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11050016 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11250 REDONDO CT CONTRACTOR:VOLTZ ELECTRIC PERMIT NO: 11050016 OWNER'S NAME: LESLIE ORTA 6245 LEAN AVE DATE ISSUED:05/03/2011 OWNER'S PHONE: 4088353866 SAN JOSE,CA 95123 PHONE NO:(408)835-3866 L LICENSED CONTRACTOR'S DECLARATION /� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# `7/237? 1 MECH F RESIDENTIAL� COMMERCIAL � Contractor 21 C_�. . Date 5-?/ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD 3 BRANCH CIRCUITS DEDICATED FOR FUTURE (commencing with Section 7000)of Division 3 of the Business&Professions SUMP Code and that my license is in full force and effect. PUMP&FANS LOCATED AT BASEMENT FOUNDATION 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 Sq.Ft Floor Area: Valuation:$300 permit is issued. APPLICANT CERTIFICATION APN Number:35621014.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. // lo _� Signatu Date �/ Issued by Date—;,-T— F OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by 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. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Own r or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. =t Date: T- ! APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the I ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION V, .Il non-point source regulations per the Cupertino Municipal Code,Section 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: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35621014 . 00 DATE ISSUED. . . . . . . : 05/03/2011 RECEIPT #. . . . . . . . . : BS000013361 REFERENCE ID # . . . : 11050016 SITE ADDRESS . . . . . : 11250 REDONDO CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LESLIE ORTA ADDRESS . . . . . . . . . . : 11250 REDONDO CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MATE SABICH JR CONTRACTOR . . . . . . . : MATT SABICH LIC # 31809 COMPANY . . . . . . . . . . : VOLTZ ELECTRIC ADDRESS . . . . . . . . . . : 6245 LEAN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 835-3866 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 300 . 00 1. 00 0. 00 1. 00 0 .00 1BREMRECEP NO. OUTLETS 1. 00 42 . 00 0. 00 42 .00 0.00 1BSEISMICR VALUATION 300 . 00 0 .50 0 . 00 0.50 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 ----------------- --------------- -------------------- CHECK 166 .50 #1577 --------------- TOTAL RECEIPT 166.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 512 FINAL HANDI-CAP GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 - (408)777-3228• FAX(408)777-3333•building(cDcupertino.org MISC CUPERTINO ❑PLUMBING ❑M�JECHANICAL/// ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS /17— APN# OWNER NAME L�S PHO(YE� TS' E-MAIL STREET ADDRESS L �J7 N �� CiTY� STATE. ,IP _J C KL. FAX CONTACT NA •'((� PHONE E-MAIL ME STREET ADDRESS �(� CTfY,STATE ZIP S�(2 FAX �' , C_ 7 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME )tZ LIC&S NUMBER LIC SFS TYPE BUS.LIC# i COMPANY NAME E-MAIL FAX STREET ADDRESS Z C �� CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE -ISE OF C rS'F_Dor Duplex [I Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK App 3 /Z,) f y �/vc:c.,I/f dr TOTAL VALUATION: `RECEIrXEI�BY" a "J;--5w— TOTAL S v. By my signature below,I certify to each of a 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 pr ided 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 bu'ding construction. I authorize representatives o pertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: &APLEMENTAL INFORMATION REQUIRED 1253� v MEPMiscApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 11250 redondo ct DATE: 05/03/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: $300 Y°PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP10 USE: I PERMIT TYPE: wORK add 3 branch circuits dedicated for future sump pumpand fans located at basement foundation. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Recep/Switch/Outlets 1 BREMRECEP 3 # $42 TOTALS: $42.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT Other Elec.Insp. 1 0.0 1 hrs $42.00 NOTE: Thesefees are based on the preliminary information available and are on an estimate. Contact the De t or addn 7 info, FEE ITEMS (!ee.Resolution 09-051 I . 'I-l0) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Work Without Permit? Yes E) No $0.00 Travel Documentation Fee: 1 TRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $39.00 FIADMIN SUBTOTALS: $127.50 $39.001 TOTAL FEE: 1 $166.50 Revised: 04/29/2011 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: L ,,JG- PERMIT# -g—d d OWNER'S NAME: Lr-- ; PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# S ADDRESS: -L CITY/ZIPCODE: 4PP . *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