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13020124 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22000 MCCLELLAN RD CONTRACTOR; K!LL(O/v PERMIT NO:13020124 r OWNER'S NAME: ARNOLFO NITE DATE ISSUED:02/212013 OWNER'S PHONE: 4089962865 - PHONE NO: LICENCED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL - License ClassCrDes Li k_ ��B U UPGRADE(E)100AMP PANEL TO 200AMP PANEL,SAME` 21�j3 LOCATION Contractor Dam �% I hereby affirm that 1 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 farce 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 perforrnance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1500 L 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 TPN Number:35608051.00 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 180 D ERMIT 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 1 R T C LED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, q _ costs,and expenses which may accrue against said City in consequence of the [ssued by: Date: 2 '> granting of this permit. Additionally,the applicant understands and will comply _ with all non-point source regulations per the Cupertino Municipal Code,Section . 9.18. RE-ROOFS: Signature Date - All roofs shall be inspected prior to any roofing material being installed.ff a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ - - OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that[am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER . L,as owner of the property,or my,employees with wages as their sole compensation, will do the work,;arid the structure is rietintended'or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,mut 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 1 store or handle hazardous I have and will maintain a Certificate 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 Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,w provided for by the Health&Safety Code,Sections 25505,25533,and 2W4. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agemt: Date:��y�r J13 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,atter making this certificate of exemption,I become subject 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 ccrtify that I have read this application and state that the above information is 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 upon the above mentioned properly for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and'keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may 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 GENERAL PERMIT APPLICATION � O\ M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ID V 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 /I v a� M I CUPERTINO (408)777-3228• FAX(408)777-3333• buildingcuoertino.oro SC PLUMBING Q MECHANICAL aELECTRICAL ❑MISCELLANEOUS PROJECTADDRESS 2 000 �PuL Clelle'n RI APM# s os- OWNERNAME /'O l/NI IiC/ PHONFyD�f-C/p/_ _ W65/ EMAIL STREETADDPF112ZOD() $4CC�.e fah /CD CITYSTA�ft eV4)nC) ont c(SUII FAX CONTACT NAME GD t\aVn!` & L"er P/HO�`NE ) 37y/3t-�i (� �jE' Do,V e b GCZSol eV , S7REETADDRESS/S^(71 l_.t//'A [ t-M� 1 STAXA ZIP rJ CST (fir✓ FAX -7113 73 0 ❑ OWNER ❑ OWNN�ER-BUDDER ❑ OWNMAGENT E CONJRACrOR ❑CONTRACTORAGENT ❑ AIzcmTECT ❑ENmNEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME� /`TCUl�V /JCIIllon LICENSENUMBER Q 716(el) LICENSE TYPEe//, BUS.CIC# COMPANY NAME t JJ (/` El.'�MYA�a ,CM /5e,l�t-I'i LyU� V F71�i 73 (�1.�S STREETADDRESS/So'-,'I �nCe�Y �(AytQ CAU1'IT1� 64 6e&ch G/T q?h PHONE/4372_Osw ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFDnr DUPLE% ❑ MULTI-FAMILY PROJECTINWIDLAND ❑ YES PROJECT IN ❑YES ISTHEBLDGAN ❑YES BUILDING: ❑COMMERCW.///��t ,J URBAN INIMKFACEAREA 0N FLOODZONE 0N EICHLER HOMM 0N DESCRIPTION OF WORK /(�// / !O .a7hO rQr�2. zao TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authori gent to act on the perry owner's behalf. I have read this application and the information Ihave provided is correct. I have read the Description of Work and verify it is acd5rate. I agree to comply with all applicable local ordinances and state laws relating to buil 'ng construction. I a thorize representativ, uptttino to enter the above-identified propef?y for inspection pu{poses. Signature of Applicant/Agent: Date: Oc UPPLEMENTAL INFO TION REQUIRED OFFICE USE ONLY m 'ER-THE-COUNTER ❑ EXPRESS Y U ❑ STANDARD uu ❑ LARGE r: ❑ MAJOR 1EPA&cApp_1011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22000 McCLELLAN RD DATE: 02/21/2013 REVIEWED BY: MELISSA APN: 356 08 051 BP#: `VALUATION: $1,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION 1 REAP2 USE: SFD Or Duplex PERMIT TYPE: WORK UPGRADE E 100AMP PANEL TO 200AMP PANEL SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE' FEE ID QTY UNITS BP FEES Services IBELEC200 100 Amps $45 TOTALS: w ' $45..00 r tLferh. Plan Check 7Ph,,,tnib. Plzen C'hrck Elec.Plan Check 0.0 hrs $0.00 ,bfech. Permit Fee: Plumb. Permit Fee: Elec.Permit Fee: IEPERMIT Otirebfech.Insp. lumb Insp. Other Elea Insp. 0.0 Ins $45.00 Afech.Gasp.Fine: - Phunb. Insp. Feer Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(t.a Planning,Public Works,Fire,Sanitary Sewer District,School District.eta). These ees are based on therelimin in ormadon available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/l 11112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Constntction Tax: Administrative Fee: IADWN $42.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong,Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $1.00 $178.50 $0.00 N'�MTOTALFEE,1 $178.50 Revised: 01/01/2013