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11100036 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7998 WOODLARK WAY CONTRACTOR:MAINE ELECTRIC INC PERMIT NO: 11100036 OWNER'S NAME: BRADLEY JACK TRUSTEE&ET AL 2013 RESEARCH DR DATE ISSUED: 10/06/2011 OWNER'S PHONE: 4084464391 LIVERMORE,CA 94550 PHONE NO:(925)443-3377 L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# !&27G 2 5-0 _ ,NC MECH RESIDENTIAL r COMMERCIAL� Contractor �� LDate 0_�c t t JOB DESCRIPTION:SERVICE UPGRADE,REPLACING 100AMP METER MAIN I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions WITH 100AMP SERVICE 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 Sq.Ft Floor Area: Valuation:$4500 permit is issued. APPLICANT CERTIFICATION APN Number:36204034.00 Occupancy Type: 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations pe a Cupertino Municipal Code,Section 9.18. ,' Issued by: — Date:/�_`Signature Date C7/ I— OWNER-BUILDER DECLARATION RE-ROOFS: 1...reby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Se: ns 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,Ibecome subject to the Worker's Compensation provisions of the Labor Code,I must Owner o r' d forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the ;ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36204034 . 00 DATE ISSUED. . . . . . . : 10/06/2011 RECEIPT #. . . . . . . . . BS000014961 REFERENCE ID # 11100036 SITE ADDRESS 7998 WOODLARK WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BRADLEY JACK TRUSTEE & ET AL ADDRESS . . . . . . . . . . : 7998 WOODLARK WAY CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM MARK JOHNSON CONTRACTOR SCOTT MAMOLA LIC # 32671 COMPANY . . . . . . . . . . : MAINE ELECTRIC INC ADDRESS 2013 RESEARCH DR CITY/STATE/ZIP . . . : LIVERMORE, CA 94550 TELEPHONE . . . . . . . . : (925) 443-3377 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 4, 500 .00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 4, 500 . 00 0 .50 0. 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1.00 44.00 0 .00 44 .00 0 .00 1ERT<200 UNITS 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 174 .50 0. 00 174 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 174 . 50 VISA --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(Q-cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN#7cl � p `l (/JcPHONE /l�OWNERNAME orad 9,/i~1 E-MAIL L TSTREET ADDRESS -1q l \'400d4-- 00 ICI , STAB,ZIP M o m FAX CONTACT NAME �w�i10 ONE I l n E-MAIL -T STREET �Q p c�-� ITY,STAT;`IP Cal- ' FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT IQ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA NAJNE LICENf NUMB IELRLICENSE TYPE BUS.LIC It COMPANY NAME /14 1 //I I I I E-MAIL FAX I STREET ADDRESS 'a qcf teF S��C 5 7- CIT ,STATE, �� 0. 7 L!��, 2� /C/2 -3) / 7 ARCHITECT/ENGINEER NAME LICENSE NUMBER ! BUS.LIC# T J COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK r r � l P IACIA lC)V^1 4[4sett' GJ'1 Wi/4 160 .4442 EXISTING USE PROPOSED USE CONSTR.TYPE 1 #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER / REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TO L VALUATION: PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO % l� cu— By my signature below,I certify to each of the following: I am the operty owner or authorized agent to act on the property owner's I f. I have read this application and the information 1 have provided is correct. I ha ead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil c struction. uthorize representatives of Cupertino to enter the above-identifi pr perty for inspection purposes. Signature of ApplicanUAgent: Date: /CJ 6 SUPPLEMENTU INYORMATION REQUIRED PLAN CHECK TYPE �—ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit forHE COUNTERBLT un DnvG PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. 1 ❑ EXPRESS ❑ PLANMNG PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT ubmittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7998 woodlark way DATE: 10/06/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $4,500 PPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK service upgrade. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $44 TOTALS: $44.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT Other Elec.Insp. EE hrs $44.00 NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the relirrsna information available and are onlyan estimate. Contact the De pifor addn'[info, FEE ITEMS (Ii>e Resohition 11-05 Eff ' jjj FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 F-7 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Administrative Fee: 1ADMIN $41.00 Work Without Permit? 0 Yes (E) No $0.00 Travel Documentation Fee: 1 TRA VDOC $44.00 Stroh 7 Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldy,Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: $174.50 Revised: 10/01/2011 Building Department City Of Cupertino La 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 7 'K WOO 0LA r',K U/4 Y PERMIT#'I (--) 0 OWNER'S NAME: JAS UAB PHONE# Z S 7 V(f3, 3 3 7 7 GENERAL CONTRACTOR: Mf}IIVL (C C 7�7(C M6 BUSINESS LICENSE# O 2 SCJ ADDRESS: 6tl5Q lab- CITY/ZIPCODE: C( '155-t *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY IN ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBC NT TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors an complete the following information: V 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