12060140 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1206 STAFFORD DR CONTRACTOR:CONIFER CONSTRUCTION PERMIT NO: 12060140
OWNER'S NAME: ENRIGHT MARK A AND ALARID-ENRIGHT M 1320 SELO DR DA'Z'E ISSUED:06/25/2012
OWNER'S PHONE: 6506906171 SIINNVVALE,CA 94087 PHONENO:(408)=45.9154
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic,# 607GF7r—
MECH RESIDENTIAL COMMERCIALContractor w.r-i/7vC CtwSXuiL Date -'�'2 V—/ 2
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL NEW 200 AMP P"LECTRICAL SERVICE
(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. Sq.F1 Floor Area: Valuation:$1500
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
pernhit is issued APN Number:36211017.00 Occupancy Type:
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 state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
m 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
indemnity and keep harmless the City ofCupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,th aplicant understands and will comply �7
with all non-pot ce regulations r e Cupertino Municipal Code,Section Issued byf� Date: L-
9.I R_ � //�/nt/��/yam.
Signalu l Datc
RF:ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed If roof is
installed without first obtaining an inspection,1 agar to remove all new materials for
I hereby affirm that 1 am exempt from the Contractor's License Law for one of inspection
the following Iwo reasons:
1,as owner of the property.or my employees with wages as their sale compensation, Signature of Applicant: Date-
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner Of the property,am exclusively contracting with licensed contractors to ALI,ROOF COVERINGS I'D BE CLASS"A"OR BETTER
construe((he project(Sec.7044,Husiness&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Ilealth&Safety Code,Sections 25505,25533,and 25534. I wi11 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 Ilealth&
performance of the work for which this permit is issued. Safety Code,Section 25532(s)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 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 Code.Chapter 9.12 and the
Ilealth&Safely Cade 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 so as to become subject to the Worker's Owm or tint rF agent:
Compensation laws of California If,after making this certificate of exemption,I ,^ ar„ Date: 0
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 aff rrn that there is a construction lending agency for(he performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify(hal 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 this 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, ARC.111"TF.CT'S DECLARATIONcosts,and expenses which may accrue against said City in consequence of the
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 Cade,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 1206 stafford dr. DATE: 06/25/2012 REVIEWED BV: bob s.
APN: BP#: -VALUATION: $1,500
-PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMITTYPE: 1REAP
WORK install new 200 amp electrical service.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services CERT<200 200 Amps $44
TOTALS: $44.00
.1 A,,h. I'/r„,rh.r:: Pnunh. Plm,ChctA Elec. Plan Check 0.0 hrs $0.00
1h=cL- It=twit G2=,: Phunh. I'crnw lir: Elec. Permit Fee: IF_PERMIT
011,, llc.h hr.p. Odrt•r I'luml,Ince. Lj Other Elec. Insp. E hrs $44.00
,llrrh. lu,u. I'rr: Phunb. h,dp. l-vc 0,” In,p. I L"
NOTE: This estimate does not includejees due to other Departments(i.e. Planting, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS (Fcc Resolution 11-053 Elf 711111) FEE QTY/FEE MISC ITEMS
Plan ( /1"(/, /i3C
PME Plan Check: $0.00
l'rrnrit h�•r.
17r/q,l. hGc/, h2a.
PME Unit Fee: $44.00
PME Permit Fee: $44.00
C,mxn vrrrion 1'n
Administrative Fee: (ADMIN $41.00
Work Without Permit? O Yes Q No $0.00
,I rlr,nrctall'hnurint Fees:
Travel Documentation Fee: ITRAVDOC $44.00
i
Strone Motion I'CC* IBSFISMICR $0.50 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $174.50 $0.00 TOTAL FEE:F $174.50
Revised: 06/30/2012
( Z 0 C-0 C�
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014.3255 MIS C
CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(d.)cupertino.orcl
❑PLUXB[NG. ❑MECHANICAL CRELECIRICAL / ❑NUSCalANEOUS
PROJECT'ADDRESS APN a c) 1
p W
OWNER NAME O -6
sTREEranDREss - CRY,STATE,ZIP FAX
CONTACT NAME PHONE E-MALL
/13�57v 2-2 y�
STREET ADDRESS
� � =; ATE yG�� FAx
❑OWNER ❑ OWNER-BUILDER ❑'OWNER AGENT MICONTRACMR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC R
COMPANY N E-MAIL FAX
Q/AO�
STREET ADDRESS CRY,STATE,ZIP PHONE
ARCI(ITECTIENOMEFR NAME LICENSE NUMBER- BUS.IJC 9
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE ZIP PHONE
USE OF CfSFD w DUPID( ❑ MULTI-FAMILY PROJECT IN WIDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
'BUMOENG: ❑COMMERML URBAN(NTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOMET ❑ NO
DESCRIPTION OF WORK
N e— 4eVt14th/re V — X00 2 co p
TOTAL VALUATION: CrV RECEIVED BY:
By my signature below,I certify to each of the fnllowmg:- the property owner or aathorind agent to act on the property owner's behalf. f have read this
application and the information I have provided is come have irad the Daaiption of Work and verify it is accurate. I agree m comply with all applicable local
ordinances and state laws relating to Idmg constro I authorize ro resentatives of Cupertino to enter the above-id/entifiedpropc.—y;or inspection pulposcs.
Signature of ApplicaoVAgrnta Date: �'-2 —/
SUPPLEMENTAL"INFORMATION-REQUIRED gOFFI�CEUSEONLY
m [ OVER-THE-COUNTER
❑ EXPRESS
V
❑ STANDARD
U
❑ LARGE
❑ MAJOR
MSPA•facApp_2011.doc revised 06/21/11