12120052CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10201 BUBB RD
CONTRACTOR: CUADRA CONSTRUCTION
PERMIT NO: 12120052
OWNER'S NAME: BUBB PARTNERS
3200 OSGOOD CMN
DATE ISSUED: 12/11/2012
OWNER'S PHONE: 4083665000
FREMONT, CA 94539
PHONE NO: (510)353-1260
❑ LICENSED CONTRACTOR'S DECLARATION
r r F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class G10 Lic. N A26S02 -
r
F COMMERCIAL �
Contractor L1SQ-A EI C -1C. Date IZ. 11.7,012-
1•ZO12I
MECH RESIDENTIAL
1hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: INSTALL NEW COMM TRANSFORMER AND PANEL
(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: $9450
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.
APN Number: 35720006.10201
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
accrue against said City in consequence of the
costs, and e7'source
180 DAYS FROM LAST CALLED INSPECTION.
granting of onallplicant understands and will comply
with all non th Cupertino Municipal Code, Section
jregulations�per
9.18•
Issued by//s�i>>
Signature Date 12• ll• 2olZ
❑ OWNER -B LDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined b the Bay Area Air Quality Management District I will
maintain Com rth the Cu tino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Health & ety Code, Sections 255 , 25533, and 25534.
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
O er or author' nt:
become subject to the Worker's Compensation provisions of the Labor Code, I must
Date: 12. ►�. 2012
forthwith comply with such provisions or this permit shall be deemed revoked.
�i TRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of Hork's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. i agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
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
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
MM -0, FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10201 bubb rd.
DATE: 12/11/2012
REVIEWED BY: bobs.
UNITS
APN:
BP#:
'VALUATION: $0
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION 1 REAP8
PERMIT TYPE:
WORK
install new comm transformer and panel
SCOPE
Suppl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plrunh. Plan Check
QTY
UNITS
BP FEES
IELCPLNC Elec. Permit Fee: IEPERMIT
Transformers
1BREMPOWER
Other Elea Insp. 0.0 hrs $45.00
1
#
$167
Services
1 ERT<200
Suppl. Insp Fee
100
Amps
$45
PME Unit Fee:
$212.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: ]ADMIN
$42.00
Work Without Permit? 0 Yes (E) No
$0.00
TOTALS:
$212.00
$45.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etr-). These fees are based on the Dreliminary information available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
rtikch. Plan Check
Plrunh. Plan Check
Elec. Plan Check 1.0 1 hrs $133.00
y710,r. Penin[ Fee:
PhImb. Po -mil Fce:
IELCPLNC Elec. Permit Fee: IEPERMIT
Orher Afech, Insp,
Orber Ph!mh Insp,Li
Other Elea Insp. 0.0 hrs $45.00
,Meth. lnz p. Fee:
Phmmb. hlsp. Fee:
ELL. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etr-). These fees are based on the Dreliminary information available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$133.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$212.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: ]ADMIN
$42.00
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planting Fees:
Travel Documentation Fee: ITRA VDOC
$45.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
L$477.001
$0.001TOTAL FEE:
$ 7.00
Revised: 10/01/2012
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