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11060012
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10620 CULBERTSON DR CONTRACTOR:3D DATACOM PERMIT NO: 11060012 OWNER'S NAME: WRIGHT MARK B E AND MAN-WAI 11365 SUNRISE GOLD CIR DATE ISSUED:06/02/2011 OWNER'S PHONE: 4082030942 RANCHO CORDOVA,CA 95742 PHONE NO:(925)455-1884 Li LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class(--10,&7 Lic.# 7.57 15-7 "19/a MECH RESIDENTIAL COMMERCIAL Contractor .3'b <a CCsrr) Date /1; I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL NEW ELECTRIC SERVICE METER ENCLOSURE (commencing with Section 7000)of Division 3 of the Business&Professions FOR CAR CHARGER.PERMIT FOR METER ENCLOSURE ONLY, Code and that my license is in full force and effect. CHARGER BY OTHERS. 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. Sq.Ft Floor Area: Valuation:$2692 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:37534031.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DA ROM LAST CALLED INSPECTIO . 9.18. / // Signature c�C, Date /Z Issued by: � Datet,J_77 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 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 I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must t�o ized a e �ivau forthwith comply with such provisions or this permit shall be deemed revoked. Date: 10 r APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the Lender's Address .ng of this permit.Additionally,the applicant understands and will comply �:...�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 FEE ESTIMATOR-BUILDING DIVISION F.0 ADDRESS: 10620 Culbertson Dr. DATE: 06/02/2011 REVIEWED BY: jsg APN: BP#: '"VALUATION: $2,692 °PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY -j SFD or Du lex PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK Install new elec service meter enclosure for car charger. Charger by others. Permit for meter enclosure SCOPE only. APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $42 TOTALS: $42.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: ]EPERMIT Other Elec.Insp. 0.0 hrs $42.00 NOTE: These fees are based on the preliminary information available and are onl an estimate. Contact the Dept for addn7 info. FEE ITEMS jF'ee Resolution 09-OSI F..tf. 7,-1.'']O) 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 E) No $0.00 Travel Documentation Fee: IIRA VDOC $42.00 A Strong Mention Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $39.00 ]ADMIN SUBTOTALS: $127.50 $39.00 TOTAL FEE: $166.50 Revised: 04/29/2011 ArsiffAwomCalifornia Contractor's License# 757157 195 Contractors St., Livermore, CA. 94551 June 2, 2011 City of Cupertino 10300 Torre Ave. Cupertino, CA 95014 RE: Authorization to apply for Cupertino Business License&Permit To whom it may concern: I am authorizing Debbie Boyle to be the authorized registrant for 3D DATACOM to obtain a Business License and Electrical Permits. Should you have any questions or concerns,please feel free to contact me at 925-455-1884. Regards, Brian Boyle Treasurer 3D DATACOM CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37534031. 00 DATE ISSUED. . . . . . . : 06/02/2011 RECEIPT #. . • • . • • • • : BS000013635 REFERENCE ID # . . . : 11060012 SITE ADDRESS . . . . . : 10620 CULBERTSON DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WRIGHT MARK B E AND MAN-WAI ADDRESS . . . . . . . . . . : 10620 CULBERTSON DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : 3D DATACOM CONTRACTOR . . . . . . . : BRIAN BOYLE LIC # 27773 COMPANY . . . . . . . . . . : 3D DATACOM ADDRESS . . . . . . . . . . : 11365 SUNRISE GOLD CIR CITY/STATE/ZIP . . . : RANCHO CORDOVA, CA 95742 TELEPHONE . . . . . . . . : (925) 455-1884 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, 692 . 00 1. 00 0. 00 1 .00 0 .00 1BSEISMICR VALUATION 2, 692 . 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 166 .50 0. 00 166 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 166 .50 2125 --------------- TOTAL RECEIPT 166 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 408 777-3228•FAX(408)777-3333•buildingpcupertino.orq LoMISC CUPERTIN© ( ) PLUMBING MECHANICAL ELECTRICAL Lj MISCELLANEOUS PROJECT ADDRESS / ` / - I /^-e r L so� �r,' APN# OWNER NAME (Q �(� �`J j PHONE 4/./ .2 O 3 6 E-MAIL STREET ADDRESS ,Z` �� CITY, TATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME/ / . ,/& a- CJ LICENSE NUMBER-75 / LI N��TYPE BUS.LIC#� COMPANY NAME 2D '_D6 f&_e, /h E-MAIL -1 FAX STREET ADDRESS n CITY,STATE,ZIP s� (� A Ci Con lroue ors sl Li✓ermo/'e �' PH NES ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#027773 027773 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF l� SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: Fl Commercial URBAN INTERFACE AREA ❑ Yes �1 No FLOOD ZONE ❑ Yes E] NO DESCRIPTION OF WORK TOTAL VALUATION: rJ C/ (j(� e� BB ' By my signature below,I certify to each of the following: 1 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. 1 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. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED a tc us�aNL CD c� rllE cam . laxpss Cl s�cnrlin,�ta It �>� MEPMiscApp_201 1.doc revised 03/16/11