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12090055CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22221 MC CLELLAN RD CONTRACTOR: CITY OF CUPERTINO PF-RMIT N0: 12090055 OWNER'S NAME: CITY OF CUPERTINO MC CLELLAN RD DA'Z'E ISSUED: 09/10/2012 OWNER'S PDONE: 4087773407 CUPERTINO. CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG C ELECT rl PLUMB r License Class C — / v Lic. 4 Z170 r Cl CODIDIERCIAL Contractor /CJ2 Date DIECII RESIDENTIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVECURRENT 200 AMP MAIN ELECTRICAL MErr-R (commencing with Section 7000) of Division 3 of the Business & Professions AND SEPAREPLACE WITH A SINGLE 200 BRrAKERL100934 Code and that my license is in full force and effect. AMP METER PANEL-PG&E 4TE 81 I 1 hereby affirm under penalty of perjury. one of the following r"a 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. I 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 permit is issued. Sq. Ft Fluor Area: Valuation: $5000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above informmion is APN Number. 35706018.00 Occupancy Type: correct. 1 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date e% Issued by: �Ei9n/ Date: %•!O'/a .R&04 fT�%� ❑ OWNER-BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material beiig installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without Drs( obtaining an inspection, 1 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, am exclusively contracting with licensed contractors to Signature of Applicmt: Date: construct the projeco(Sec.7044, Business &Professions Code). ALI. ROOF COVERINGS TO RE CLASS "A" OR 1 E ITER 1 hereby affirm tinder penalty of perjury one of (he following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE: Compensation, its provided for by Section 3700 of the Labor Code, for the perfommnce 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 Health & Safety Code, Sections 255115, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the health & Section 3700 of the Labor Code, for the cr(ormance of the work for which this p Safety Code, Section 25532(8) should I store or handle. hazardous material. permit is issued. Additionally, should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work forwhich this permit is issued, I shall contaminants as defined by the Bay Area Air Qualify Management District I will not employ any person in any manner so as to become subject to die Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and (he Compensation laws of California. If, alter making this certificate of exemption, I I leallh & Safety Code, Sections 25505, 25533• and 25534. 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. O r nr au(I oriiFd agent: /G T_ Date: 5' r APPLICANT CE RTIFICATION CONSTRUCTION LENDING AGENCY I certify.tha( I have read this application and slate that the above information is correct. I agree to comply with all city and count)' ordinances and state Imes relating I hereby affirm (hat (here is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which 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 harmlcssthe City of Cupertino against liabilities,judgnments, 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 Cupertino Municipal Code, Section ARCIIITECI'•S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 7i//-3333 • buildinalcDcuoedino.cra I PLUINM ENG —,mEc--kNICaL. IJUELE=CAL FTvjc= l Arrcnrrc Z-�s MEP MIST PROJECT ADDRESS AFNa / /^ D /^ O /[�[J— (�Vr OWNER NAME C, Yo� CG ,2 /Ncl 77 7 " 4/07 I/ EMARnIV ST??Ec7 ADORE' / c� 2R e A /iJ oo / �e CT S Ar- ZIP /'� C� z �'/�l�-777- FAX %9 CONTAC7 NAME (� // \\ W /AJXt .L -J 140 -.?Os -d'd36 e�a},�a. ,a /c'er�22 �`% �C J P?��Nb_ C' , STREcz ADORES!, CI Y, STATE, ZIP FAX ❑ OWNER ❑ CW 'BUILDM ❑ OWN' AGEY; ❑ CONTRACTOR ❑CON, COR AGE+T ❑ ARCNJTECT, ❑ ENGD - ❑ DEVELOPER ❑ iv.'-NANT CONTRACTOR NAME /cot E/ L'CENSE NL:M3 O Z O L1C�uSE j`�7E 9US. liC: P"n� Z/70/ COMPANY NAME /CG.2 /— /P G E-MAB.FAX L_/coir e%c/,e/C14 - 90% - 1325' S i R):.TT ADDRESS iATE 3 I o ,6 rn st. GTPA ,.. �A c/A� A 9-soS'Y PHONE I •� - 5� - i3� o ARCHITCT/E4G1NEEi NAME N lA LICENSE NUNHER I BUS. LC 4 COMPANY NAS ' I E-MAIL I FAX STREET ADDRESS I CITY STA:: ZIP I PHONE BUT-DING:'f.OMMERC]AJ. ❑ MU1Tt-FA�.Y U APROJECTBJTFJIFAC. AREA ❑ NO PROJECT IN I FLOG ZD ONE 0I ECHLEI HOMEl NO DESCRUMON OF WORK Re owe- coRRP MA/�j elec R/c4l rre%Q'e Amo/ re 6JekP? P,4NeI . Re /gee. C,., t�17 A s/� le e]oo q.+ rre%.e /7 /'6c Me�A loa�3y� d'/J TOTAL VAL UATION: S ODO I RECEIVED BY: F ^r 1behhal`. By my signamra below, I certify m each of Lye :allowing: lam the proper; j owns, or authorized agent to act on die propery ownei s I have read dus application and the iniormaaor. I have provided is cored 1 ve .—a the Desripaon of Work and verify is is accuram. [ agu to comply with all applicable local ��edpt/y,^F-.;j for inspection puipescs. ordinances and sate laws relating m lding cors aZ' n. authorirl represe-taCve pertmc :_ ene: the above-ideau//0/./ Signature of Applicam/Ag=t: Date: 9 /' O/ . -Z SUPPLENENT'AL INFMR N REQMED OFFICE USE ONLY v i 's u U a OVER-THE-COUNTER EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR rMEP.Wuc.4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO lye//I FEE ESTIMATOR -BUILDING DIVISION L. ADDRESS: 22221 McClellan Road DATE: 09/10/2012 REVIEWED Bl': Sean UNITS APN: BP#: 'VALUATION: $5,000 *PERMIT Tl'PE: Electrical Permit PLAN CIIECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps PENTAMATION 1REAP2 PFRMIT TI'PE: (YORK Remove current 200 am main electrical meter and separate breaker panel. Replace with a single 200 SCOPE amp meter panel. APPLIANCE/ EQUIP TYPE FEE ID Plumb. Plan Cheek QTY UNITS BP FEES Dec. Permit Fee: 1EPERMIT Services 1ERT<200 Other Elec. Insp. 0.0 hrs $45.00 200 Amps $45 Permit Fee: .Supp/. Insp Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Cmtsn•uction Tar: Administrative Fee: ]ADMIN $42.00 Work Without Permit? O Yes (j) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: /BSE/SAIICR NOTE: This estimate does not include jeer clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirr. etc ). These fres are haled as the nreliminan, information available and are adv an estimate Contact the Dent for addn7 info. FEE ITEMS (Fce Resoluiat 11-053 Elf 77111 /) Mech. Plan Check Plumb. Plan Cheek Elec. Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: Plumb. Permit Fee: Dec. Permit Fee: 1EPERMIT Other Mech. Insp. Other Plumb /n.cp. Other Elec. Insp. 0.0 hrs $45.00 Mech. buy. Fee: Plumb. btsp. Fes: Elec, Insp. Fee: NOTE: This estimate does not include jeer clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirr. etc ). These fres are haled as the nreliminan, information available and are adv an estimate Contact the Dent for addn7 info. FEE ITEMS (Fce Resoluiat 11-053 Elf 77111 /) 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 Cmtsn•uction Tar: Administrative Fee: ]ADMIN $42.00 Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: /BSE/SAIICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $178.50 $0.001 TOTAL FEE: $178.50 Revised: 07/01/2012