12070147 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23016 VOSS AVE CONTRACTOR:VOLTZ ELECTRIC PERMIT N0: 12070147
O\YNER'S\AME: SWANII ARUN N 624.5 LEAN AVE DATE ISSUED:07/182012
OWNER'S PHONE: 4083380906 SAN.JOSE.CA 95123 PIIONE NO:(408)835.3866
LICENSSED CON IRAC`fOR'S DEICLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class_C— 0 -._ Lic.d -9�! l�7 AIECH` r r r
/ RESIDENTIAL COMMERCIAL
Contractor /Oth-.'figffvrL Date
I hereby affirm That Into licensed under the pruvisioI of hapten 9 •JOB DESCRIPTION:ADDlVO(2)GI7CI OUTLETS FOR EXISTING SUMP PUMP,
(commencing e'ith Section 7000)of Division 3 of the Business S Professions ADD
Code and that nay license is in full force and effect. l'R'0(2)GFCI OUTLETS Al'CRAWL SPACE
hereby affirm under penalty of perjury one of the following two dcclnruiuns:
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
Section 3700 of the Labor Code,for the performanuce of the work for which this Sq.Fl Floor Area: Valuation:$600
permit is issued.
API'I.IC\N'I'CER'fIPIC,%'1'ION APNNumber:34250018.00 Occupancy Type:
I certify that I have read this application and state Ihan the above information is '
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorise representatives of this city to enter
upon theabove mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnity and keep harmless the City of Cupertino against liabilities,judgments. WI-ERIN IRO DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of thispemtit. Additionally.the applicant undcrstands and will comply IRO DAYS FROM LAST CALLED INSPECTION.
with all non-p int source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signature - Dave 011
❑ OWNER-I UILDER DECLARATION
RE-ROOFS:
hereby:dlirm that I am exempt from the Contractor's License Law for One Of All roofs shall be inspected prior to any rooting material beug installed If a roof is
the follow'i E2 two reasons: installed without first obtaining an inspection.I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business K Prolcssions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business R Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BFITER
hereby affirm under penalty Of perjury one of the following three
declarations: IIAZARDO11S MATERIAI S DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued California Ilcalth&Safety Code.Sections 25505.25533.and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino dlunicipal Code,Chapter 9.12 and the Health S
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(.)should I store Or handle ha'r>trdnus material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Day Area Air Quality Management District 1 will
I certify that in the perfomtance of the work for which this permit is issued I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Ilealth S Safety Code.Sections 25505.25533,and 25534.
Compensation laws of Califbnua. If after making this certificate ot'exemption,1
become subject to the Worker's Compensation provisions ofthe Labor Code,I must Ownen r authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked Date'
APPLICANT CERTI FIC\'1'ION CONS'I'ItIIC1'10N'I.IiNDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances mud state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned propertyfor inspection purposes.(We)agree m save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may aceme against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply AItCI I1'1'ECI"S DECLARATION
till non-point Source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Dale Licensed Professional
j � 0 ► y -7
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 M I /�
(408)777-3228 • FAX(408)777-3333 • buildinc(BrUDertino.om v\
GUPERTINO ,�//
❑PLUMBLNG ❑NECY.ANICAL FTELECTRICAL ❑MIISCELI—ANEOUS
PROIECr ADDRESS r I APN a
OWN NAME PN NE I E-MAIL
n
S[REEi0 DRESS /I I CITY. STATE.IIP FAX
VDIFt Cz, .175014
CONTACT NAME L Piµ/SNE E-MAIL
STREETADDRESS / Z l� .iA ZP C' FAX
❑OwNER ❑ OwNER-BLEIDER ❑ OWNER ADEM NiRACiOR ❑CONT'iUCrOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEv*.SAPER ❑ T'-SIAM
CONTRACTOR NAME tL'Q SE NUMBER t SE 7Y2E I BUS.LIC d
CO.MEA.NY NAME Z t E-MAILI FAX
b - T
STREET ADDRESS ITATE, I — —c
ARC.YITECiENGLNEEt NAME I LIC,NSENUMBER I BUS.IUC,Y O
COMPANY NAME' E-MAE. FAX
STREET ADDRESS I CITY,STATE,IIP I PHONE
USE OF 11SFD a DUPLEX Cl MULTI-FM Y PROMCtWWIDLND 0 YES I PRODECr DI ❑ YES I LSTHEBLDGAN ❑YES
BUILDING: COMMERCIAL URBAN OREIIFAL'E AREA NO FLOOD LANE ❑NO EOC.Et HOME. Cl ND
DESCRIPTION OF WOR.0
�M
Add 62) C v
TOTAL VALUATION: .[ T RECEIVED BY:
By my signature below.I certiry mea hof the following: I am the propery owner or authorized agent to act on the property owner's behalf. I have read this
appbmtion and the infortnadun I ham provided is correct. 1 have=d the Description of Work and verify it is accurate. I agree'o comply with all applicable local
ordinances and state laws relating uilding consavetion. I autboriu representatives of Cupertino to enter the above-identified prope,Ty for inspection purposes.
Signature of ApplimnJAgenD Dare: l Y /2
6YIPLEMENTAL INFORMATION REQUII=D OFFICE USE ONLY
>t B--07 ER-THE-COUNTER
s
❑ EXPREss
u
❑ STANDARD
U
i ❑ LARCE
❑ MAJOR
MEP,Wuc4pp_2011.doc revised 06/]1/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 23016 voss ave. DATE: 07/18/2012 REVIEWED BY: bobs.
A PN: BP#: 'VALUATION: $600
*PERDi1T TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIM.\I21' PENTAMATION
USE: SFD Or Duplex PERMITTYPE: 1REAP10
WORT: add 2 qfci outlets for existing sump pump, add 2 qfci outlets at crawls ace.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Recep/Switch/Outlets 1BREMRECEP 4 # $45
TOTALS: $45.00
,4/ech.Plan Check Plumb.Plan Check Elec. Plan Check 0.0 1 hrs $0.00
,L e& Permit Fee: Plumb. Permit Fee: Elec. Permit.Fee: IEPERAIIT
Other•Mech.Insy. Other Plumb Insp. Ll I Other Elec. Insp. 0.0 hrs $45.00
,hath. lisp. Fee. Plumb. hisp. Fee: Elec.Insp. Fc:
A'OTE: This evinunte doev not include jeer due to other Departments(i.e. Planning, Public Works. Fire,Samitap•Sewer District.School
District, etc.). These eev are based nn the prelindnan information aw,ailable and ire mnlr can eathntate. Contact the De t or aild n'I in a.
FEE ITEMS (Fee Resolution 11-0531,' ' 7/1/1l) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Supp/. Insp Fee
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Consm•tiction Tar:
Administrative Fee: 1ADMIN $42.00
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fees:
"Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
131c1e Stds Commission I-cc: IBCBSC $1.00
SUBTOTALS: $178.50 $0.00 TOTAL FEE: $178.50
Revised: 07/01/2012
Building Department
City Of Cupertino
10300 Torre Avenue
CUPERTiIVo Gine��tinn:C_a 0 (11 1�«
Fax: 408-777-3
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: rµl s PERMIT#
OWNER'S NAME: 7 e) PHONE #
GENERAL CONTRACTOR: V — ;L BUSINESS LICENSE #
ADDRESS: 6Z�15- jqletCITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTIN'O
BUSINESS LICENSE. J
am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets& Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum /Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving'
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date