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12060114 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1670 JAMESTOWN DR CONTRACTOR:RUNNING ELECTRIC PERMIT NO: 12060114 OWNER'S NAME: GLENN SERRE 935 HILLCREST DR DATE ISSUED:06/19/2012 OWNER'SPHONF.: 4084462099 FELTON,CA 95018 PHONE NO:(831)335-9024 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COAIhIERCIAL❑ License Class CJ Lic.p 7121 GG '3- INSTALL CT500 COULOMB EVC STATION 40 AMP TO /J Convector '''""" """��D ` /� EXISTING 200 AMP PANEL �` �7//L/�r-c�7ate , 1 hereby affirm that 1 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. 1 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 perfomance of the work for which this peril is issued- Sq.F1 Floor Area: Valualion:$2400 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 perit is issued. APN Number:36610062.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read[]its application and stale that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED corrccl. 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 save180 DA ROM 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 granting of[his permit. Additionally,the applicant understands and will comply Issued by t� Date: lv / with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signalur ® Dal /.0— All roofs shall be inspected prior to any roofing material being installed. If a roof is I installed without first obtaining an inspection.I agree to remove all new materials for inspection El OWNER-RUILDF,R DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Dale: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the struclure 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 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 1 hereby affirm under penally 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 Cenificale of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Cade,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this peril is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by The Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent:4el +7, Date: I certify Ihm in the performance of the work for which this peril is issued,1 shall 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby of it 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 1 certify that I have read this application and slate that the above information is corrccl. 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 peril Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18, Signature Dale CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 1670 Jamestown Drive DATE: 06/19/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $2,400 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Du lex PENTAMATION SOLAR-RES USE: p PERMITTYPE: WORK Installation of a CT500 Coulomb Car Charging Station. SCOPE. ,I fech. Nun Check 1'hnuh. I'Inn CherA E/n:, Phin Chcek Llrc'h, Pernw Fee; I/4n01h. Pe"nih Fee: tiler. Pernrih Pe,!: Odrrr,1 terh. Insp, Other I'Inmh Insp. Usher F.ler. lnvp. .1h.,it hiv, her: 1'luurh. hup. Fed: like.Imp. Fec; 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 prefinddna information available and are only an estimate Contact the Dept for addh7 info. FEE ITEMS(Fee Resolution 11-053 EII. LLI11 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Alternative Energy System Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $100.00 ICIIRGSTA EV Charging Station PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: 1717 $0.00 C'nnsnvclion Tux: Admiui.snvuire Fee: O Work Without Permit? 0 Yes Q No $0.00 E) Advanced Planning, Fee: $0.00 Select a Non-Residential 0 T-771Building or Structure 0 /total DocumcNalion Pecs: Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Olda Stds Commission Fee: IBCBSC $1.00 T_ SUBTOTALS: $1.50 $100-001, TOTAL FEE: 1 $101.50 Revised: 06/30120 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: counter COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36610062 . 00 DATE ISSUED. . . . . . . : 06/19/2012 RECEIPT # . . . . . . . . . BS000017104 REFERENCE ID # 12060114 SITE ADDRESS . . . . . : 1670 JAMESTOWN DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GLENN SERRE ADDRESS 1670 JAMESTOWN DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5315 RECEIVED FROM . . . . : RUNNING ELECTRIC CONTRACTOR . . . . . . . : JOHN C FASOLAS. LIC # 28994 COMPANY . . . . . . . . . . : RUNNING ELECTRIC ADDRESS . . . . . . . . . . : 935 HILLCREST DR CITY/STATE/ZIP . . . : FELTON, CA 95018 TELEPHONE . . . . . . . . : (831) 335-9024 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ------- --- ---------- ------ --- 1BCBSC VALUATION 2,400 .00 1 . 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 2,400 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1CHRGSTA UNITS 1 . 00 100. 00 0 .00 100 . 00 0 . 00 ---------- ---- ------ ---------- ---- -- TOTAL PERMIT 101.50 0 . 00 101 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER -------- --------- --------------- -------------------- CHECK 101 .50 7720 --------------- TOTAL RECEIPT 101 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 313 ROOF NAIL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL