The URL can be used to link to this page

11020062 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20937 FAIRWOODS CT CONTRACTOR:DOLLENS ELECTRIC PERMIT NO: 11020062 CORPORATION OWNER'S NAME: SUSAN CAMPBELL 3591 PINE RIDGE WAY DATE ISSUED:02/16/2011 R'S PHONE: 4083430986 SAN JOSE,CA 95127 PHONE NO:(408)929-6100 LICENSED CONTRACTOR'S DECLARATION [ r— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contracto,i) �'(C fY/&ate, t1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SWAPING OUT SUBPANEL UPGRADE-� (commencing with Section 7000)of Division 3 of the Business&Professions E l� 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 whi "this { Sq.Ft Floor Area: Valuation:$1200 permit is issued. APPLICANT CERTIFICATION APN Number:35913111.00 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-pojart source regulations per the Cupertino Municipal Code,Section 9.18. tIssued by: / '� --""-~ Date: Signature' - -- Date-"el) • IL', ( t L 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: 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 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(x)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 maintajn 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 Healt► &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 owMer r authorized' nt: Date1 ` R'. forthwith comply with such provisions or this permit shall be deemed revoked. 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 •lnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the gr..amg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION witl.Al non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 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 . . . . . . . . : 35913111. 00 DATE ISSUED. . . . . . . : 02/16/2011 RECEIPT #. . . . . . . . . : BS000012725 REFERENCE ID # . . . : 11020062 SITE ADDRESS . . . . . : 20937 FAIRWOODS CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SUSAN CAMPBELL ADDRESS . 20937 FAIRWOOD CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4200 RECEIVED FROM . . . . : DOLLENS ELECTRIC IN CONTRACTOR . . . . . . . : JASON DOLLENS LIC # 28146 COMPANY . . . . . . . . . . : DOLLENS ELECTRIC CORPORATION ADDRESS . . . . . . . . . . : 3591 PINE RIDGE WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95127 TELEPHONE . . . . . . . . : (408) 929-6100 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 200 . 00 1. 00 0 . 00 1 . 00 0. 00 1BREMMISC EACH 1 . 00 126 . 00 0 . 00 126 . 00 0. 00 1BSEISMICR VALUATION 1, 200 . 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 253 . 50 0 . 00 253 . 50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 253 . 50 74514 --------------- TOTAL RECEIPT : 253 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20937 fairwood ct. DATE: 02/16/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$1,200 -� *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP7 USE: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Apparatus 1BREMMISC 1 # $126 Services 1 ERT<200 100 Amps $42 TOTALS: 1 $168.00 "c'h_ PLW'l t;.of k 01i"Ci, 71 Elec.Plan Check 0.0 1 hrs $0.00 Fcc, Elec.Permit Fee: IEPERMIT 0 , t'I r tit:Env/ Other Elec.Insp. 0.0 hrs $42.00 NOTE: Thesefees are based on the preliminarqy in ormation available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 09-051 Eff. 7111i70) FEE QTY/FEE MISC ITEMS Man Chuck Fcc. sZ,pplr PC 1'cc PME Plan Check: $0.00 l�c't"Il'FIL�c'E" S11p /, hop Fec PME Unit Fee: $168.00 PME Permit Fee: $42.00 Con,�Iruction 7-ax fta�t�stlt:ctl l4'�'s'It�ty I-e<>: Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $253.50 $0.00 TOTAL FEE: $253.50 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# / Z6;0 OWNER'S NAME: j�,i� l Y 1 LLt - PHONE# t ,Z GENERAL CONTRACTOR: j+ ;f` ice* 4� �> USINESS LICENSE# ADDRESS: -- -, j �� { CITY/ZIPCODE: 's *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 Til r Owner/ ontractor Signature Date CITY OF CITY OF CUPERTINO 1�01 GENERAL BUILDING CUPERTINO PERMIT APPLICATION FORM APN# ,� Date: � Building Address: 1 , Mailing Address (if different from building address): Are Hazardous Materials being used as part of s project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No ' If yes, provide letter from HOA If Residential.is house an Eichler? Yes ❑ No If es, needs planning approval. Owner's Name: Phone#• l 31'f- Contractor:- Phone: /4 C ce C12 el to (L C) Fax: /414 Contractor License#: Cupertino Business License #: Contact: (�, q Phone: �� ' '' J Fax/e-mail: V Residential Commercial ❑ ! p/I Job Description: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑�. ll'1.�; "t �u t Valuation: Square otage: Project Size: Counter Ex ress ❑ Standard ❑ Laze ❑ 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.builditi!reeg.org Revised 12/06/10