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11050007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10321 GREENWOOD CT CONTRACTOR:GREENTECH ELECTRIC PERMIT NO: 11050007 OWNER'S NAME: CUPERTINO COMMUNITY SERVICES 12333 SARATOGA SUNNYVALE RD DATE ISSUED:05/02/2011 OWNER'S PHONE: 4088570888 SARATOGA,CA 95070 PHONE NO:(408)280-1180 L. LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 199 Lic.# y✓� a L130 MECH F RESIDENTIAL� COMMERCIAL Contractor Date rl I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT I&APT 2-SERVICE UPGRADE TO 100AMP (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 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. Sq.Ft Floor Area: Valuation:$1400 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:36914025.10321 Occupancy Type: APPLICANT CERTIFICATION "Cf 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 by"'"2, Date: 9.18. Signature Date RE-ROOFS: r 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,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 permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the p 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 authorized agent: Compensation laws of California. If,after making this certificate of exemption,IG i Date:�Z 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"ark'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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. s11 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 . . . . . . . . : 36914025. 10321 DATE ISSUED. . . . . . . : 05/02/2011 RECEIPT #. . . . . . . . . BS000013347 REFERENCE ID # . . . : 11050007 SITE ADDRESS . . . . . : 10321 GREENWOOD CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CUPERTINO COMMUNITY SERVICES ADDRESS . . . . . . . . . . : 10114 VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GREENTECH ELECTRIC CONTRACTOR . . . . . . . : MANUEL CORTINAS LIC # 32286 COMPANY . . . . . . . . . . : GREENTECH ELECTRIC ADDRESS . . . . . . . . . . : 12333 SARATOGA SUNNYVALE RD CITY/STATE/ZIP . . . : SARATOGA, CA 95070 TELEPHONE . . . . . . . . : (408) 280-1180 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 1,400. 00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 1,400 .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 VISA --------------- TOTAL RECEIPT 166 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL f c�s coo (`--7 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 Lo (408)777-3228• FAX(408)777-3333•buildin_g(@cuPertino.org misc CUPERTINO ❑PLUMBING ❑MECHANICAL QELECTRICAL ❑MISCELLANEOUS PROJECT'ADDRESS l 1307- y ` ll^^ L.� / APN# ( ��Wq / 1. V�� - C. OWNERNAME / PONE E-MAIL STREET ADDRESS C V1' 1 O I^-ItLV K CITY,STATE,ZIP FF Lza;'_fj elm L1. CONTACT NAME / //'' PHONE i E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT u CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME e G,y LICENSE NUMBER O 4?3 0 LICENSE TYPE C /0 BUS.LIC# COMPANY NAME n^ J / 1 E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK ��' CA rk TOTAL VALUATION: 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 build' g constructio I out riz presentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: S z Ir o2 O�� LEMS TION REQUIRED - MEPMiscApp 201 Ldoc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10321 greenwood ct. DATE: 05/02/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $1,400 1 °PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex lex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK service upgrade to 100 am SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services J 1 ERT<200 100 Amps $42 TOTALS: $42.00 Elec.PlanCheck 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT F-1 —1 0 Other Elec.Insp. hrs $42.00 EHI NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resolution 09-05I Etf. 7,1.%10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 z 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 Str_ot�Motion Fee: IBSEISMICR $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 B Building Department City Of Cupertino ELI] 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: / 7Z / - PERMIT# c7 0 0 v OWNER'S NAME: Le,Mew �' „ ya�v ' PHONE# off? ZOO y GENERAL CONTRAC R: r BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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: �! Z _ 0/// Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical /moi dC- le,r,6 tL 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