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11070137r CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10208 BARBARA LN CONTRACTOR: PERMIT NO: 11070137 OWNER'S NAME: CHRISTOPHER SINGER I j �,� ^ �? f--�e4vw i DATE ISSUED: 07/19/2011 I 0"UNER'S PHONE: 4084720905 LICENSED CONTRACTOR'S DECLARATION License Class ('�' 1'� —D Lic. # � � L f' Contractor (C Q 1�� to I hereby affirm that I am licensed under the provisions of Cha ter 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature \�X,��j?Z"4��Date /%c r� OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) 1, 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 this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, c- and expenses which may accrue against said City in consequence of the ng of this permit. Additionally, the applicant understands and will comply .. all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date. PHONE NO: BUILDING PERMIT INFO: BLDG ELECT PLUMB I— MECH RESIDENTIAL f— COMMERCIAL JOB DESCRIPTION: PANEL UPGRADE 125 AMP TO 200 AMP *SEE NOTES* Sq. Ft Floor Area: I Valuation: $1800 APN Number: 35912021.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Date: 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 Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or zed gent: �� )Date: / <T 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 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35912021.00 DATE ISSUED.......: 07/19/2011 RECEIPT #.........: BS000014102 REFERENCE ID # ...: 11070137 SITE ADDRESS .....: 10208 BARBARA LN SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: CHRISTOPHER SINGER ADDRESS ..........: 10208 BARBARA LN CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: MICHAEL A BETTNCOUR 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 1,800.00 1.00 0.00 1.00 0.00 1BELEC200 METERS 1.00 42.00 0.00 42.00 0.00 1BSEISMICR VALUATION 1,800.00 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 ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 287.50 --------------- 287.50 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building d( cupertino.orq MEP MISC I—( PLUMBING F I MECHANICAL IKELECTRICAL [:]MISCELLANEOUS 34— PROJECT ADDRESS 9049 L 44,,j - APN # 65(1 t 2. c 2_ OWNER NAME Y V wo PHO140,O � -iY E-MAIL STREET ADDRESS CI�Y�3TATE, V FAX CC C CONTACT NAME (. B� 6,0( �� P J�tEC r�� ) �f TJ E-MArI �j c ! �i% J.t= A- 9 1 r ")d1l STREET ADDRES �a a 5 A -vv IJ 5 A- T CITY STATE, ZIP L� S �-N o , 3 &`3 ,�— FAX WNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME , , E LIC EN E NUMB P LICENSE�YP lJ BUS. LIC # COMPANY NAM'660 LZl6l T2l C G�� IL E MA FAX STREET ADDRESS9,�W) � �� r _ CITY, STATE ZIP D 44_i � P OPV C .. _ n 4, / ARCHTTECT/ENGINEER NAME LICENSELNUM 3ER BUS. LIC # COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP -T-FLOOD PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑COMMERCIAL PROJECT IN WILDLAND ElYES URBAN INTERFACE AREANO PR07ECT IN YES ZONE El NO IS THE BLDG AN El YES EICHLER HOME? NO DESCRIPTION OF WORK )- TOTALVALUATION: / `J��(� RECEIVED BY: By my signature below, 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 have provided is correct.,.( have 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)ftVJion` authorize repres ves of Cupertino to enter the above -identified property for inspection pu{poses. cant/Agent: %G!� Date: c �4' ` 8 Signature of Appli/ SUPPLEMENTAL INFORMATION REQUIRED OFF( s USE ONLY ff-w OVER-THE-COUNTER c ❑ EXPRESS U U ❑ STANDARD ❑ LARGE F -i MAJOR MEPMiscApp_2011.doc revised 06121111