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11060073 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20588 STEVENS CREEK BLVD CONTRACTOR:LAMBOCO ELECTRIC PERMIT NO: 11060073 OWNER'S NAME: 6 4614� DATE ISSUED:06/10/2011 I`vNER'S PHONE: 4086746837 PHONE NO: Ju`1 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r- License Class C Lic.# 6 JU�,2 2, MECH[_ RESIDENTIAL COMMERCIAL Contractor til— -k--`,Date (,t I L, Z) I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: Hong Fu-REPAIR ELECTRICAL SERVICE DUE TO FIRE (commencing with Section 7000)of Division 3 of the Business&Professions DAMAGE- Code and that my license is in full force and effect. SMOKE DAMAGE ONLY 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. I�Z)A Sq.Ft Floor Area: Valuation:$3000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35908021.20588 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 DAYS FROM LAST CALLED INSPECTION. 9.18. / Signature < � Date - It= II Issued by: Date: 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 Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 forthwith comply with such provisions or this permit shall be deemed revoked. Owna nt: Date: 6 L1,0 l� 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 ting of this permit.Additionally,the applicant understands and will comply with 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 6 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35908021 .20588 DATE ISSUED. . . . . . . : 06/10/2011 RECEIPT #. . . . . . . . . : BS000013710 REFERENCE ID # . . . : 11060073 SITE ADDRESS . . . . . : 20588 STEVENS CREEK BLVD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . ,/ OWNER . . . . . . . . . . . . . wjt Pl ,Dro. ADDRESS . . . . . . . . . . . off SiT NS GRH;'HK 5WD t1u, Petr 1 CITY/STATE/ZIP . . . . RECEIVED FROM . . . . : DARRYL PAYNE CONTRACTOR . . . . . . . : D LIC # 00096 COMPANY . . . . . . . . . . 411NED ADDRESS . . . . . . . . . . . LA'IM.E" CITY/STATE/ZIP . . . : ,,�r ,i Cr. TELEPHONE . . . . . . . . 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 1ECT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1EPERMITFE FLAT RATE 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 ----------------- --------------- -------------------- CREDIT CARD 166 .50 Visa 01080B --------------- TOTAL RECEIPT 166 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL rr � CITY OF CUPERTINO \V FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20588 stvns crk blvd. DATE: 06/10/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$3,000 °PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: I I PERMIT TYPE: wORK repair electrical service due to fire damage. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ECT<200 200 Amps $42 TOTALS: $42.00 Elec.Plan Check0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elea 0.0 Insp. hrs $42.00 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (F"ee Resolution 09-05.1 Ef'. 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? Q Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: 1BCBSC $1.00 $39.00 1ADMIN SUBTOTALS: $127.50 $39.00 TOTAL FEE: $166.50 Revised: 04/29/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: C IV c4 PERMIT# �ll OWNER'S NAME: V PHONE# GENERAL CONTRACTOR: 4 BUSINESS LICENSE# ADDRESS: Irf f *-c (. -- CITY/ZIPCODE: C 9Y1 T' *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 CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date 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 GENERAL PERMIT APPLICATIONMEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION .� 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 ' CUFERTIN{391 (408)777-3228 • FAX(408)777-3333 •building(.5cupertino.om misc ❑PLUMBING ❑MECHANICAL ®•ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS A� �0 S OWNER NAME � � PFIO� ` 7 b d' '� E-MAII STRIMT ADDRIP CITY,STA ZIP FAX G tS" 'f ��S C 1�.�K V - f toe c ft CONTACT NAME PHONE E-Nye, SfR=ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-HUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEC LICENSE NUMBER LICENSE BUS.LIC; ^ ep• cc G C, y I o COMPANY NAME E- 1 L�i�• co hj��-rpt C� -►1CC , CG3� cf1 _g S —CJ`Ycl STREET ADDRESS CITY,STATE,ZIP / PRONE L`C 7iZ L C� i-rl /n C. 2� L t Vc•Y47C A ARCHMCTIENGZMER NAME LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAL FAX STREET ADDRESS CITY,SPATE,ZIP PHONE 'SE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN 37RUCTURE; Commercial J SAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK �^r Q- C-"L •� t t57i Ij 4 TOTAL VALUATION O /� ��Z'. `; a By my signature below,I certify to each of the following: I am the property owner or authorized agent to act an the property owners 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 auth, ' e representatives of Cupertino to enter the above-identified pro erty for inspection purposes. Signature of Applicant/Agent1 Date: 6� �I SUPPLET ENTAL INFORMATION REQUIRED &EFMiscApp_2011.doc revised 03/16/11