11020028IK\«,A
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10150 SANTA CLARA AVE
CONTRACTOR: P V S ELECTRIC
PERMIT NO: 11020028
OWNER'S NAME: KLEIN LAURENCE K AND LYNN M
6110 LARIOS WAY
DATE ISSUED: 02/07/2011
O""NER'S PHONE: 4083167063
SAN JOSE, CA 95123
PHONE NO: (408)224-1785
Li LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r
License Class Ir I Lic. #��
MECH RESIDENTIAL COMMERCIAL �
Contractor � ?` Date 2-07- i l
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: HOUSE REWIRE W/240 VOLT 100 AMP REPLACEMENT
(commencing with Section 7000) of Division 3 of the Business & Professions
SERVICE PANEL
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: $9000
1 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: 32624017.00
Occupancy Type:
APPLICANT CERTIFICATION
1 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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FRO AST CALLED INSPECTION.
granting of this permit. Additionally, a applicant understands and will comply
with all non -point source reg Municipal Code, Section
ti=Date
—
2-7-11
9.18.
Issued by: Date:
Signature �•� •
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
E OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
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).
HAZARDOUS MATERIALS DISCLOSURE
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
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
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 w' h the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Health & Safety ond 25534.
not employ any person in any manner so as to become subject to the Worker's
=1c,
Compensation laws of California. If, after making this certificate of exemption, I
O Lrauth)fized
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
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
ARCHITECT'S DECLARATION
.ng of this permit. Additionally, the applicant understands and will comply
wan all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
6 ITEMS OF 7
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32624017.00
DATE ISSUED.......: 02/07/2011
RECEIPT #......... BS000012662
REFERENCE ID # ...: 11020028
SITE ADDRESS 10150 SANTA CLARA AVE
SUBDIVISION
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER KLEIN LAURENCE K AND LYNN M
ADDRESS 10150 SANTA CLARA AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: P.V.S. ELECTRIC
CONTRACTOR LUCCHINI, PAUL LIC # 21213
COMPANY ..........: P V S ELECTRIC
ADDRESS 6110 LARIOS WAY
CITY/STATE/ZIP ...: SAN JOSE, CA 95123
TELEPHONE (408)224-1785
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
----------
NEW BAL
-------
----------
1BCBSC
-------------
VALUATION
----------
9,000.00
----------
1.00
----------
0.00
1.00
0.00
1BREMFIXT
NO. FIXTURES
51.00
156.00
0.00
156.00
0.00
1BSEISMICR
VALUATION
9,000.00
0.90
0.00
0.90
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
----------
283.90
0.00
283.90
0.00
VOICE ID DESCRIPTION
-------- ----------------------------
103 UFER
505 FINAL ELECTRICAL
VOICE ID DESCRIPTION
-------- ----------------------------
304 ROUGH ELECTRICAL
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10150 Santa Clara Ave
DATE: 02/07/2011
REVIEWED BY: RDW
UNITS
APN:
BP#:
*VALUATION: $9,000
PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
Amps
PENTAMATION 1 REAP2
PERMIT TYPE:
Fixtures, Lighting
WORK
,? fol"1', h!";P 1- ",
51
#
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
-
QTY/FEE
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPERMIT
Services
1 ERT<200
Other Elea ElInsp.hrs $42.00
100
Amps
$42
Fixtures, Lighting
1BREMFIXT
,? fol"1', h!";P 1- ",
51
#
$156
PME Unit Fee:
$198.00
PME Permit Fee:
$42.00
L. �)Ii1It't?t` ISIii 7,
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
Travel Documentation Fee: 1 TRA VDOC
$198.00
Strong; Motion Fee: 1BSEISMICR
.•_ _ J_4'_..__A1:.,.. ..:L.R/a and nrn only nn vct%rnO/P_ Contact the DeDt for addn 7 info.
tvViP_ mese Lees are ouseu ar[ arie Press•sussu• ••• .•
FEE ITEMS (Fee Resolution 09-051 Eff. T"b"10j
•••++••�•• ..
FEE
-
QTY/FEE
Elec. Plan Check 0.01 hrs $0.00
I'lon ��t'le'Cli 1'L,�,•
Elec. Permit Fee: IEPERMIT
n` 111"pl. PC 1 `I c
b" Lj
Other Elea ElInsp.hrs $42.00
PME Plan Check:
$0.00
.•_ _ J_4'_..__A1:.,.. ..:L.R/a and nrn only nn vct%rnO/P_ Contact the DeDt for addn 7 info.
tvViP_ mese Lees are ouseu ar[ arie Press•sussu• ••• .•
FEE ITEMS (Fee Resolution 09-051 Eff. T"b"10j
•••++••�•• ..
FEE
-
QTY/FEE
- --
MISC ITEMS
I'lon ��t'le'Cli 1'L,�,•
n` 111"pl. PC 1 `I c
PME Plan Check:
$0.00
i! cc
/('con ?`
,? fol"1', h!";P 1- ",
PME Unit Fee:
$198.00
PME Permit Fee:
$42.00
L. �)Ii1It't?t` ISIii 7,
Work Without Permit? 0 Yes E) No
$0.00
Travel Documentation Fee: 1 TRA VDOC
$42.00
Strong; Motion Fee: 1BSEISMICR
$0.90
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$283.90
$0.00 TOTAL FEE:
$283.90
Revised: 01/15/2011
CITY OF
I 10?, �,-DozR
CITY OF CUPERTINO
GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
APN #� 1 �'
Date:
Building Address: Ed (SO AJ u c_� N� � G. �T2i .i�
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from RGA
If Residential is house an Eichler? Yes ❑ No 156 If yes, needs planning approval.
Owner's Name:
Phone #:
,7C6
Contractor:
Phone: 8• Z24 • (T8 5-
!a/
S CLQ_ 1 L
Fax: 40
Contractor License #: 43644--3
Cupertino Business License #: 2/,2/3
Contact:/
/�o�v L, !,U �{-�
Phone:
ax -mail �• N
Residential Commercial ❑
Job Description:p of 0X20
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B E] II/III/V-A ❑ II/III B, IV -HT, V-B[jJ/
r
`�
Valuation: Square Footage: 2
+. *oo:;*,-Ot
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
Lim