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14020005CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: MAIN STREET CUPERTINO CONTRACTOR: REDWOOD ELECTRIC PERMIT NO: 14020005 GROUP INC OWNER'S NAME: 500 FORBES LLC 2775 NORTHWESTERN PKWY DATE ISSUED: 02/03/2014 OWNER'S PHONE: 4085936605 SANTA CLARA, CA 95051 PHONE NO: 6503695555 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATION MAIN ST- INSTALL TEMP POWER �\� 4�� REV # 1 - EXPAND TEMPORARY POWER - ISSUED 5/5/14 License Classn Lic. # _ \� Contractor Yt('c-►�w�C E1Cl,�tl C`l�GttD Date 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 Valuation: $100000 performance of the work for which this permit is issued. Sq. Ft Floor Area: I have and will maintain Worker's Compensation Insurance, as providedifor by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31620079.00 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 T ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save 180 DAYS A ED INSPECTION upon indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ed b a e: -� granting of this permit. Additionally, the applicant understands and will com with all n -p t sou a regula 'o s er the upertino Municipal Code, Sec ion 9.18. Signature Date RE -ROOFS: All roofs shall be inspecte 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 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 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 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 1 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(x) should I store or handle hazardous I 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 AA' Quality Management District I air contaminants as defined by the Ba�eririca icip Code,Chapter 9.12 and performance of the work for which this permit is issued. will maintain compliance wi t e C the Health & SafetyCode, S ti ns 2 05, 3, a 34. 1 have and will maintain Worker's Compensation Insurance, as provided for by for this Section 3700 of the Labor Code, for the performance of the work which 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: MAIN STREET CUPERTINO CONTRACTOR: REDWOOD ELECTRIC PERMIT NO: 14020005 GROUP INC OWNER'S NAME: 500 FORBES LLC 2775 NORTHWESTERN PKWY DATE ISSUED: 02/03/2014 OWNER'S PHONE: 4085936605 SANTA CLARA, CA 95051 PHONE NO: 6503695555 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL LJ License Class C --,V Lic. ## 3��y3� MAIN ST- INSTALL TEMP POWER , 1 ` Contractor u*QD\\G\eLoL \'1tWP Date 2 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: $100000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31620079.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY RMIT ISSUANCE OR 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 LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by; Date: v2 granting of thi permit. ddition ly applicant understands and will comply with all non-po t sour regulat' s pet rtino Municipal Code, Section RE -ROOFS: 9.18. Q Signature Date 2 J 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 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 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 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. 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 I 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 Area it Quality Management District I performance of the work for which this permit is issued. will maintain compliance wi a pert' u i 1 Code, Chapter 9.12 and 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 the Health &Safety Code, S ct ns 5505 533 5534. Date: Z Owner or authorized agent: 0� 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION t 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \ 1 (408) 777-3223 - FAX (408) 777-3333 • bulldino0cupertino.orq v ❑ PLUMBING F1 MECH.XN1CAL IRrELECTRICAL n MISCELLANEOUS PROJECT ADDRESSA \� fx_� _� e` \� V,) (:) APN q OWNERNAMb�Q U`� U W PHONE l 7 �Jl�� 1�1 E-MAIL SfRIFT ADDRESS CITY, STATE, 21 P 7 FAX CONTACT NAME {� 1_ k1,IkVV10, PHONE 1 E MAU STREET ADDRESS CrrY, STATE, ZIP FAX ,q OWNER ❑ OWNER-BLJQAER ❑ OWNERAGENr ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARC{MCT ❑ ENGWEER ❑ DEVELOPER ❑ TFNANT CONTRACTORNAMER A \�� 1V \ LICENSENIJMBER �1(�I122 v 1 7 J LiCENSETYPE (__j0 BUS.LIC M 2�1jDb V L/ COMPANY NAME R wood E-MAIL v\nca5�ci10 ��.�oode .0 Ppb STREET ADDRESS 1,11-5 r ` �W CITY, STATE, ZIP t GL ��.705 1 PHO ��� • V Z� ARCHnECT/EW0INEPR WAKE LICENSE NUMBER BUS. LIC iF COMPANY NAME B -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE US5 OF ❑ SFD arDLPL X ❑ MULTLEAMIL.Y BUCLDINQ ❑COMMKIAL PROJECT LN WILDLAND Cl YES U"ANDMAPACEA r--\ ❑ NO PRWECr W ❑ YES FLOOD ZONE ❑ NO IS 17HE BLDG AN ❑ YES EICHLERHOME1 ❑ NO DESCRIPTION OF WORK � 5 \ O \ � � 7O TOTAL VALUATION: By my signature below, I certify to each f the fol wing: I am roperry owner or suthorize agent to act on the pro owner's beha]f. I have recd this application and the information I ve vided i orrect. I av r th De tion of Work and verify it is accurate, I agree to comply with all applicable local ordinances and state laws relaring bu' g n tion. ut of s of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent. Date: SUPMNENTALINFORMATION REQUTit D_ �• � � � �" I� ' ovER. il'Co'OtilrLt�.' 9 Ivi �';1',. ❑l � ss: ,z aAxAl` r ❑ . MAJOR. WP.WiscApp_1011.doe revised 06/21/11 CUPSRTINO n GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinc(5cuoertino.org �O MISC1 r7. .,-....,', 1 71 =T Er9-DTrAT nMT.SC'F.LLANEOUS LJ IViLl.ilt1.tNll.rw u -G�- -- LAnJ PIn,LuNib i PRO.TECr ADDRESS % , 1- APN # %l Cf .2� 01 OWhTERNAISP PHONE E-MAIL W STREET ADDRESS ,"'` G e'10 50-A1.► IN %k' 1 rle CITY, STATE, ZIP . I FAX - G Aows COI ITACf NAME ; �n \ \�o PHONE �-n / (� �a �1 S0 . y$ Z2 vv�MAM \� `CA t owe 7L. I ' 5 DRESS V\ Nom+ CITY, STATE, �J0.v� CGR P FAX ❑ OV.'1.'ER -❑ OWNER -BUILDER ❑ OIAWERAGEI.T K CONTRACTOR ❑ CONPRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACPORNAME (� A* Goya V `WOOA LICA, FR , LICENSE `E BUS. LIC# COMPANY NAME' C-'` C C� �l e FAX STREET ADDRESS CITY, STATE, ZIP c RSo PHONE .q $ L2 LL -11 ( �JJ ARCH=/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAII FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES ❑ IS THE BLDG AN ❑ YES EICHLER HOMF? ❑ NO BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE NO DESCRIPTION OF WORK C o ,RPCEID $Yg TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized aeent to act on er's b al£ 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEDEN�TTAL INFORIv4ATION REQUIRED �' OFFICE " r = USEQ�YIs x = © O«R THE COIRiTER s g _ y, >_'i �" ' ' i`�',.'a g,'4 v E3TRESS R I d_ ��ST/DARDxr�r slh� , O UnT+� fO� U RE NOW IN MEP.WiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: MAIN ST DATE: 05/05/2014 REVIEWED BY: MELISSA APN: 316 20 079 BP#: 14020005 *VALUATION: $0 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMA PENTAMATION 10EAP14 ommercial Building PERMIT TYPE: WORK REV # 1 - EXPAND TEMPORARY POWER - ISSUED 5/5/14 SCOPE APPLIANCE / EQUIP TYPE FEE ID u— ....» »• � QTY/FEE QTY UNITS Temporary Power 1 ECT<200 100 Am $47 TOTALS: I I I $47.001 I N01,E: 1 his estimate aoes not inetuue jen uue w vrnGr—ct.u..... —.. J.....»•••• -•-a. - - - - - I - ._. the 11—f fnr nddn 'l infra_ District, etc.). These fees are Dasea on the pretinunur FEE ITEMS (Fee Resolution 11-053 L . 7if %1,%13) trr urrrruuo.n urusa FEE u— ....» »• � QTY/FEE Elec. Plan Check 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elec. Insp. 0.0 hrs $47.00 r. [cc, Aictrict_ School N01,E: 1 his estimate aoes not inetuue jen uue w vrnGr—ct.u..... —.. J.....»•••• -•-a. - - - - - I - ._. the 11—f fnr nddn 'l infra_ District, etc.). These fees are Dasea on the pretinunur FEE ITEMS (Fee Resolution 11-053 L . 7if %1,%13) trr urrrruuo.n urusa FEE u— ....» »• � QTY/FEE -- - - MISC ITEMS A PME Plan Check: $0.00 PME Unit Fee: $47.00 PME Permit Fee: $47.00 Conso-action Tax Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 1[,�l't:fIICC'C� �%tlPt?17t7,` �'c'iiti: Travel Documentation Fee: ITRA VDOC $47.00 Strong Motion. Fee: IBSEISMICO $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $185.00 $0.00 TOTAL FEE: 85.00 RC�U. U-+iU iI i-. �CITY OF CUPERTINO 10U__ , FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, school Thaca faao nra hncoil nn tho nroliminary infnrmntinn available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E ' 7.%1%73) ADDRESS: Main st DATE: 02/03/2014 REVIEWED BY: Mendez Plan Check Fee: APN: BP#: / 110oZ0S� *VALUATION: 1$100,000—� PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PME Plan Check: PENTAMATION 10EAP14 PERMIT TYPE: i WORK Main St- install temp power - SCOPE Suppl. Insp. Fee -.0 Reg. Q OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, school Thaca faao nra hncoil nn tho nroliminary infnrmntinn available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E ' 7.%1%73) FEE QTY/FEE Elec. Plan Check 0.0hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elea Insp. 0.0 �rs$47.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, school Thaca faao nra hncoil nn tho nroliminary infnrmntinn available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E ' 7.%1%73) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00F-270070amps Electrical $82.0011ECT51K7 Temporary Power Suppl. PC Fee: Q Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? Q l'cs Q No $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Administrative Fee: (ADMIN $44.00 0 G) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Travel Documentation Fee: ITRA VDOC $47.00 Strom: Motion Fee: 1BSEISMICO $21.00 3.0 hrs Inspections $417.00 ISTINSP Inspection, Hourly Iilh, Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $163.00 $499.00 TOTAL FEE: 1 $662.00 Revised: 01/15/2014