13010137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10401 CASTINE AVE CONTRACTOR:MDE ELECTRIC INC. PERMIT NO: 13010137
OWNER'S NAME: MARSHALL GOLDMAN 152 COMMERCIAL ST DATE ISSUED:01/28/2013
OWNER'S PHONE: 4087388600 SUNNYVALE,CA 94086 PHONE NO:(408)738-8600
❑ - MCEINnS�ED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C Iy Lic.# 5-716 'z S SERVICE CHANGE OUT(E)200 AMP,(N).200 AMP
Contractor MOS r L1L c 2t L Date -2 a —
I hereby affirm that I 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.
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.Ft Floor Area: Valuation:$1500
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 APN Number:32641039.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct:I agree to comply with all city and county ordinances and state laws relating WITHIN 1 D YS 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 save 180 DAYS M 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
Date:
granting of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-poin source regu ations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Data / All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ - OWNER-BUILDER DECLARATION
Signature of Applicant: Dater
I hereby affirm that I am exempt from the:Contractor's License Law for one of -
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
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 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
I hereby affirm under penalty 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(a)should I store or handle hazardous
I have and will maintain aCertificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the.Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I.
performance of the work for which this permit is issued. will maintain compliance with the Vupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25505,25 33,a it 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: :
permit is issued.
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
Compensation laws of California. If after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become$object to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm 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
I certify than have read this application and state that the'above information is
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and,expenses whichmay accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10401 CASTINE AVE DATE: REVIEWED BY:
APN: BP#: `VALUATION:
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex 1REAP2
PENTAMATION
USE: PERMIT TYPE:
WORK
SCOPE
W
Nfech. Plan Check Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00'
Mech. Penult Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT
Other Meeh.ln.sp. Other Plumb Insp. Li I Other Elec.Insp. 0.0 hrs $45.00
He&Insp. Pae.', - Plumb. Insp.Fee: Elec.Insp.Fire: -
NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
Distric eta): These fees are based on the prelindna in ormadon available and are only an estimate. Contact the Dept for addn'1 info.
S
FEE ITEM (Fee Resolution 11-053 Eff 7/1/121 FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 200 amps Electrical
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $45.00 IERT<200 Services
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. FeelD Reg., 0OT 0,0 I hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Construction Tax.
Administrative Fee: IADJWN $42.00 0
Work Without Permit? 0 Yes O No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential (D
Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00 Er
$133.50 $45.00 � i, TeO,T�1LFEE ' $178.50.
Revised: 10/01/2012
GENERAL PERMIT APPLICATION 0-MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION I-�\V
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 / O y _ � '
SC
CUPERTINO (408)7773228•FAX(408)777-3333•buildinO cDcupertino.org
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CONTRACTOR NAME LICE14SENUMBER LICENSE TYPE BUS.LIC%
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COMPANY NAME E-MAIL FAX
STREEFADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF [I SM or DUPLEX EI MULTI-FAMILY PROJECT IN WDDIANO ❑ YES PROJECT IN ❑YES ISTHEBLDGAN [I YES
BUILDING []COMMERCW- URBAN INTERFACE AREA NO FLOOD ZONE El NO EICHLER HOME? NO
DESCRIPTION OF WORK
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TOTAL VALUATION: �• C) RECEIVED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro owner's behalf. I have read this
application and the information I have pro 'dad is co I. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b 1 g wnstruc n. I tborize representatives of Cupertino to enter the above-identified'property,for inspection putposes.
Signature of Applicant/Agent: Date:
z$ - 2013
SUffLEMENTAL TNFORMATION REQUIRED OFFICE Us N
M VER-THE-COUNTER
❑ EXPRESS
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❑ STANDARD
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❑ MAJOR
MEPMueApp_201 Ldoe revised 06121111
Building Department
City Of Cupertino
10300 Tone Avenue
•. C..f....... .. C.l OrAf.f_O4r�
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: JO o , `G'r4 -1/nTG (L PERMIT#
OWNER'S NAME: /hgKSHqLC PHONE#
GENERAL CONTRACTOR: Mp ELLC` ( C_ BUSINESS LICENSE#
ADDRESS: Sfz o.4S7i vE . DfL_ ITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR.F NAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL CON RACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR,. BUSINESS NAME BUSINESS LICENSE#
Cabinets & Millwor
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
ile
Owner/Contractor Signature Date