The URL can be used to link to this page

11120114 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10450 N PORTAL AVE CONTRACTOR:ROMANO ELECTRIC PERMIT NO: 11120114 OWNER'S NAME: KLEIN PETER A AND WOON SANDRA 2198 LAUREL DR DATE ISSUED: 12/21/2011 OWNER'S PHONE: 4087252544 SANTA CLARA,CA 95050 PHONE NO:(408)564-0583 -C� LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT PLUMB F License Class C 1 Lic.# 11 t `l' MECH r RESIDENTIAL COMMERCIAL Contractor ��IaAAO -OfC1L (L V Date �- 'Z i I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SERVICE UPGRADE TO 200 AMPS (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 Sq.Ft Floor Area: Valuation:$3150 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 APN Number:31629014.00 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 PERMIT 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 FROM 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 J granting of this permit. Additionally,the applicant understands and will comply Issued Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. tZIL1 �L Signature � �-� Date RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: 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) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by 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 Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall OwJpeC or,�uthorized agent: I_ not employ any person in any manner so as to become subject to the Worker's �� :Y L �� Date: 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 CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of Hork's for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name 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 Lender's Address 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, cr and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. E :g of this permit.Additionally,the applicant understands and will comply waw all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31629014 .00 DATE ISSUED. . . . . . . : 12/21/2011 RECEIPT #. . . . . . . . . : BS000015620 REFERENCE ID # . . . : 11120114 SITE ADDRESS . . . . . : 10450 N PORTAL AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : KLEIN PETER A AND WOON SANDRA ADDRESS . . . . . . . . . . : 10450 N PORTAL AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2325 RECEIVED FROM . . . . : RAMNO ELECTRIC CONTRACTOR . . . . . . . : JASON ROMANO LIC # 32435 COMPANY . . . . . . . . . . : ROMANO ELECTRIC ADDRESS . . . . . . . . . . : 2198 LAUREL DR CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050 TELEPHONE . . . . . . . . : (408) 564-0583 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41. 00 0. 00 41. 00 0. 00 1BCBSC VALUATION 3, 150 .00 1. 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 3, 150 . 00 0. 50 0 . 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1. 00 44.00 0. 00 44 .00 0. 00 1ERT<200 UNITS 1.00 44 . 00 0. 00 44 .00 0. 00 1TRAVDOC FLAT RATE 1.00 44 . 00 0.00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 174 .50 0. 00 174 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 174 .50 1231 --------------- TOTAL RECEIPT 174 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO �\9 FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10450 n. portal ave. DATE: 12/21/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$3,150 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Du lex --T PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK service upgrade to 200 amps. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $44 TOTALS: 1 $44.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT LjOther Elec.Insp. 0.0 hrs $44.00 NOTE: This estimate does not include fees due to other Departments(i.&Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the relinina in ormation available and are onl an estimate. Contact the Det or addn'1 info. FEE ITEMS (I ee Resolution 11-053 4f 7/'j//1) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Administrative Fee: IADMIN $41.00 Work Without Permit? Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $174.501 $0.00 TOTAL FEE: $174.50 Revised: 12/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 ;U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: in PHONE# U _J GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: I CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. /r��/�� r I am not using any subcontractors: 6961 Signatureo Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date APPLICATION GENERAL PERMIT APP MEP COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 CUPERTiNO (408)777-3228- FAX(408)777-3333- building(a-)cupertino.org \ MISC ❑PLUMBING ❑MECHA ICAL ELECTRICAL J ❑MISCELLANEOU)S PROTECT ADDRESS OWNER NATIE PHONE E-MAIL STREET ADDRESS C STA ,ZIP FAX CONTACT NAME y PHI .I .0 1/O (.I -MAIL�Q STREET DSTRESS Y, TE, ZIP _ FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 0,42ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTQR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# �.,4 ,�; C COMP NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP C�� T1`` �>-4 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE JSE OF -KSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WI DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE 5WO EICHLER HOME? ❑NO DESCRIPTION OF WORK rti �t IL (J J— TOTAL VALUATION: �� RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct.j have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin Il g constructi d I auth -I a representatives of Cupertino to enter the above enti$e property for inspection poses. Signature of Applicant/Agent: ef;)el- Date: f r SUPPLEMENTAL MORMATM REQUIRED OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS Y U S ❑ STANDARD U ❑ LARGE c ❑ MAJOR MEPMiscApp_2011.doc revised 06/21111