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10100035 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRkSS: 6375 MYRTLEWOOD DR CONTRACTOR:CALIFORNIA POWER AND PERMIT NO: 10100035 LIGHT TER'S NAME: SABADO ANTONIO A AND ELIZABETH 8887 LILLY AVE DATE ISSUED: 10/04/2010 OWNER'S PHONE: 4082524683 GILROY,CA 95020 PHONE NO:4088470520 ❑ LICENSED CONTRACTOR'S DECLARATION FI- / BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class �_ �(� Lic.# �V r f MECH RESIDENTIAL COMMERCIAL Contractor j= - Datef� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UPGRADE ELECTRICAL SERVICE BOX FROM 100 AMPS TO (commencing with Section 7000)of Division 3 of the Business&Professions 200 AMPS Code and that my license is in full force and effect. 20 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. Sq.Ft Floor Area: Valuation:$2400 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36917003.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. F, ture G � Date Issued by: Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Own! ►orized ag nt P Y P P '� Date: ��'`4,,,--- APPLICANT CERTIFICATION / CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) 'he above mentioned property for inspection purposes.(We)agree to save Lender's Name mify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN . . . . . . . . : 36S17003 . 00 DATE ISSUED. . . . . . . : 10/04/2010 RECEIPT #. . . . . . . . . : BSC00011640 REFERENCE ID # . . . : 10100035 SITE ADDRESS . . . . . : 63;5 MYRTLEWOOD DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SALADO ANTONIO A AND ELIZABETH ADDRESS 635 MYRTLEWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ENRIQUE ACOSTA III CONTRACTOR . . . . . . . : ACOSTA, ENRIQUE LIC # 20954 COMPANY CALIFORNIA POWER AND LIGHT ADDRESS 88E,7 LILLY AVE CITY/STATE/ZIP . . . : GII,ROY, CA 95020 TELEPHONE . . . . . . . . : 40F;8470520 FEE ID UNIT QUANTITY ILMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- ------ ---------- ---------- ---------- 1BCBSC VALUATION 2, 400 . 00 1 . 00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 2, 400 . 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ------------------- ------ -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 6375 Myrtlewood DATE: REVIEWED BY: larry s APN: BP#: *VALUATION: 1$2,400 R*PERMITTYPE: Electrical Permit PLAY CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex >(1T,fZ_ PENTAMATION 1REAP2 USE: ;. ��/� .� s ,� PERMIT TYPE: WORK up rade electrical service from 100 amps to 200 amps. change out mast size to appropriate. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $42 TOTALS: $42.00 Elec.Plan Check 0.0 1 hrs $0.00 Elec.Permit Fee: IEPERMIT LiOther Elec.Insp. 0.0 hrs $42.00 fits,'_),ISL c' NOTE. These ees are based on the preliminary information a vailable and are only an estimate. Contact the De t or addn'l info, FEE ITEMS{Fee Resohition 09-05I Eff. 7iF7O) FEE QTY/FEE MISC ITEMS Pkm CIrcck Fec Sits PIs/. PC l CC PME Plan Check: $0.00 Pct'rttrt Fce StfP1>T. Inslo Fee PME Unit Fee: $42.00 PME Permit Fee: $42.00 C�«ttstt-rr<`t�r�tt Izr.� I<.;OtfSIGt'ia� lit viciv Fec. Work Without Permit? 0 Yes E) No $C.00 Plczrtrtfot�Y f c�c:�: Travel Documentation Fee: ITRA VDOC $4'e.00 Strong Motion Fee: $(.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127'.50 $0.00 TOTAL FEE: $127.50 Revised: 9/29/2010 CITY OF CUPERTINO REPIPE/SEWS SERVICE CUPEkTiNO PERMIT APPLICATION FORM APN # C, Date: Building Address: -' Owner's Name: Phone#: Contractor: ? Phone#: Fax #: Contact: Phone#: d y�►f' S�(3z Fax #: Contractor License #: 7.;?-0 6 9 Cupertino Business License Job Description: / Residential Commercial ❑ Valuation: Project Size: fxpress Standard LargeT1 Major Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial buWing P 1CPSS sewer/sanitary.ewer 1BPREPIPE Commercial re-pipe per fixture P 1CPR.P 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission.. B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Comm,;rcial P Revised 01/07/09