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11060041 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1063 TUSCANY PL CONTRACTOR:CALIFORNIA POWER AND PERMIT NO: 11060041 LIGHT OWNER'S NAME: VINCE LAZANO 550 E CENTRAL AVE DATE ISSUED:06/06/2011 C ',R'S PHONE: 4087681100 MORGAN HILL,CA 95037 PHONE NO:4088470520 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class G Lic.# 7 Z10 (0 3 y MECH RESIDENTIAL COMMERCIAL Contractor f�L t (, Date Ga & t 1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ELECTRICAL PANEL CHANGE OUT TO 100AMPS (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 declaration 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. Sq.Ft Floor Area: Valuation:$1350 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. APN Number:35929036.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued Date: 9.18. Signature /--- Date RE-ROOFS: L. OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Owner or orized agent* Compensation laws of California. If,after making this certificate of exemption,I �r Date: 42–f, -- (( 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save ip'--nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION mind expenses which may accrue against said City in consequence of the g.—ing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35929036 . 00 DATE ISSUED. . . . . . . : 06/06/2011 RECEIPT #. . . . . . . . . BS000013664 REFERENCE ID # . . . : 11060041 SITE ADDRESS . . . . . : 1063 TUSCANY PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : VINCE LAZANO ADDRESS 1063 TUSCANY PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4325 RECEIVED FROM . . . . : ENRIQUE ACOSTA III CONTRACTOR . . . . . . . : ACOSTA, ENRIQUE LIC # 20954 COMPANY CALIFORNIA POWER AND LIGHT ADDRESS 550 E CENTRAL AVE CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037 TELEPHONE . . . . . . . . : 4088470520 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 1, 350 . 00 1. 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 1, 350 . 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 ----------------- --------------- -------------------- CREDIT CARD 166 .50 MC --------------- TOTAL RECEIPT 166 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1063 tuscany pl. DATE: 06/06/2011 REVIEWED BY: bob s. APN: BP#: "VALUATION: 1$1,350 -PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex lex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK electrical main panel change out 100 amps. SCOPE 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: IEPERMIT Other Elec.Insp. 0.0 hrs 1 $42.00 NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the Det or addn'l info, FEE ITEMS (lee Resolution 09-051 f;tf. 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 Q) No $0.00 Travel Documentation Fee: IIRA VDOC $42.00 Strony,Motion Fee: IBSEISMMR $0.500.5 hrs Admin./Clerical Fee Bldg?Stds Commission Fee: 1BCBSC $1.00 $39.00 ]ADMIN SUBTOTALS: $127.50 $39.00 TOTAL FEE: 1 $166.50 Revised: 04/29/2011 Building Department City Of Cupertino Is 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: L - u - Cz r') PERMIT# ) OWNER'S NAME: ;'/V ' PHONE# GENERAL CONTRACTOR: /,'-Q,�,7 BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: .J 7 *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: - �gnature 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 "�5wlwner/Contractor Signature Date i I 'D cP O `-t 1 GENERAL PERMIT APPLICATION _ MEP COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 (408)777-3228 - FAX(408)777-3333 -building-8cupertino.org misc CUPERTINO ❑PLUMBING ❑MECHANICAL "ECCAL ❑MISCELLANEOUS PROJECT ADDRESS7 '` S G GZ /il APrI �J �C 0:3 �`' OWNER NAME PHONE -2 g/l v E-MAIL STREET ADDRESS ` CTIY,STATE,ZIP /'J FFAX CONTACT NAME PHONE E-MAIL Zi STREET ADDRESS CITY,STATE, ZIP b 1 FAX C3OWNER 13OWNER-SUILDER ❑ OWNER AGENT ZICONTRACTOR ❑ TR CONACTORAGENT 13ARCHITECT ❑ENGINEER 11DEVELOPER TEN ANT CONTRACTOR NAME LICENSE NUMEER LICENSE TYPE BUS.LIC Y COMPANY NAME ? / E-MAIL FAX ! ( [��7 STREET ADDRESS /� CITY.SfA'I'�, K 1 `,frY MBPHONE ARCHTIcCT/ENGINEERNAME p� JC�yZ LICENSE NUERt� BUS.LIC 1A (G COMPANY NAME E-MAEL FAX STREET ADDRESS CITY,STATE,ZIP PHONE TrsE of ff_s_FDorDuplex ❑ Multi-Family PROJECT IN WZLDLAND PROJECT IN ,gUCTURE: ❑ Commercial UR 3AN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRII'TION OF WORK l TOTAL VALUATION: F 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. uthorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicanr/Agent � Date: SUP DENTAL INFORMATION REQUIRED - --vim MEPMiscRpp_2011.doc revised 03/16/11