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11080136 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18610 STARRETT CT CONTRACTOR:TMV- PERMIT NO: 11080136 OWNER'S NAME: MARK FLANIGAN tE�FF DATE ISSUED:08/17/2011 NER'S PHONE: 4085448027 C-T�2 1 G/k PHONE NO: Cr LICENSED CONTRACTOR'S DECLARATION (_ F, / c, BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L Lic.# O 9'97d 7 F_ F_ r, //�� _ MECH RESIDENTIAL COMMERCIAL. Contractor (-� GoSf-Q CLQ�� Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: UPGRADE ELECTRICAL SERVICE 125 AMP (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:$1200 1 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 w ich this APN Number:37526029.00 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 SOF 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 DA FROM AST 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 �j granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: O 7-1 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature _Dat 7Jiv/l 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. u OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. 1 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 Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,255 ,and 5534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date• ® r C I certify that in the performance of the work for which this permit is issued,I shall 1711 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 APPLICANT CERTIFICATION Lender's Address 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 unon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION and keep harmless the City of Cupertino against liabilities,judgments, .s,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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 18610 Starrett Ct. DATE: 08/17/2011 REVIEWED BY: RDW APN: BP#: '"VALUATION: 1$1,200 Y PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK Upqrade elect. service to 125 Amp. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 125 Amps $44 TOTALS: $44.00 Elec.Plan Check 0.0 1 hrs $0.00 wx Elec.Permit Fee: IEPERMIT Other Elea Insp. 0.0 1 hrs $44.00 NOTE. Thesefees are based on the prelindnary in ormation available and are only an estimate. Contact the De t or addh7 info, FEE ITEMS (Fee Resolution 11-053 Eff, 7-l.-"11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $41.00 IADMIN `2 SUBTOTALS: $133.50 $41.00 TOTAL FEE: $174.50 Revised: 07/04/2011 CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37526029 . 00 DATE ISSUED. . . . . . . : 08/17/2011 RECEIPT # . . . . . . . . . : BS000014475 REFERENCE ID # . . . : 11080136 SITE ADDRESS . . . . . : 18610 STARRETT CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MARK FLANIGAN ADDRESS 18610 STARRETT CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM J. COSTELLO CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ----------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 1, 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BELEC200 METERS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 1, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 . 00 115 . 00 0 . 00 115 . 00 0 . 00 1EPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 287 . 50 0 . 00 287 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- - -------------- -------------------- CHECK 287 . 50 880 --------------- TOTAL RECEIPT 287 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL GENEEL PERMIT APPLICATION - MEP - COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408)777-3228 • FAX (408)777-3333 • buildina(rJcuoertino.orq MISC CUPERTIN0 1 R rl ❑PLUMBING ❑1v�C?�IICAL ELECTRICAL ❑MISCELLANEOUS U080115W v115W PROJECT ADDRES zgdlio C 7� 7APN R 2,U OT?- - OV OWNER NAME / / , P -�7 2 E-MAIL. STREET ADD S C , STATE ZIP FAX CONTACT N /' PHONE E IMAIL STREET ADDRES U TA'T� t N � �SO / L FAX �-�VOWNER ❑ OWNER-BUrIZER ❑ OWNERAGE T ❑ CONTRACTOR ❑CONTRAC;ORAGENT ❑ ARCHITECT` ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LIC .S$NUMBER LI SE TYPE BUS.LIC# C d COMPANY NAM;!jQ�,kjj(, E- �p FAX STREET ADDRESS37/ ^ STATE, PHONE ib ,o 9 Ifo 50- s5-o<:)ct ARCHITECTIENGINEER N.kME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE JSE OF ❑SFD or DUPLEX ❑ MULTI-FANCILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK .?. e, C' TOTAL VALUATION: e' d RECEIVED BY: 3y my signature belo ,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I hav provide :s correct.,.I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating uild' construc'on.' uthc ' e r esentatives of Cupertino to enter the above-identified property for inspection puiposes. Signature ofApplicant/Agent: Date: d v UPPL NTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER r ❑ EXPRESS t U ❑ STANDARD U ❑ LARGE ❑ MAJOR a 1EPMiscApp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT 1 N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: C PERMIT# //GB0/ 3 OWNER'S NAM E:XlqrkWt,-,"*,4,%, PHONE# `%6e GENERAL CONTRACTOR: � l� ^G:-li, BUSINESS LICENSE# O o 9 ADDRESS: 717 r �% t7 CITY/ZIPCODE: S'r�. M p• 9q Yo *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature ate Please check applicable subcontractor and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork 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 Tile Owner/Contractor Signature Date