12110039COV E RS H E ET
12110039-D
10231 BUBB RD
ER rr D•
t_ •.�...
ADDRESS `s.
fc? - 30-- G2
APN# . �� % • ,�;O. OU % RES. OxNG)
(GARAGE)
COMM. SQ. FT. (NEVI T.I. SQ. FT. RES. REMODEL
CONTACT Jo r✓ /1%o fzl � PHONE# 5'DB 7,727 • ,6665 FAX
VALUATION (C st of Project) 7, Soo EMAI • cJ,2�<Zq-r. e- y
NOTES:
READ PAID
CONSTRUCTIONTAX (Y) (N)
SCHOOL FEES (Y) (N)
HOUSINGNMG (Y) (N)
HEARTOFTHE CITY (Y) (N)
ISSUED BY 4�ilc DATE ■■ TOTAL FEES
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10231 BUBB RD I CONTRACT
OC[AT TOR: T. MARSHALL I PERMIT NO: 12110039
OWNER'S NAME: SI 57 LLC 1 7042-B COMMERCE CIR I DATE ISSUED: 12/04/2012 1
OWNER'S PHONE: 4089744876 1 PLEASANTON, CA 94588 1 PHONE NO: (925) 734-9999 1
❑ LLICENSED CONTRACTOR'S DECLARATION
License Classy (/',� O Lic. 4 O o C �'2
Contractor `T �l;_� /LCe-WaTe �fChaptcr!)l
I hereby affirm that I am licensed under the provisions
(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.
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
permit is issued.
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 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date a �0�
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
WEST SIDE OF BLDG-INSTALLATION OF
THREE(3)ELECTRIC
VEHICLE CHARGING STATIONS-40 AMPS EACH
Sq. Ft Floor Area: I Valuation: $7500
APN Number: 35720007.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS M LAST CALLED INSPECTIOON.
Issued by: 4C Date: y �O
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505,2 an 5534.
Owner or authorized agent: Date
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
t24( C)v39
CIJf'Et3'WO
ALTEPNATIVE ENERGY PERMIT APPLICATION
CtiNAWN" DE1qaAXDM9fr DEPARTMENT • BUILDNVfy DlViS1.ON
1M TORRE AVEME • CUPERnNO, CA 95014-3256
(408) 777 3228_ • FAX (40M 77 7-3W- • bW,dytg0gjnedno.txo
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Sign&tum of Appl:W
y owner or audmized agnu to act as the I have mad this
tea he D�xion of Work wW verify a kaocm . E.spam to copy with all spoicable local
preatsataaves of Cupattiao to eater the tried pwpeny forinfpectioa purposes.
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PYApp_'012.dac revised 8612011
CITY OF CUPERTINO
I/1il FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10231 Bubb Road
DATE: 11/07/2012
REVIEWED BY: Sean
APN:
BP#:
'VALUATION:
1$7,500
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
PENTAMATION SOLAR-COMM
I PERMIT TYPE:
WORK
Installation of 3 electric vehicle charging stations.
SCOPE
I'te(A Plan Check
Phunb, Plan Check Dec. Plan (,heck FT
�Lfeclt. Permit Fee:
Phimh Permil Fee. Elec. Perrnil Fee:
Other Afech. Insp.
01her Plumb Insp. Other Elec. Insp.
Rleeh. Insp. Fee:
Plrrmh, hasp. Fe... Elcc. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District.eta). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7111122
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
3 #
$306.00
Alternative Energy System
ICHRGSTA7 EV Charging Station
Suppl. PC Fee: (E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. Q OT
0.0
1 hrs
$0,00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Adininistrative Fee:
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICO
$1.58
Select an Administrative Item
Bldp, Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.58
$306.00
TOTAL FEE:
1 $308.58
Revised: 10/01 /2012