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11060016 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10431 CORTE DE MADRID CONTRACTOR:DALCON,INC. PERMIT NO: 11060016 OWNER'S NAME: JOAN JONES 757B CHESTNUT ST DATE ISSUED:06/02/2011 OWNER'S PHONE: 4082573721 SAN JOSE,CA 95110 PHONE NO:(408)298-1690 I� LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT� PLUMB License Class Lic.# [ �D MECH F RESIDENTIAL COMMERCIAL Contractor A.`C r 1,�,KL• Date "�Z"" "1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE EXISTING 150AMP MAIN PANEL AND 100 AMP (commencing with Section 7000)of Division 3 of the Business&Professions SUBPANEL Code and that my license is in full force and effect. IKLI I hereby affirm under penalty of perjury one of the following two declaraASns: 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:$3000 permit is issued. APPLICANT CERTIFICATION APN Number:35705003.00 Occupancy Type: 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 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 per the Cupertino Municipal Code,Section 9.18. 6-2-11 Signature — Date Issued by: Date:6"';p r OWNER-BUILDER DECLARATION RE-ROOFS: I hereby 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 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 HAZARDOUS MATERIALS DISCLOSURE 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 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,Sections 25505,25533,and 25534. 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 Ownerry authorized ent: r forthwith comply with such provisions or this permit shall be deemed revoked.—Dater t APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 co-,.and expenses which may accrue against said City in consequence of the ig of this permit.Additionally,the applicant understands and will comply �A all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35705003 . 00 DATE ISSUED. . . . . . . : 06/02/2011 RECEIPT #. . . . . . . . . BS000013641 REFERENCE ID # . . . : 11060016 SITE ADDRESS . . . . . : 10431 CORTE DE MADRID SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER JOAN JONES ADDRESS . . . . . . . . . . : 10431 CORTE DE MADRID CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DALCON, INC CONTRACTOR . . . . . . . : DAVID LEE LIC # 24157 COMPANY . . . . . . . . . . : DALCON, INC. ADDRESS . . . . . . . . . . : 757B CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 298-1690 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 0 .50 39. 00 0. 00 39. 00 0. 00 1BCBSC VALUATION 3, 000 .00 1 . 00 0 . 00 1 .00 0 . 00 1BSEISMICR VALUATION 3, 000 . 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 2 .00 84 . 00 0 . 00 84 .00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 208 .50 0 . 00 208 .50 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 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: Q PERMIT OWNER'S NAME: Q ws PHONE# GENERAL CONTRACTOR: 11 BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: 41 ace ?L 57 It *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 CIT//Y�� OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and 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 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10431 Corte de madrid DATE: 06/02/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$3,000 R'PERMITTYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK replace 150 amp main panel and 100 amp sub panel. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 150 Amps $42 Services 1 ERT<200 100 Amps $42 TOTALS: $84.00 Elec.Plan Check 0.0 1 hrs $0.00 Elec.Permit Fee: ]EPERMIT Other Elec.Insp. hrs $ 0.0 42.00 NOTE: These ees are based on the preliminary in ormation available and are only an estimate. Contact the Det or addn'l in o. FEE ITEMS 0h' e Resolution 09-051 f,,f. T,[,10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $84.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg, Stds Commission Fee: IBCBSC $1.00 $39.00 IADMIN SUBTOTALS: $169.50 $39.00 TOTAL FEE: $208.50 Revised: 04/29/2011 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333 •building(cDcupertino.org misc CUPERTlINO ❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 'O/1 � 6APN !� �j {"1 / 3 OWNER NAME �00o'. � �w PHONE C-7 E-MAIL STREET ADDRESS ` 0( 1 L or CITY• STATE,�U�`_� � 6(SQ tU FAX CONTACT NAME abut v c�� PHONE�y C �E-MAIL STREET ADDRESS ?5-7 C1TY•ST//ATE ZIPc _ \ 6� A ��i\ FA C ❑OWNER ❑ OWNER-aUILOER ❑ OWNER AGENT ❑ CONTRACTOR 2 CONTRACTOR AGENT ❑ ARCHITECT ❑•ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME0��C O �,� p LICENSE NUMBERF�R L� ( r LICENSETYPEC(O BUS.LIC N CONTANY NAME T O�/'/�•• `/ E ZM W n' Q ('� / �.C.Q FAX STREET ADDRESS 1!0 j t� V�7 CITY,STATE.ZIP 5c"3 tS e--) PHONE(J F 7 j Zq� ! C(6 ARCI IITECTIENGINEER NAME `J LICENSE NU[vIDER BUS.LIC# (J 'v COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 1SE OF ff"SFI)or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN rRUCTURE: ❑ Commercial URBAN II14TERFACE AREA ❑ Yes Cl No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK S II amp t o o TOTAL VALUATION: O0 CE1 "`?"l , 2 -. 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 tobuilding tion o . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/AgenC Date: SUPPLEMENTAL INFORMATION REQUIRED &ffFWucApp 2011.doc revised 03/16/11