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11010082I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6021 SHADYGROVE DR I CONTRACTOR: SMITH ELECTRIC INC PERMIT NO: 11010082 OWNER'S NAME: MEHR TARIQ ("`'NER'S PHONE: 4089309320 L3 LICENSED CONTRACTOR'S })DECLARATION License Class — o Lic. # �� t'I'� -2 Contractor�� ii-� ► GDate �. I hereby affirm that I am licensed under the provisions of Chapter 9 (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. 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. 1/1 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 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, 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 -port s rce regulations per the Cupertino Municipal Code, Section 9.18. Signature L J% / " Date L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 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, 's, and expenses which may accrue against said City in consequence of the ring of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 15732 LOS GATOS BLVD I DATE ISSUED: 01/14/2011 LOS GATOS, CA 95032-2504 1 PHONE NO: (408) 835-2122 BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r MECH F RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: ELECTRICAL PANEL UPGRADE, 200AMPS SAME LOCATION Sq. Ft Floor Area: I Valuation: $200 APN Number: 37540002.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by. 2: Date:lo— �� RE -ROOFS: 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 He& Safety Code, Sections 25505, 25533, and 25534. wn �auth a agent: C %-I - IL 4 Date:_ �_ 1(� ) o /� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 5 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37540002.00 DATE ISSUED.......: 01/14/2011 RECEIPT #......... BS000012483 REFERENCE ID # ...: 11010082 SITE ADDRESS .....: 6021 SHADYGROVE DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER MEHR TARIQ ADDRESS 6021 SHADYGROVE DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM SEAN SMITH ELECTRIC CONTRACTOR SEAN SMITH LIC # 27853 COMPANY SMITH ELECTRIC INC ADDRESS 15732 LOS GATOS BLVD CITY/STATE/ZIP ...: LOS GATOS, CA 95032-2504 TELEPHONE (408) 835-2122 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC -------- NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 200.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BELEC200 METERS 1.00 42.00 0.00 42.00 0.00 1BSEISMICR VALUATION 200.00 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 ---------- 127.50 ---------- 0.00 127.50 0.00 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL CITY OF CUPERTINO F..S7 FEE ESTIMATOR - BUILDING DIVISION imlADDRESS: 6021 shadygrove dr. DATE: 01/14/2011 REVIEWED BY: bobs. UNITS APN: BP#: *VALUATION: $200 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p Amps PENTAMATION 1 REAP2 PERMIT TYPE: WORK dfd service upgrade to 200 amps at same location SCOPE Silpp/. Irlsp Fc -le APPLIANCE / EQUIP TYPE FEE ID t't<«,,.��. I'k,ri C'iii:c& QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Services J 1 ERT<200 Other Elec. Insp. 0.0 hrs $42.00 100 Amps $42 Permit Fee: Silpp/. Irlsp Fc -le PME Unit Fee: $42.00 PME Permit Fee: $42.00 onslri `fion7-�Lk' F r'i<:C3vs!ical Rcvici Pee: Work Without Permit? 0 Yes No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $42.001 1 N1 'ri • Th- or gra hgcad nn tho nraliminnry infarmatinn availahle and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS dee Resolution 09-05I Eff 7,'1%10) a.t��t:1,. Pt"ori <'7,f t't<«,,.��. I'k,ri C'iii:c& Elec. Plan Check 0.0 hrs $0.00 t,k {, Elec. Permit Fee: IEPERMIT Onc��r ri�ec h. T�is;r� Olhci- 1'1r mlt ir�s;�. Other Elec. Insp. 0.0 hrs $42.00 A'A"c{i. Mv), kcc.- PME Plan Check: I"10' Msp, FCC, N1 'ri • Th- or gra hgcad nn tho nraliminnry infarmatinn availahle and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS dee Resolution 09-05I Eff 7,'1%10) FEE QTY/FEE MISC ITEMS Plan C 'trcck Fe(,,: Sz ppl. PC Fee PME Plan Check: $0.00 Permit Fee: Silpp/. Irlsp Fc -le PME Unit Fee: $42.00 PME Permit Fee: $42.00 onslri `fion7-�Lk' F r'i<:C3vs!ical Rcvici Pee: Work Without Permit? 0 Yes No $0.00 llCinl"llt7ir l`('t'.t`; Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldiz Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50 Revised: 01/03/2011 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 6 5/wCt L Cyul PERMIT # . OWNER'S NAME: i kL2 PHONE # 4th GENERAL CONTRACTOR: A, i1%4 1 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: Signature Please check applicable subcontractors and complete the following information: Date Owner / t6ntractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing i/ Electrical _ "ric- 3C.) 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 / t6ntractor Signature Date X x CITY OF CITY OF CUPERTINO Id GENERAL BUILDING C O P E RT I N O PERMIT APPLICATION FORM APN # ,7 Date: Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part this project? Yes No HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA If Residential. is house an Eichler? Yes No ❑ If yes, needs planning approval. Owner's Name:li To -q Phone # L . , 30, Contractor: e 'I C Phone(; 1 `l Fax: Contractor License #: 1 Cupertino Business License #: Contact: / / Phone: ,y � � N) Ci Fax/e-mail: Residential Ej Commercial Job Description: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ ILgII/V-A ❑ II/III B, IV -HT, V -B ❑ Valuation: Square Footage: Project Size: Counter ❑ Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.org Revised 12/06/10