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12040056CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10437 AVENIDA LN CONTRACTOR: ABC REMODEL, INC PERMIT NO: 12040056 OWNER'S NAME: PARPARITA ANN S AND MIHAI 544 HICKORY PL DATE ISSUED: 04/11/2012 OW'NER'S PHONE: 6502834582 SANTA CLARA, CA 95051 PIIONE NO: (4091887-2514 ❑ LICENSED CONTRACTOR'S DECLARATION F- r PLUMB r License Class Lic.q L !!//I. 6 r BUILDING PERMIT INFO: BLDG ELECT r r r "Dal MECH RESIDENTIAL COMMERCIAL Contractor I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION; UPGRADE MAIN PANEL FROM 125AMP T0200AMP (commencing with Section 7000) of Division 3 of the Business & Professions Cade and that my license is in full force and effect. 1 hereby affirm under penally 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 critic work for which this permit is issued. Sq. FI Floor Area: \'elualion: $2300 1 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: 34245044.00 Occupancy Type: permit is issued- APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and slate laws relating PERMIT EXPIRES 1 F WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs, and expenses which may acerae 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 /f7//j Issued by: /411 ��flTG/-i Date: A/ - ✓/ VZ 9.18. (/�(),,,, Signature/%(��/ i.L_JLz"7 Date4/46?a(Z, RF. -ROOFS: ❑ OWNER -BUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed. If a roof is installed without first obtaining an inspection. I agree to remove all new materials for 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation. Signature of Applicant: Date: wil I do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the 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). 1 hereby affirm under penally of perjury one of the following three HAZARDOUS 51ATF.RIAIS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapler6.95 of the I have and will maintain a Certificate of Consent to self -insure for Worker's California llealth & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & performance of the work for which this permit is issued. Safety Code, Section 25532(1) should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should I use equipment or devices which emit hazardous air Section 3700 of the labor Code, for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Cade, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner soas to become subject to the Worker's O o aup mhof�'�9d agent: Compensation laws of Califamia. If, alter making this certificate ofexemption, l become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTI FICATION for which this permit is issued (Sec. 3097, Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of [his city to enter Lender's Address 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 ARCHITECT'S DECLARATION granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 6 ITEMS. OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34245044.00 DATE ISSUED........: 04/11/2012 RECEIPT #.........: BS000016508 REFERENCE ID # ...: 12040056 SITE ADDRESS .....: 10437 AVENIDA LN SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 174.50 --------------- 174.50 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL REFERENCE NUMBER -------------------- MC VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL OWNER ............: PARPARITA ANN S AND MIHAI ADDRESS ..........: 1381 ORMONDE WAY CITY/STATE/ZIP ...: MOUNTAIN VIEW, CA 94043 RECEIVED FROM ....: ORHAN BASER CONTRACTOR .......: ORHAN BASER LIC # 33165 COMPANY ..........: ABC REMODEL, INC ADDRESS ..........: 544 HICKORY PL CITY/STATE/ZIP ...: SANTA CLARA, CA 95051 - TELEPHONE ........: (408) 887-2514 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 2,300.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 2,300.00 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 ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 174.50 --------------- 174.50 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL REFERENCE NUMBER -------------------- MC VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION IWADDRESS: 10437 Avenida Lane DATE: 04/11/2012 APN: BP#: 7REVIEWED BY: Sean -VALUATION: $2,300 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex Elec. Permit Fee: IEPERMIT PENTAMATION 1REAP2 PERMITTYPE: rSE: ORK U rade main anel from 125 am to 200 am .COPE 100 Amps APPLIANCE / EQUIP TYPE FEE ID PGonh. Phan Cher6 QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Services 1ERT<200 Other Elec. Insp. 0.0 hrs $44.00 100 Amps $44 P('I"/nit beer Sup/d, /lisp Pee PME Unit Fee: $44.00 PME Permit Fee: $44.00 Conslr-arlion Tax Administrative Fee: !ADMIN $41.00 Work Without Permit? Yes Q No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $44.00 Stront± Motion Fee: iBSEISMICR NOTE: This estimate does not include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the areliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resalalion 11-053 E0: 711111) Plan C'herk PGonh. Phan Cher6 Elec. Plan Check 0.0 hrs $0.00 ,Hach. A"-folil Fer: Plumb. Pe'rnil Fee : Elec. Permit Fee: IEPERMIT 011x, dlc, h. /resp. 011ier Plamb Imp. Other Elec. Insp. 0.0 hrs $44.00 3 h-, h, Grail. Fee.' Pham. hr.p. Fee: li[n•, Insp. Fac: NOTE: This estimate does not include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the areliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resalalion 11-053 E0: 711111) FEE QTY/FEE MISC ITEMS Plan Chcc% 1' e: suppl. PC Fee PME Plan Check: $0.00 P('I"/nit beer Sup/d, /lisp Pee PME Unit Fee: $44.00 PME Permit Fee: $44.00 Conslr-arlion Tax Administrative Fee: !ADMIN $41.00 Work Without Permit? Yes Q No $0.00 Aovnaced Planning Fees: Travel Documentation Fee: ITRA VDOC $44.00 Stront± Motion Fee: iBSEISMICR $0.50 Select an Administrative Item Blde, Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: F $174.50 Revised: 04/01/2012 a GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 M I w CUPERTINO �r // (v_ n PLumnmG MMECHANICAL I✓IQ.E=CAI_ nkrtcm r enrcMM (408) Tf1-3228 •FAX (408) TR -3333 • buildinOC�cuoertino.o FROIECT ADDRESS IC -1, 3� fi yG/v/(�(LP' G/I C �e � FNN OWNER NAME ,A p O SL2,2,1_45 •WJ SC/� E-MAIL . STREETADDRESS CITY. SLATE, UP FAX CONTACT NAME PHONE E-,yAp- STAMADDRESS -' CITY. STATE. ZIP FAX ❑ OwNPR ❑ OWNEA-BVLLDER ❑ OWNFAAGINI' ❑ coNTRAcmR ❑ CONTRACTOR AGENT ❑ ARQpfF1T ❑ Escam FR ❑ DEvaLoPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC a /t ' COMPANYNAME n {C /' �-JLJC' in E-MAIID��/I srREETAnnRFsa 2p6 CITY,srATE,' LSI ds GC��r G�+ B FHO7,f D8-� 25/ ARCIIRECT/ENOBIEER NAME LICENSE NUMBER BUS. DC a COMPANY NAME ' E-MAIL FAX STREETADDRESS CITY. STATE, ZIP PHONE USE OF ❑SED mouP1ER ❑ MULTI -FAMILY BUILDING: ❑CDRLMERCIAL PRONECT IN WRDIAND ❑ YES URBAN INTERFACEARPA ❑NO ZR ZTN ❑ YES FlDOD zONH [3 NO STHE BLDG AN ❑ Yas EsaOEI HOME) ❑NO DESCRIPTION OF WORK Y— nM lQ (1 ,IPI �2 1 X7m DOS ✓ TOTAL VALUATION. RECENED BY: By my signature below, I certify to each of the following. I am the property owum err amhorized agent to act on the property awoer's behalf I have read this application and dte information I have provided u correct have read the Desorption of Work and verify it is accart m. I agree to comply with all applicable local ordinances and sum laws relating m ' din constraud , I authorize representatives of Capertmo to mter the above-ide ri ed property for inspection pu@oses. Signature ofApptiaot/Agent d�]IB-J-�- Dare: Z49/ SUPPLEMENTAL INFORMATION REQUIILID OFFICE USE ONLY y OVER-THE-COUNTER d Y ❑ WRESS u r 'u ❑ STANDARD ❑ LARGE 6 ❑ M OR MEPMIscApp_2011.doe revised 06/21/11