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11060232 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18950 BARNHART AVE CONTRACTOR:MAINSTREAM ELECTRIC PERMIT NO: 11060232 OWNER'S NAME: DEBBIE&STEVE STEFANKO 1505 KELLY PARK CIR DATE ISSUED:06/30/2011 OwNER'S PHONE: 4086246363 MORGAN HILL,CA 95037 PHONE NO:(408)776-3410 L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 1-4 MECH j— RESIDENTIAL r COMMERCIAL Contractor �tntda W—abrye �( I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COURTESY LIFE SAFETY INSECTION FOR FIX ELECTRIC (commencing with Section 7000)of Division 3 of the Business&Professions PANEL(UPGRADE/REPLACE EXISTING SERVICE PANEL) Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two decla ti 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 Sq.Ft Floor Area: Valuation:$2000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37533005.00 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 Cu rtino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which ma accrue ag 2 et said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this perm' . Ad io y plwant understands and will comply with all non-poi o cc ti r e Cupertino Municipal Code,Section 9.18. y / Issued by: Date: Signatur Date Yaj—V V l r 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. 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, 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I 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 deb d by the ay Area Air Quality Management District I will permit is issued. maintain complia wittti Cup ino 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 de ec ons O5,25533,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 Own or r' ed e become subject to the Worker's Compensation provisions of the Labor Code,I must Date: I 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 work'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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, co— and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ig of this permit.Additionally,the applicant understands and will comply H. _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 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# 2 Z� OWNER'S NAM : �� S - PHONE# a GENERAL CONTRACTOR: s eta BUSINESS LICENSE,# ADDRESS: if f-2O -,� t�,, CITY/ZIPCODE: ri ; *Our municipal code requires alf businesses working in the city to have a City of Cuperti 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 Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Ca nets & Millwork ement Finishing Electrical5le- C14,C 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 Owne ontractor Signature Date CITY OF CUPERTINO 7 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37533005. 00 DATE ISSUED. . . . . . . : 06/30/2011 RECEIPT #. . . . . . . . . : BS000013936 REFERENCE ID # . . . : 11060232 SITE ADDRESS . . . . . : 18950 BARNHART AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DEBBIE & STEVE STEFANKO ADDRESS . . . . . . . . . . : 18950 BARNHART AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SHANE L HALSTAD CONTRACTOR . . . . . . . : SHANE HALSTEAD LIC # 30545 COMPANY . . . . . . . . . . : MAIN STREAM ELECTRIC ADDRESS . . . . . . . . . . : 1505 KELLY PARK CIR CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037 TELEPHONE . . . . . . . . : (408) 776-3410 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 2, 000. 00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 2, 000. 00 0 .50 0. 00 0 .50 0 . 00 1ELECINSP HOUR 1. 00 126 . 00 0. 00 126 . 00 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 292.50 0. 00 292 .50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 18950 barnhart ave. DATE: 06/30/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$2,000 'PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK courtesy life-safety inspection of existing electrical panel, upgrade main panel tp 125 amps. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $42 TOTALS: F $42.00 - I T Elec.Plan Check 0.0 1 hrs $0.00 - 777 , Elec.Permit Fee: IEPERMIT Other Elea Insp. 1.0 hrs $42.00 Elec.Insp.Fee: IELECINSP $126.00 NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-05/ liff' "I%I0) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $168.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 i Strong Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldi>Stds Commission Fee: IBCBSC $1.00 $39.00 IADMIN SUBTOTALS: $253.50 $39.00 TOTAL FEE: $292.50 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(d)cupertino.org MISC CUPERTiNO F]PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS D n j i� APN#­2"7:5 S OWNER NAME " J I' PPHONE// MAIL v � • STREET ADDRESS CITY, STATE,ZIP --[FAX CONTACT NAMEDo(A J, rf- PHONE/,© STREET ADDRESS O //` CITY,STATE, ZIP joje i�f ❑OWNER OWNER-BUIl DER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT El ARCHITECT ElENGINEER 1:1DEVELOPER ❑ TENANT CONTRACTOR NAME � � LICENSE NUMBER LICENSE TYPE BUS.LIC# ,y J L COMPANY NAME z ry E-MAIL FAX STREET ADDRESS / 4 /\ + ,STATE,ZIP Q (I1 C ARCHITECT/ENGINEER NAME LICENSE NUMBERLi BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY I 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 /` , 1= J Aa-4, /W� s � TOTAL VALUATION: RECEIVED BY: By my signature below, certify to each of oll ing: I e p pe owner or authorized agent to act on the property owner's behalf I have read this application and the information I have pro d i rrect. a re t Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b c cti uth z repre tatives of Cupertino to enter the aj e- enti grope for i spection putposes. Signature of Applicant/Agent: Date: � SUPPLEMENTORMXTION REQUIRED OFFICE USE ONLY 13—OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD ; ❑ LARGE V J ❑ MAJOR MEPMIscApp_2011.doc revised 06121111