13030084CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10092 MANN DR CONTRACTOR: S PERMIT NO: 13030084
I OWNER'S NAME: DENNIS WIANTMAN I 1 DATE ISSUED: 03/15/2013 1
OWNER'S PHONE: 4083202392 1. I PHONE NO:
19 LICENSED CONTRACTOR/'S DEECLARATION
License Class C �� 10 Lic. # Q t Qj 7 �'6
Contractor (TL G l & Date 17
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.
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.
APPLICANT CERTIFICATION
I certify 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 property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additio lly, the applicant understands and will comply
with all non -point source reg ons per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or thi&permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county 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,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature Date
JOB DESCRIPTION: RESIDENTIAL
REPLACE (E) 100 AMP EL PANEL, SAME LOCATION
Sq. Ft Floor Area: I Valuation: $1500
APN Number: 32419004.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAY IT ISSUANCE OR
180 DAY LAS LLED INSPECTION.
RE- ROOFS:
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.
Signature of Applicant:,
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Q ality Management District I
will maintain compliance with the Cupertino Zr Mu pal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25595, 2553 , nd 25534.
Owner or authorized agent: Arx Jr/ – ' Date: S —1
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
ER AP
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION D MEP
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 rr--��
(408) 777 - 3228 • FAX (408) 777 -3333 • building Mcuoeriin V
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F-1 PLUMBING nMECHANICAL 5ifELECTRICAL ❑MISCELL.ANEOUS
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❑ OWNER ❑ OWNER. BUILDER ❑ OWNERAGENT
WICIZACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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COI•�TRACTOR NAME K` . t �`L C
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LICENSE NUMBE
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COMPANY NAME K11 1WS 7r { C
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PHONE
ARCHI=/ENGINTEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME '
E -MAIL,
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX ❑ MULTI- FAMII.Y
BUILDING: ❑ COM'MERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN YES
FLOOD ZONE O
IS THE BLDG AN ❑ YES
EICHLER HOME? O
DESCRIPTION OF WORK �Q e
` M
TOTAL VALUATION: O
RECEIVED BY:
By my signature below, I certify to each of the following: the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have prop ided i correc I ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building co cti authorize representatives of Cupertino to enter the above - identified propei& for inspection putposes.
Signature of Applicant/Agent: x ` Date: A 3 r- (57— l
SUPPLEMENTAL
INFORMATION REQUIRED
OFFICE USE ONLY
OVER- THE�COUNTER
EXPRESS
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U
❑ STANDARD
❑ LARGE
❑ MAJOR
MEPA&cApp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Services JBELEC200 100 Amps $45
TOTALS: $45.00
{
Lech. Plan Check
.ilech. I'c>rrnit Fee
t)the r ,11ech. Insp.
ltech. Insp. Fee:
Phrrnb, Plan Check
Plumb. Permit ree:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec. Plan Check 0.0 1 hrs $0.00
Elec. Permit Fee: 1EPERMIT
Other Elec. Insp. 0.0 hrs $45.00
Elec. Insp. Fee: .
NOTE: This estimate does not include fees due to other Departments (i e. Planning, Public Works, Pire, Sanitary Fewer District, school
District, etc). These-fees are based on the pralimina information available and are only an estimate Contact the De t or addn7 info.
10092 Mann Dr
DATE: 03/15/2013
REVIEWED BY: Sean
JimADDRESS:
APN:
BP #:
*VALUATION: 1$1,500
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
PENTAMATION
PERMIT TYPE: 1 REAP
WORK
Remove and re lace main electrical service 100 amp).
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Services JBELEC200 100 Amps $45
TOTALS: $45.00
{
Lech. Plan Check
.ilech. I'c>rrnit Fee
t)the r ,11ech. Insp.
ltech. Insp. Fee:
Phrrnb, Plan Check
Plumb. Permit ree:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec. Plan Check 0.0 1 hrs $0.00
Elec. Permit Fee: 1EPERMIT
Other Elec. Insp. 0.0 hrs $45.00
Elec. Insp. Fee: .
NOTE: This estimate does not include fees due to other Departments (i e. Planning, Public Works, Pire, Sanitary Fewer District, school
District, etc). These-fees are based on the pralimina information available and are only an estimate Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Cheep lice:
sZppl. PC Fee.
PME Plan Check:
$0.00
Permit .Fee:
, ZljJvl. Itas() I'ee
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: IADMN
$42.00
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item .
Bldg Stds Commission Fee: IBCBSC
$1.00
$178.50 $0.00 $178.50
Revised: 01/01/2013