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10090002 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22449 STEVENS CREEK BLVD CONTRACTOR:NEKO ELECTRIC PERMIT NO: 10090002 OWNER'S NAME: DEBBIE CONTRO 22430 CUPERTINO RD DATE ISSUED:09/01/2010 ZR'S PHONE: 4083525888 CUPERTINO,CA 95014 PHONE NO:(408)446-4141 ❑ LICENSED CONTRACTOR'S DECLARATIONr- C- (/ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class y,.tt l 7 MECH r— RESIDENTIAL r— COMMERCIAL r Contractor - /tt K0 (=lr Z�f.2 Date ��1� �6 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CHANGE PANEL FROM 60 TO 200AMP SERVICE CHANGE (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. Sq.Ft Floor Area: Valuation:$1000 I have and will maintain Worker's Compensation Insurance,as provided for by j Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. C_ , APN Number:32650078.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit.-Additionaliy,`t I* ant understands and will comply with all non.pdint source regulations per the Cu in o Municipal Code,Section Issued by: �r'' Date: ( GF 9.18. Signatu Date RE-ROOFS: Lt OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by 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 with the Cupertino Municipal Code,Chapter 9.12 and the P Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or aut rorized agent: t I G Compensation laws of California. If,after making this certificate of exemption,1 A&4 Date: 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 I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save inify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST It --I- JOB ADDRESS: 22 V 9 cq cq\ LIV PERMIT# (Vb 152 " 19 OWNER'S NAME: e ) i e PHONE# L Ub GENERAL CONTRACTOR: Ao z BUSINESS LICENSE# ADDRESS:G2q3c7 a,-Lr t'AQ � CITY/ZIPCODE: Zu 0- I:nC *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCC_U_PANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AN r'SUBCO_NT DOCTO�R4 AVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontracto __.__.____._,••..•_._._._,_.. Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing /Y' 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 Tile er/Contra Date 1... !� CITY OF C�JPERTINO - BUMI)ING "TM°f GENERAL cuP��r�� PERMIT APPLICATION FORM Date: f0 N # "— 1-� v. �X Building Address: Z ,2 y V q 5t veA �f �-V Mailing Address (if different from building address). c being used as part of this project? Yes No Are Hazardous Materials OA: xterior Fork only) Yes ❑ No If 'es, rovide letter from HOA Z - 8� H Phone#: G$ S Owner's Name: ��b Ne �a o Phone: �� f Contractor: JI/�e� LcZ r� Fax: CIO 8) 6 ' Contractor License#: 3 L Cu ertino Business License#: phone: L Contact: A �� (��A P A L Fax: c 4 ci residential ,/ Commercial (fi� ^ �O r d Job Description: Building Permit Info: �1 Plumb ❑ Mech ❑ Bldg ❑ Elect L� Occupancy Type: a Type of Construction (Us a g Class): IUIII B, N 1-A, 1-B ❑ II/IIYV-A ❑ Square Footage: Valuation: � 1000 . Ce Larz;e ❑ Major ❑ . Project Size: Ex ess ❑ Standard ❑ ED Checklist & attach it Green Building: Please complete relevant Portion of the incen B lude an set& the sheet ecklis to the application or if applicable, in oints Achieved: P'or help, contact Build it Green at www•buildit een.or Revised 07/14/09