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12020103 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20821 SCOFIELD DR CONTRACTOR:ALTAP ELECTRICAL PERMIT NO: 12020103 OWNER'S NAME: SAGDEO AN,IALI AND VIVEK PO BOX 41009 DATE ISSUED:02/22/2012 OWNER'S PHONE: 408071262 SAN JOSE,CA 95160 PHONE NO:(408)561-2806 ❑ LICENSED CONTRACTOR'S DEt:LAI2AT[O1V BUILDING PERMIT INFO: BLDG ' ELECT ' PLUMB ' License Class Lic.# Z MECH ' RESIDENTIAL 1 COMMERCIAL i Contractor AL t R ��e C+r.&I Date JOB DESCRIPTION:ELECTRICAL PANEL UPGRADE TO 200AMPS I hereby affirmthat 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 Sq.Ft Floor Area: Valuation:$18.50 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35912006.00 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 costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.l8. Issued by �✓-� Date: Signature /"(, to Z 2 r t ❑ OWNER-BUILDER 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 C'ontractor's License Law for one of installed without first obtaining all inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,Auld the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&.Professions Code) 1,as owner of tile property,am exclusively contracting with licensed contractors to ,ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ILAZARDOUS NiATERI.ALS DISCLOSURE declarations: 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. 1 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. Additionally,should I use equipment or devices which emit hazardous air 3760 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino 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&Safety Code,Sections 25505,25533,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,I Ownerfflr authorized Allagen : become subject to the Worker's Compensation provisions of the Labor Code,I must tf forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work'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,turd 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 ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply 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 CrgnatuCe Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . 35912006 - 00 DATE ISSUED. . . . . . . : 02/22/2012 RECEIPT #. . . . . . . . . BS000016087 REFERENCE ID # . . . 12020103 SITE ADDRESS . . . . . 20821 SCOFIELD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SAGDEO ANJALI AND VIVEK ADDRESS . . . . . . . . . . : 20821 SCOFIELD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : BAHRAM MOSTAFAZADEH CONTRACTOR . . . . . . . : BAHRAM MOSTAFAZADEH LIC # 26282 COMPANY . . . . . . . . . . : ALTAP ELECTRICAL ADDRESS . . . . . . . . . . : P0 BOX 41009 CITY/STATE/ZIP . . . : SAN JOSE, CA 95160 TELEPHONE . . . . . . . . : (408) 561-2806 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1ADMIN HOURS 1.00 41.00 0 . 00 41 .00 0 .00 1BCBSC VALUATION 1, 850 .00 1.00 0 .00 1 .00 0 .00 1BSEISMICR VALUATION 1, 850 .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 ----------------- --------------- -------------------- CREDIT CARD 174 .50 MC --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID --------DESCRIPTION--------- ----- -- ----------- -------- ---------------------------- 304 ROUGH ELECTRICAL 103 UFER 505 FINAL ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION IRINA ADDRESS: 20821 scofield dr. DATE: 02/22/2012 REVIEWED BY: bob s. APN• BP#• VALUATION: $1,850 IT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair RY PENTAItitATION 1 REAP2 SFD or Duplex PERMIT TYPE:service u rade to 200 am s. APPLIANCE 1 EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 200 Amps $44 TOTALS: $44A0 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPER!�IIT Other Elec. Insp. 0.0 hrs $44.00 Fire,Sanitary Sewer District,School NOTE: This estimate does not include fees due to other Departments{i.e.Planning,Public Works, District,etc.). These Lees are based on the prelininary information available and are on1v an estimate. Contact the Dept for addn'l info. FEE ITEMS ' "e �3 MISC ITEMS soli J—• i_' f3 , t r: FEE QTY/FEE PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Administrative Fee: 1ADAMV $41.00 Work Without Permit? (j Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 )!I llyloi.r t t. 1BSEISAIICR $O.rJO Select an Administrative Item Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: $174.50 Revised: 1(19(2012 GENERAL PERMIT APPLICATION MEP 2 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERT{NO (408)777-3228• FAX(408)777-3333- buildingC@cuperdno.org MISC ❑PLUMBING ❑MECHANICAL [:]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 2 D Aprr# OWNER NAME P ONE - -50'7 - N-Z V 2 E-MAIL et Ir STREET ADDRESS 2 s c � r��. DT, e r FAX CONTACT NAME eQ �Q1N^ PHONE ^S�� O6 E- � 1 p K alta eJeC�tf,Cj0 4lL0 .cam STREET ADDRESS / 7 3 r �E(w oQ J ►` cl a__n S, Cr4 FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT ME �� /e G�r► 4 I LIC -7 II�ISE NUMBi ( LICENSE TYPE (O� HUS.LIC# / G 'Z CONTRACTOR NA COMPANY NAME A L TA� �t/f Lt r l C t ` 1O E Q A e Q C+YCa'—��O✓ q FAX STREET ADD S O a I _l CITY,STATE,Z4 v St 9S1'G 6 PHONE v�_��/^ Q ARCHTTECTIENGINEER NAME cl c LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMMY PROJECT IN WIr DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK r c r a e ra a o G 2 O D TOTAL VALUATION: 7570 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.,have read the Description of Work and verify it is accurate. I agree to comply wit all applicable local ordinances and state laws relating to buil#g g construction:'I authorize repres tatives of Cupertino to enter the above-id tified pro erty for inspection pu{poses. Signature of Applicant(Agent Date: 2. 2 Z SUPPLEMENTAL INFO ON REQ=D OFFICE USE ONLY ❑ OVER-THE-COUNTER a ❑ EXPRESS Y U T ❑ STANDARD U ❑ LARGE ❑ MAJOR A PMircApp_2011.doc revised 06/21111