12080090CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 1042013UBB RI) CONTRACI'OK: PERMITINO: 12080090
O\VNE,R'SNA\Ili: -, HOR1170FCIIIZISTCIIUIZCII
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DATE, ISSUED: 08/082012
OWNE,R'S 1'I IONE: 4089968208
['[]ONE NO:
l� LICENSED CON"I'RACI'OR'S DECLARATION
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BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.H
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\fECll RESIDENTIAL COMMERCIALr
Contractor SCC:7KUC- Dole O
I hereby affirmth:l l a m licensed under l lie pro% inions of Cha pter9
JOB DESCRIPTION: REPIACEJOAMP RRGI:HR WITH 60 Ah1P RRGIAER,
(conune ting with Section 7000) cif Division 3 of the Business S Professions
CHANGE
OUT 88 CABLES TO q6 CABLES.
Cute and that fire license is in full force anti effect.
I hereby affirm under penalty of perjury one of the fallowing [.a declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation, as'provided for by Section 3700 oflhc 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 orthe Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $700
permit is issued.
APPLICANT CERTIFICATION
APP' Number: 35720038.00
Occupancy Type:
I certify that I have read this application and state that the above intlinnalion is
correct. I agree to comply with all city and county ordinances mid 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
indelarily :aid keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAPS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code, Section
186 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date
Issued b Dater 04— / L
;_
❑ OWNER-BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law Incline of
RF. ROOFS:
file following two reasons:
All roofs shall be inspected prior to any roofing material beiig installed. If a roof is
I, as owner ollhe property, or my employees with wages as their sole comRnsation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, ani exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business a Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" Olt RE 17Ei12
declarations:
I have and will maintain a Certificate ofCansent to self-insure for Workcr's
IIAZARDOUS \IATERL\LS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California llealth S Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Section 3700 of the Labor Code, for the performance Of the Work fur which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health S''
Safety Code, Section 2553_(,) should 1 store or handle hazardous material.
permit is issued.
Additionally, should 1 use equipment or devices which emit hi¢ardous air
I eenify that in the performance office work for rhich this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Managemem District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 acid the
Compensation laws of California. If, after staking this certificate of exemption, I
Health & Safety Code. Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
%
Umvyr./tyr/(uth .eJ genC
forthwith conmply with such provisions or this permit shall be deenmed revoked
< Date. O
APPLICANT Clilt'I'IFICA'I'ION
CONSTRIICI'ION LENDING AGENCY
I certify that I have read this application mid state that the above information is
correct. I agree to comply with till city and county ordinances and state laws relating
I hereby affirm thin there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter
for mhich this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupenino againSl liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupenino Municipal Code, Section
AKCI I I'I'FC71"S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
'
Licensed Professional
CITY OF CUPERTINO
I►�'//I FEE ESTIMATOR -BUILDING DIVISION
jaiADDRESS:
10420 bubb ave.
DA'Z'E: 0 810 812 01 2
REVIEWED BY: bobs.
UNITS
APN:
BP#:
'VALUATION:
$700
*PERMIT TYPE: Electrical Permit
PLAN CIIECK TYPE: Alteration / Addition / Repair
PRIMARY
Commercial Building
USE:
$133
PENTAMATION
PERMITTYPE: 10EAP7
NVORK
replace 40 amp breaker with 60 amo breaker, change out #8 cables to #6 cables.
SCOPE
1
APPLIANCE / EQUIP TYPE
FEE ID
Phuuh. Plan Cheek
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPEnMIT
Conductors
1BREMMISC
Other Elec. Insp. 0.0 hrs $45.00
1
#
$133
Recep/Switch/Outlets
1BREMRECEP
Suppl. Insp Fee
1
#
$45
PME Unit Fee:
$178.00
PME Permit Fee:
$45.00
Const)-tiction Tar:
F-
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? O Yes Q No
$0.00
TOTA LS:
A
Travel Documentation Fee: ITRA VDOC
$178.00
Strone Motion Fee: IBSF-ISMICO
NOTE: This asrintate does not include fees due to other Departments (i.e. Planning, Public 11'orks. Fire, Sanitare Server District, School
District. etc.). These lees are baser/ an the prelintinart• information available and are mtb, an estintate. Contact the Dept for atldtt7 into.
FEE ITENIS (Fee Resohnion 11-053 Ef7: 7/1/11)
,Wech. Men Check
Phuuh. Plan Cheek
Elec. Plan Check 0.0 1 hrs $0.00
Meth. Permit Fee:
Plumb. Permit Fee:
Elec. Permit Fee: IEPEnMIT
OtherMuch. /asp.
Other Plumb Insp.
Other Elec. Insp. 0.0 hrs $45.00
.14ech. hup. Fec:
Plumb. hest. Fee:
Elec. Imp. Fec:
NOTE: This asrintate does not include fees due to other Departments (i.e. Planning, Public 11'orks. Fire, Sanitare Server District, School
District. etc.). These lees are baser/ an the prelintinart• information available and are mtb, an estintate. Contact the Dept for atldtt7 into.
FEE ITENIS (Fee Resohnion 11-053 Ef7: 7/1/11)
FEE
QTV/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Pernit Fee:
Suppl. Insp Fee
PME Unit Fee:
$178.00
PME Permit Fee:
$45.00
Const)-tiction Tar:
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fees:
A
Travel Documentation Fee: ITRA VDOC
$45.00
Strone Motion Fee: IBSF-ISMICO
$0.50
Select an Administrative Item
Bldg, Stds Commission Fee: IRCRSC
$1.00
SUBTOTALS:
$311.50
$0.00
TOTAL FEE:
1 $311.50
Revised: 07/01/2012
CUPERTINO
12,09- 009 6
GENERAL PERMIT APPLICATION M E P
COMMUNI iY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255 W p I S C
(408) 777-3228 • FAX (408) 7i7-3333 • building0ruoerino.ora M
I�PLLINMING 7M`F(r AV,,( -AT i cr-'a tral ns,ncr Tiuznr:c
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PRCI':CTADDREss APNa
OWNER NAME / r /e D7Y(e b
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E-MAIL
S iRET ADDR=ESS
C1Y. STA c L7
FAX
CONTACT NAME G I _ I PHONE M,1y
�•Q��-�f
SrRFT ADDRESS
=.STATE. IIP
FAX
❑ OWNER ❑ OWNER -B=E! ❑ OWNER AGc CONTRACTOR ❑CON,, ACTORAOFNT ❑ ARCL FLT ❑ FNG�- ❑ OEV�'._OPR ❑ YAN
CONTaACTOR NAMc �o I e )�
llCENSE NIiM3R
LICE E
I BUS. _IC 0
COT &NrY NAME=_-MAII.
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�-[CfU31cT• l��
FAX
S7= ADDRESS oZ3=oc
4
ARCHITEC VENGacR NAME I LICENSEuUMBR
Bus. LIC a
COMPANYNAME'
I E-MAE.
FAX
STREET ADDRESS
I Cr,', STATE- ZIP
I PHONE
USE OF ❑SFD.D PL_x ❑ MULTI -FA y
BURDP'G: C.AL
I PROIECTN WILDLWD Y3 I PR=rN ❑ YEs
URBAN INTERFACE AREA NO FLOOD ZONE ❑ No
115=f BLDGMI ❑ YES
FJCF`_.R' HOME. ❑ No
DESCRIP'lON OF WORK
n e (/� X0.4 J P J2r24
TOTAL VALUATION: •ZDd
I RECEIVED BY:
By my signature below, I cert) to each of the following: I= the property owner or authorized agent to act on the pmpe ,y owner's behalf. I have read this
application and the infortnazon I have provided is cc=cL I have :rad the Description of Work and ver.;y it is acct. -ate. I agrees comply with all applicable local
ordinances and sate laws relating ildin co /yd��. I authorze representatives of Cuper'..=c :c ^tr:l:e �MGyeyideatiFc3prope.-1 for inspection pu:;3oses.
Signature ofApplicaut1Agecu I��T Date:
SUPPLEI-AENTA,L. T +TORULA -MN REQUIRED
,
OFFICEUEE ONLY
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OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ MAJOR
AEP.4fuc4ppj011.Coc revised 06PI/11