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11030116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10131 PARLETT PL CONTRACTOR:VOLTZ ELECTRIC PERMIT NO: 11030116 OWNER'S NAME: RAMASWAMY SRID14AR 6245 LEAN AVE DATE ISSUED:03/28/2011 .')WNER'S PHONE: 4084460926 SAN JOSE,CA 95123 PHONE NO:(408)835-3866 L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r /' License Class C..— Lic.# 9/2 / MECH F RESIDENTIAL� COMMERCIAL V � Contractor UI'L�tlia�L Date I hereby affirm that I am licensed under the provisions of C apter 9 JOB DESCRIPTION:REMOVE&REPLACE EXISTING MAIN PANEL WITH A (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. MAIN 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:$1600 permit is issued. APPLICANT CERTIFICATION APN Number:31626052.00 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-poin source regulations per the Cupertino Municipal Code,Section 9.18. �� `� Issued by: Date: Signature Date 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 I,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: I,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 I 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 Ow er or auth ed agent: p. forthwith comply with such provisions or this permit shall be deemed revoked. Date: t fi CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 c- '�,and expenses which may accrue against said City in consequence of the ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION w...i all 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 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31626052 . 00 DATE ISSUED. . . . . . . : 03/28/2011 RECEIPT #. . . . . . . . . BS000013002 REFERENCE ID # . . . : 11030116 SITE ADDRESS . . . . . : 10131 PARLETT PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER RAMASWAMY SRIDHAR ADDRESS 10131 PARLETT PL 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 600 .00 1. 00 0. 00 1 .00 0.00 1BSEISMICR VALUATION 1, 600 .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 127.50 0 . 00 127.50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 127. 50 #1513 --------------- TOTAL RECEIPT 127.50 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 CUPERTINa (408)777-3228• FAX(408)777-3333 •building(5-cupertino.org MISC ❑PLUMBING ❑MECHANICAL '''�3t_?ECTRICAL ❑MISCELLANEOUS PROJECTADDRESS APN# OWNER NAME ✓ P NE 1; E-MAIL STREET ADDRESS CIT}, STATE,ZIP FAX CONTACT NAMEi (/P O / E- pl / 4(4�1 STREET ADDRESSC ,ST TE, ZIP FAX Z S/.S�CY c� � �/l.T R ❑ OWNER-BUILDER ❑ OWNER AGENT �NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRA 0 .A l � LIC E NUMBER LICENSE TYPE BUS.LIC# COMPANY NAM / ',l� - L� FAX ¢L STREET DDRESS ee4 ,ZIP n„rZ r P 0 ✓ / ARCHrrECT/ENGINEER NAME (,r LICENSE NUMBER BUS.LIC# (' COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE 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 i G I c h TOTAL VALUATION: RECEIVEDBY: By my signature below,I certify to ea 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 hav 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 t ui constructio rize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFEIC>�USEOrit r EXPRESS - -. , STAIYDF[Rb U Q;LARGE G t` CC MASOR= MEPMiscApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10131 parlett pi DATE: 03/28/2011 REVIEWED BY: larry s APN: BP#: 'VALUATION: 1$1,600 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK remove and replace existing main panel with a 125 amp main SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 125 Amps $42 TOTALS: $42.00 Elec.Plan Check0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT LiOther Elec.Insp. 0.0 hrs $42.00 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept./or addn'1 info, FEE ITEMS (Pe Resolution 09-05./ 111' /.x'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 No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld€;Stcls Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: 1 $127.50 Revised: 03/01/2011