Loading...
13040020CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21782 LINDY LN CONTRACTOR: JOHNSTON ELECTRICAL PERMIT NO: 13040020 CONTRACTOR OWNER'S NAME: NOLAND SYLVIA 1302 LINCOLN AVE STE 204 DATE ISSUED: 04/03/2013 OWNER'S PHONE: 4082551691 SAN JOSE, CA 95125 PHONE NO: (408)266-0236 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL0 ❑ LICENSED CONTRACTOR'S DECLARATION .' License Class G —%D Lic. # REMOVE & REPLACE 125 AMP PANEL, SAME LOCATION, ' LIKE FOR LIKE -�-, Contractor JrJ��57�cs Daterl� 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 Sq. Ft Floor Area: Valuation: $900 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 APN Number: 35624025.00 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 180 D T ISSUANCE OR to building construction, and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We) agree to save IWITHIN 180. A O ' 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 Y 3 3 granting of this permit. Additionally, the applicant understands and will comply e: with all non -point source er the Cupertino Municipal Code, Section 9.18. /Coy / y RE -ROOFS: Signature — Date i / 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: Date: 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 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 Cuper#Ro7unicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as,provided for by the Health & Safety Code, Sections 2 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: /l 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 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 Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my pians 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 �MEP COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION .10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CI PEEtTIN© (408) 777-3228 • FAX (408) 777-3333 - building5CUDertino.orgmisc ( V ❑PLUMBING ❑MECHANICAL P<ECTRICAL []MISCELLANEOUS I!P , w / PROJECTADDRESS ('rj / � G Z / / /(/ �I , / APN# Z _ O OWNERNA1vIEG�/(4 Ila -120 S PHO7\ �—s- —u j� q1 E 7 7- STREETADDRESS CITY, STATE, ZIP F CONTACT NAME PHONE E-MAIL > d STREET ADDRESS CITY, STATE, ZIP FAX Ef OWNER ❑ owNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRALTO AM LIC SE NUMBERLICEII'SE TYPE x'70 BUS. LIC # COMPANY NAME 4V4AZWG[G� moi' E-MAIL FAX STREET ADDRESS oa G�Gcr�w CITY3, ST s: PHOTS ARCHITECT/ENGDIEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME ' E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF WeOb . DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA PROJECT IN ❑ YES FLOOD ZONTE IS THE BLDG AN ❑ YES EICHLER HOME? DESCRIPTION OF WORK TOTAL VALUATION: RECEIVE By my signature below, I certify to each of the follo application and the information I have provide co ct. ordinances and state laws relating to buil ' c s Signature of Applicant/Agent the property owner or authorized agent to act on the o mer's beh I have read this ave read the Description of Work and verify it is acc te. I gree to com with all applicable local I authorize representatives of Cupertino to enter the ab a -id tified propelTy for inspection puiposes. /3 Date:F-�w PLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY VER -THE -COUNTER ❑ EXPRESS U V U ❑ STANDARD ❑ LARGE ❑ MAJOR MEPA1iscApp_2011.doc revised 06121/11 gou CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 21,782 LINDY LN DATE: 04/03/2013 APN: 356 24 025 BP#: REVIEWED BY: MELISSA *VALUATION: $900 *PERMIT TYPES Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex BP FEES PENTAMATION PERMIT TYPE: 1 REAP2 .WORK REMOVE & REPLACE 125 AMP PANEL SAME LOCATION LIKE FOR LIKE SCOPE PME Plan Check: APPLIANCE / EQUIP TYPE FEE ID QTY/FEE MISC ITEMS QTY UNITS BP FEES S11PI) . P(.' Fee? Services 1BELEC200 PME Plan Check: 125 Amps $45 Supx)l. Insp Fee PME Unit Fee: $45.00 PME Permit Fee: Xk,ch. Plan Ckieck PhmiL Plan Check Elec. Plan Check 0.0 1 hrs $0.00 biech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT l)ther ;llech. Imp. Other Plumb Insp.EIF-t- Other Elec. Insp. 0.0 hrs $45.00 dfech. Insp. Fee: Plumb. hisp. Fee: Elec, Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). Thesefees are based on the prefimina information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check F'ee: S11PI) . P(.' Fee? PME Plan Check: $0.00 Perm it .Fee: Supx)l. Insp Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? ® Yes (E) No $0.00 Aclvancecl Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 b. _�.. `.. $178.50 s '� ivE:tF»'=SRA'eT�1 lTM3 ��� $0.00 �E $178.50 Revised: 04/01/2013