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13050057I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10050 N WOLFE RD I CONTRACTOR I PERMIT NO: 13050057 OWNER'S NAME: I&G DIRECT REAL ESTATE 27 LP /17 /9.r,,, / / L /, wI. r/( DATE ISSUED: 05/07/2013 OWNER'S PHONE: 4089828433 1 1 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS License Class Lic. # `� `� SUITE- 276-290- INSTALL NEW ELECTRICAL PANEL, 46 ®7 CIRCUITS Contractor Date I hereb 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. 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. 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 sou5e6egulations eY the Cupertino Municipal Code, Section 9.18. Signature Date 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 Sq. Ft Floor Area: I Valuation: $7500 APN Number: 31620086.10050 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WIT 18fDAYS OF PERMIT ISSUANCE OR 180 DA S LAST CALLED INSP CTION. Issued by: Date: 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, SeUio 05, 25533, an/ 534. Owner or authorized agent: d' Date: CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I 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 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. Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Date CITY OF CUPERTINO ti lt1U5_V FFF FSTIMATOR — BUILDING DIVISION ADDRESSN Wolfe Rd DATE: 05/07/2013 REVIEWED BY: Mendez APN: BP#: �,! 6) 0 *VALUATION: 1$7,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingPENTAMATION USE: 10EAP2 PERMIT TYPE: WORK I install new electrical panel, power poles SCOPE Xlcch, Plan Check Plumb. Plug Cheek Elec. Plan Check 0.0 1 hrs $0.00 A,kch, permit Fee: phimb. Permit Fee: Elec. Permit Fee: ]EPERMIT Other Alech. hup.Li Other phnnb hist,. Other Elec. Insp. 0.0 hrs $45.00 Alech. Insp, Fee: Ptranb. Insp. Fee. Elec, Insp, Fce: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, *'ire, sanitary sewer District, Smoot M: 4_* nIn 1 71-4 f oc nro hncod not fho nrolimi"ary ininrntation available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resohition 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = amps $45.00 Electrical IBELEC200 Services Suppl. PC Fee:- Q Reg. Q OT FO.0 hrs $0.00 PME Plan Check: $0.00 46 $149.00 Electrical IBREMRECEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 CO77S10IM017 KII. F-1 Administrative Fee: IADMIN $42.00 0 G Work Without Permit? © Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) ®'A Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICO $1.58 Select an Administrative Item. Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $134.58 $194.00 TOTAL FEE: $328.58 Revised: 04/29/2013