DIVISION ADDRESS: 10351 BUBB RD DATE: 0711012014 REVIEWED BY: SEAN APN: BP#: D 0 "VALUATION: 1$40,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY Commercial Building PENTAMATION SOLAR-COMM USE: PERMIT TYPE: WORK INSTALLATION OF 2 EV CHARGING STATIONS CREATING 3 STANDARD EV STALLS AND 1 SCOPE ACCESSIBLE EV STALL (4 TOTAL). t;f Aletch. Phu, k J'lumb. Pi"In(,Jio k 'ilech.1'ermit Fee' Plump.Permit 1'e" I~Ic, Pcrmit Fees. Other lfcc11.Irt7). Other Plumh Insp_ Other F.lec, by,,, Neck lisp. Fce: I'ltttnh. Insp. reee, Ele('.Lisp. Fee. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prelimina information available and are on an estimate. Contact the Det or addn't info, FEE ITEMS (Fee Resolulion 11-053 Eff T/,,'/3) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Alternative Energy System Suppl. PC Fee: Q Reg. Q OT Q.0 hrs $0.00 $ 9.00 ICHRGST9 EV Charging Station PME Plan Check: $0.00 14 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1clmitristrufire Fee: O Work Without Permit? © Yes (F) No $0.00 0 Advanced. Planning Fee: $0.00 Select a Non-Residential Ti-arel Doeumenteition.Fees: Building or Structure i Stronk Motion Fee: IBSEISMICO Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 l go SUBTOTALS: $10.40 $109.00 TOTAL FEE: I $1 . Revised: 07/07/2014