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12050082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10552 LA RODA DR CONTRACTOR:E G ELECTRICAL PERMIT NO: 12050082 SERVICES OWNER'S NAME: BARR DAVID TRUSTEE 1170 BISMARCK DR DATE. ISSUED:05/08/2012 OWNER'S PHONE: 4082527156 CAMPBELL,CA 95008 PHONE NO:(408)370.2222 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.p FF j2 MECH r RESIDENTIAL r COMMERCIAL r Contractor Date -0 hereby vm Ihet I am licensed under the provisions of hapter9 JOB DESCRIPTION:MAIN ELECTRICAL SERVICE UPGRADE TO 200 AMP (commencing with Section 7000)of Division 3 of the Business&Professions Code 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 of the work for which this permit is issued. Sq.FI Floor Area: Valuation:$2500 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 forwhich this permit is issued. APN Number:36933021.00 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 PERMIT EXPIRES IF 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 exPeases hich may accrue against said City in consequence of the granting of this - Additionally,the applicant understands and will comply y �� /�r / with all non-point s ice regulations per the Cupertino Municipal Code,Section Issued b �TG/-y- Date: �• ' f� 9.18. Signawre .bate RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material tieing installed.[fa roof is installed without first obtaining an inspection,I agree to remove all new materials for hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended oroffered for sale(Sec.7044, Business&Professions Code) I,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 MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&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 Ileallh& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 ollhc Labor Code,for the performance of the work for which this contaminants as de ned by the Bay Area Air Qualify Management District 1 will permit is issued. maintai/com/pin' with the Cupertino Municipal Code,Chapter 9.12 and the fleallh e,Sections 25505,25533,and 25534. I certify that in the performance of the work forwhich this permit is issued,I shallnot employ any person in any manner so as to become subject to the Worker's Owner o a enl: ,L Compensation laws of California If,after making this certificate of exemption,1 Dete: 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 ACENCI' 1 hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION 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 stale laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harriless 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 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36933021 .00 DATE ISSUED. . . . . . . : 05/08/2012 RECEIPT #. . . . . . . . . : BS000016746 REFERENCE ID # . . . : 12050082 SITE ADDRESS . . . . . : 10552 LA .RODA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BARR DAVID TRUSTEE ADDRESS 10552 LA RODA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : E.G.ELECTRICAL SVCS CONTRACTOR . . . . . . . : EDWARD GORGINIAN LIC # 24831 COMPANY . . . . . . . . . . : E G ELECTRICAL SERVICES ADDRESS . . . . . . . . . . : 1170 BISMARCK DR CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 370-2222 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 2,500.00 1.00 0.00 1 .00 0.00 1BSEISMICR VALUATION 2,500.00 0.50 0. 00 0 .50 0.00 1EPERMITFE FLAT RATE 1 .00 44 .00 0. 00 44 .00 0 .00 IERT<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 #627 --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------- -- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10552 Laroda Dr DATE: 05/08/2012 REVIEWED BY: Sean APN: BPH: -VALUATION: $2,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1REAP2 USE: PERMIT TYPE: WORK Main electrical service upgrade to 200 amp. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 200 Amps $44 TOTALS: $44.00 ,blech. I'Inn Check Phuub. Me")Chead Elec. Plan Check 1 0.0 1 hrs $0.00 Meat). I'err❑it Fe's' Phunh. Permit F,•c: Elec. Permit Fee: IEPERM/T Other Mcch. Imp, Other Plumb Imp. Li I Other Elec. Insp. 0.0 hrs $44.00 hr,p. Fuc: Phnrrb. hr.sp. Fee: like. Insp. Fre: NOTE: This estimate does not ineludejees due to other Departments(ie.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina in ornwtion available and are only an estimate. Contact the Dellifor addn7 info. FEE ITEMS (Fee Resohnion //-053 E2' 7/1//11 FEE QTY/FEE MISC ITEMS l'lun Cherh, Fer.: Sttppl. PC 1:'ee PME Plan Check: $0.00 Perinil (•err•: Suppl, /acp bee PME Unit Fee: $44.00 PME Permit Fee: $44.00 C'ona•natction Tax. Administrative Fee: !ADMIN $41.00 Work Without Permit? Yes Q No $0.00 ,IrPounccd Pluming lies Travel Documentation Fee: ITRA VDOC $44.00 A Strong Motion Fee: IBSE/SM/CR $0.50 Select an Administrative Item Blde Slds Commission Fee: 18CBSC $1.00 SUBTOTALS: 1 $174.50 $0.00 TOTAL FEE: $174.50 Revised: 04/01/2012 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255 M I /sem CUPERTINO (408)777-3228• FAX(408)777-3333•buildina(@cuoertino.ora /v_ []PLUMBING []MECHANICAL ELECTRICAL ❑MISCFTinNEOUS PROIECTADDRESS I AFN* OWNER PH r' I E-MAIL •–J �/J STBFF[ADD QTY,STATE,ZIP FAX WMACT r. E PHONE E-MAR STREFC ADDAF59 CIN;STATE. ZIP FAX , OWNER ❑ OWNER-BUD.DEIL . ❑ OWNERAGENT ❑•mxtnncTOR ❑CONTRACTOR AGENT ❑ ARaBrFJ:r ❑wcrNmt ❑ DEVELOPER ❑TLNANr CONTRACTOR NAME r' LICENSE NUMBER — LICENSE TYPE BUS LIC a COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS uC A CONOANYNAME' E-MAB. FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF wDUPIF]t ❑ MO -mmmRY PR =rv;WDDLAND ❑ YES PROIFITIN ❑Yas LSTREBLDOAN ❑ BUDDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE 0 EICHUR HOME? NO DFSCRIPIION OF WORK /ny TOTAL VALUATION: aSDO RECEIVED BY: By Dry sipamm below,I certify to each of the follo I am the pmperry owner or anthorired agent m act on the property awneds behalf I have rad this application and the mforme.on I have - L ,have tad the Deseipt,.of Work and verify it is accrete. I to wmpIY With all applicable local ordinances and stare laws relating m boil m I authori a representatives of Cupertino m enter the above-i ti — for mspe=ou Pof{roses. Sipamm of Applicant/Agme Date: S P AL INFO TIO"EQUIRED OFFICE USE ONLY OYER-Tire-COUNTER 6 ❑ EXPRESS Y • u ❑ SrAmABD u' 3 ❑ URGE d ❑ MAJOR AEPMsc,(gp_2011.doc revered 06/11/11