10110162 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10332 CRESTON DR CONTRACTOR:BART&IRIS GACH PERMIT NO: 10110162
OW"'FR'S NAME: BART&IRIS GACH 10332 CRESTON DR DATE ISSUED: 11/23/2010
0N-.....R'S PHONE: 4087208026 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r, ELECT r— PLUMB
License Class Lie.# MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:
(commencing with Section 7000)of Division 3 of the Business&Professions PERMIT(06060014)-RESTORE ELECTRIC POWER
TO COMPLETE INSPECTS ON EXPIRED
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 Sq.Ft Floor Area: Valuation:$1000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32637042.00 Occupancy Type:
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 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 FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued y: Date
Sig—tu Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
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 stmcture 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 c tractors 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 HAZARDOUS MATERIALS DISCLOSURE
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.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with 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 Code,Sections 25505,25533,and 25534.
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 Owne r auth ize oe.t-
become
subject to the Worker's Compensation provisions of the Labor Code,I njust �L�, Date: P/Z-g
forthwith comply with such provisions or this permit shall be deemed revok
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
ur 'he above mentioned property for inspection purposes.(We)agree to save Lender's Address
i. tify and keep harmless the City of Cupertino against liabilities,judgments,
cosrS,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
B _/ Licensed Professional
Signature 1 o d Date ll Z3/
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10332 creston dr. DATE: REVIEWED BY:
APN: BP#: `VALUATION: $1,000
xPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY "«7 + PENTAMATION 1 REAP2
USE: SFD or Duplex I iAl! PERMIT TYPE:
WORK restore electrical power
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 100 Amps $42
TOTALS: j $42.00
Elec.Plan Check 0.0 1 hrs $0.00
Elec.Permit Fee: IEPERMIT
Other Elec.Insp. 0.0 hrs $42.00
NOTE: Theseees are based on the relimina in ormation available and are onlyan estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-05I Ef. 7/1;'101 FEE QTY/FEE MISC ITEMS
t h"m C'hecA, FVC,
Supp/, PC.'fFer,
F-1
PME Plan Check: $0.00
Peril;it
Stipp/, hisp
PME Unit Fee: $42.00
PME Permit Fee: $42.00
C�`c1a�_ctrrrz`ri«x 7��:�
FCC.
Work Without Permit? 0 Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Stroniz Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldiz Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50
Revised: 11/08/2010
CITY OF CUPERTINO
5 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32637042 . 00
DATE ISSUED. . . . . . . : 11/23/2010
RECEIPT #. . . . . . . . . : BS000012086
REFERENCE ID # . . . : 10110162
SITE ADDRESS . . . . . : 10332 CRESTON DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BART & IRIS GACH
ADDRESS . . . . . . . . . . : 10332 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : IRIS J GACH
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : BART & IRIS GACH
ADDRESS . . . . . . . . . . : 10332 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 000 . 00 1 .00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 1, 000. 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
----------------- --------------- --------------------
CREDIT CARD 1, 335. 00 VISA
---------------
TOTAL RECEIPT 1,335 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
CITY OF CUPERTINO
CM 0'F
CUFF TINO GENERAL BUILDING
PER HT APPLICATION FORM
AP # Date:
31
6}0_1A I)
l
Buiding Address:
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 HOA
Owner's Name: Phone#:
Contractor: �� Phone.
Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
Residential 7 Commercial ❑
Job Description:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Tygf;
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B
Valuation: Square Footage:
Project Size: Express D---l'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.
ints Achieved:
For help, contact Build it Green at www-builditgreen.org
Revised 07/14/09
s