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11040127 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22045 WALLACE DR CONTRACTOR:A.DARIANO PERMIT NO: 11040127 CONSTRUCTION OWNER'S NAME: COCKERILL KAREN R PO BOX 254 DATE ISSUED:04/19/2011 ER'S PHONE: 6504986052 CAMPBELL,CA 95009 PHONE NO:(408)258-7143 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 7 S 0 t 1 3 MECH RESIDENTIAL COMMERCIAL Contractor,-. k�V4sv J Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UPGRADE SERVICE PANEL TO 200AMPS (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 rovided for by Section 3700 of the Labor Code,for the performa the work for which this permit is issued. I haill maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$1500 4e i 3 0 of the Labor Code,for the performance of the work for which this p it is issued. APN Number:32602037.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by: ��` _ Date: %':� �' el Signature� �-s�—'— Date—vi°r 11 L OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 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 I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 09kner or author agent: L become subject to the Worker's Compensation provisions of the Labor Code,I must �"��/ 3pdage Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of mrk's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address i• " -nnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22045 wallace dr. DATE: 04/19/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$1,500 °PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: I I PERMIT TYPE: WORK up rade service panel to 200 amps. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 200 Amps $42 TOTALS: $42.00 T7Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: ]EPERMIT LjOther Elec.Insp. 0.0 hrs $42.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS(Pee Resolution 09-051 Ejf. 7/1.,"10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: 1 $127.50 Revised: 01/15/2011 CITY OF CUPERTINO 5 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32602037. 00 DATE ISSUED. . . . . . . : 04/19/2011 RECEIPT #. . . . . . . . . : BS000013221 REFERENCE ID # • . . 11040127 SITE ADDRESS . . . . . : 22045 WALLACE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : COCKERILL KAREN R ADDRESS . . . . . . . . . . : 22045 WALLACE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : A DARIANO CONSTRUCT CONTRACTOR . . . . . . . : ANTHONY DARIANO LIC # 29843 COMPANY . . . . . . . . . . : A. DARIANO CONSTRUCTION ADDRESS . . . . . . . . . . : PO BOX 254 CITY/STATE/ZIP . . . : CAMPBELL, CA 95009 TELEPHONE . . . . . . . . : (408) 258-7143 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 500. 00 1.00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 1, 500. 00 0.50 0. 00 0 .50 0.00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 .00 0.00 1ERT<200 UNITS 1.00 42 . 00 0. 00 42 .00 0.00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0.00 42 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127.50 0. 00 127.50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO RECEIPT NUMBER: BS000013221 RECEIVED BY: PAT PAYOR: A DARIANO CONSTRUCT TODAY'S DATE: 04/19/11 REGISTER DATE: 04/19/11 TIME: 09:47 6 1BCBSC 11040127 $1. 00 1BSEISMICR 11040127 $.50 1EPERMITFE 11040127 $42. 00 1ERT<200 11040127 $42. 00 1TRAVDOC 11040127 $42. 00 BUSINESS LICENSE TAX RNEW-A. DARIANO $115. 00 ---------------- TOTAL DUE: $242 .50 CHECK $242.50 REF NUM: #5930 TENDERED CHANGE $242 .50 $ .00 Building Department City Of Cupertino 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: PERMIT# OWNER'S NAME: PHONE# e35--I fd d9�� GENERAL CONTRACTO ,., BUSINESS LICENSE# S� /� wrce CITY/ZIPCODE: ADDRESS: 5Ve *Our municipal code requires alf businesses wof king 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 subcontractors 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 ilc�-j oIZ� GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 - CUF'ERTINO (408)777-3228• FAX(408)777-3333•buildingncDcupertino.org misc ❑PLUMBING ❑MECHANICALELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESSO 45 �C APN N 2 n �1 e_k OWNER NAME ` I / , PHONE - -%-6652 i 6 5 2 E MAIL �V2c c Ifs S) "iIs--v � 66a e0— ht o. STREET ADDRESS A.n 0 4-P5 LA) A- l VVc` CITY.STATE,ZI e , FAX CONTACT NAME / PHONE . ��5 E-MAIL STREET ADDRESS STATE,ZIP FAX CI�cD S q C_ � �c C R 6 e c j ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrEcT ❑ENGINEER ❑ DEVELOPER ❑TENANT -7 CONTRACTOR NAME A ,l d /l p � 5 j i LICENSE NUMBER L� LICENSE TYPE S,> BUS.LIC# '' COMPANY NAME 4✓ 1 /`t �L �}`a/ 1 J1 E-MAIL FAX STREET ADDRESS LLI y0� CITY.STATE,ZIP ,1 PHONE C �� ARCHTTECT/ENGINHER NAME LICENSE NUMBER c p� („ BUS.LIC 9 G COMPANY NAME E-MAIL FAXy STREET ADDRESS / 2 1 j C y-C L (�� CITY,STATE,ZIP �j� �� PHONE j r < "T / C /7 R c r5i � - '16Y�3�i JSE OF ❑ SFD or Duplex ❑ Multi-Family PROTECT 1N WILDLAND PROJECT IN STRUCTURE: C] Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE C3Yes C1No DESCRIPTION OF WORK +L� 20 TOTAL VALUATION: / " RECEIEI B1C z r 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. 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 to building construction. I authorize represe`ntativcruna to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE 0RMATION REQUIRED r _ A' ............ MEPMuc4pp_2011.doc revised 03/16/11