13060175 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100 N TANTAU AVE CONTRACTOR:SPRIG ELECTRIC PERMIT NO:13060175
OWNER'S NAME: ROCKTINO FEE LLC 1860 S IOTII ST DATE ISSUED:06/20/2013
OWNER'S PHONE: 6562791180 SAN JOSE,CA 95112 PHONE NO:(408)298-3134
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALD
License Class Lic.# —4 INSTALL 1 (N)UNDERGROUND TELEPHONE BOX FOR
LOW
Contractor Date VOLTAGE CABLES
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:$12500
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: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.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building constructian.and hereby authorize representatives of this city to enter
upon the above menti d pro for inspection purposes. (We)agree to save 18 DAY CALLED INSPECTION.
8 �AY CALLED
indemnify and keep les he ity of Cupertino against liabilities,judgments, -
costs,and,expense ich ay c rue against said City in consequence of the sued by: Date:
Zda
granting of this p t. ditio ly,the applicant understands and will comply
with all non-poi sure regal ions per the Cupertino Municipal Code,Section
9.18.
RE-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.
0 OWNER-BUILDER DECLARATION Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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)
1,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 aCertificate of Consent to self-insure for Worker's material. Additionally,should I use eqMipment or devices which emit hazardous
Compensation,as provided for by,Section 3700 of the Labor Code,for the air contaminants as defined by the Ba rea �uality Management District I
e CA
performance of the work for which this permit is issued. will maintain compliance with the rtin icipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 05 55 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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 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
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CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10100 N TANTAU AVE DATE: 06/20/2013 REVIEWED BY: MELISSA
APN: 316 19 061 BP#: A j1 ( 'VALUATION: 1$12,500 —�
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY Commercial Building =VIERMIT
ENTAMATION
USE: TYPE:
WORK INSTALL 1 N UNDERGROUND TELEPHONE BOX FOR LOW VOLTAGE CABLES
SCOPE
7-77
------
14,,,ch. Plan Che--c,k T(r mb, Plan Cbeech h/ec:_Plan Check
v,ch,[`cera id Fee: Plumb,Termil Fee: glee. ;'emil Feta:
OiLher;Wr.h.InspIED--1- 01her Plumb lnsp> Other Elec.Insp,
0
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District eta . fiheseees are based on the reliminar in ormation available and are onLy an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fe Resolution 11-053 Eff 7/1/12) FEE QTY/V MIS 2 ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl.PC Fee: Q Reg. 0OT 0,0 hes $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes No $0.00
Suppl. Insp.Fee-0 Reg. 0 OT 0,0 hes $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction I ax: Ll
AkhniristrrxtiVe J�ee: 0
Work Without Permit? 0 Yes No $0.00 E)
Advanced Planning Fee: $0.00 hours Inspections E)
D- vel CDocumentafion Fces.- $133.00 ISTINSP Inspection,Hourly 0�
Strong;Motion Fee: IBSEISWCO $2.63 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
TQT
LS; $3.63 $133,00 � L �: $336.63
Revised: 04/29/2013