10080104CITY OF CUPERTINO BUILDING PERMIT
ILDING ADDRESS: 10720 MARTINWOOD WAY CONTRACTOR: ANCHOR ELECTRIC PERMIT NO: 10080104
VNER'S NAME: ERIC CARLSON
1005 N 2ND ST DATE ISSUED: 08/16/2010
;ER'S PHONE: 4088620297
SAN JOSE, CA 95112 PHONE NO: (408) 921-9292
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
ense Class C13 Lie. # y 1�9 —1 1�_,_3 MECH r r RESIDENTIAL COMMERCIAL r
ntractor A! V c o 5 R C-LtcZ R) Date Ug�y
JOB DES(;RIPTION: 200 AMP SERVICE CHANGE
ereby affirm that I am licensed under the provisions of Chapter 9
[mmencing with Section 7000) of Division 3 of the Business & Professions
[de and that my license is in full force and effect.
[ereby affirm under penalty of perjury one of the following two declarations:
ave and will maintain a certificate of consent to self -insure for Worker's
>mpensation, as provided for by Section 3700 of the Labor Code, for the
rformance of the work for which this permit is issued.
[ave and will maintain Worker's Compensation Insurance, as provided for by
xtion 3700 of the Labor Code, for the performance of the work for which this
;rmit is issued. G�
APPLICANT CERTIFICATION
:ertify that I have read this application and state that the above information is
[rrect. I agree to comply with all city and county ordinances and state laws relating
building construction, and hereby authorize representatives of this city to enter
)on the above mentioned property for inspection purposes. (We) agree to save
demnify and keep harmless the City of Cupertino against liabilities, judgments,
)sts, and expenses which may accrue against said City in consequence of the
ranting of this permit. Additionally, the applicant understands and will comply
ith all non -point source regulations per the Cupertino Municipal Code, Section
.18.
ignature �f= r Date o.
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
he following two reasons:
, as owner of the property, or my employees with wages as their sole compensation,
vill do the work, and the structure is not intended or offered for sale (Sec.7044,
3usiness & Professions Code)
, as owner of the property, am exclusively contracting with licensed contractors to
:onstmct the project (Sec.7044, Business & Professions Code).
[ hereby affirm under penalty of perjury one of the following three
Jeclarations:
[ 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
permits issued.
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
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
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
,mnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
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.
Signature Date
Sq. Ft Floo ^Area: T
aluation: $5000
APN Number: 36935032.00
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b Date:
RE -ROOFS:
All roofs s call be inspected prior to any roofing material being installed. If a roof is
installed w ithout first obtaining an inspection, I agree to remove all new materials for
inspection
Signature rf Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have re -.,d the hazardous materials requirements under Chapter 6.95 of the
Californi r Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Cr de, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
O er o = authorizd agent: Date: 1 W , / ] / l� , j V
CONSTRUCTION LENDING AGENCY
I hereby; [ffrrm that there is a construction lending agency for the performance of work's
for whicl this permit is issued (Sec. 3097, Civ C.)
Lender'! Name
Lender': Address,
ARCHITECT'S DECLARATION
I undersl and my plans shall be used as public records.
Licenses I Professional
. a,(M
CITY OF
CUPEI�TINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICA71ION FORM
APN #
Date. 0
16.
c
Building Address: �
/U w1)00 �
Mailing Address (if different from building address):
ell
Are Hazardous Materials being used as part of this projec ,? Yes L No
HOA:(Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's Name:
6�1C /�L_s'3i✓
Phone #:q
1 ;) - () )- [
Contractor:�-
AAlcl+,),z- /� L %,@! C
Phone:
Fax: Cl `� " CN I
Contractor License #: .56 ct T"
Cupertino Business License #:
Contact:
� 11� � l'/� � _ `��/� `l2 �I
Faxhone. q� 11
Residential GV Commercial
Job Description:
Building Permit Info:
'Bldg ❑ Elect L9111*� Plumb I: Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
�3
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B [
Valuation: Square Footage:
IC
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green B ' ding/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.builditpreen.om
Revised 07/14/09
s
APPLIANCE / EQUIP TYPE
CITY OF CUPEl2TIN0
FEE ESTIMATOR — BUILDING DIVISION
12
ADDRESS:
DATE:
REVIEWED BY:
Elec. Permit Fee: IEPERMIT
APN:
BP#:
'VALUATION: 1$5,000
*PERMIT TYPE: Electrical Permit
PLAN CHEC{ TYPE: Alteration /Addition /Repair
USE: SFD or Duplex
'—JPRIMARY
/'Yaic :/I .-1 K/:.4.
APPLICATION 1 REAP 14
TYPE:
WORK
Fcc
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
i'/1,,,,/, t /im Ch t (A
QTY
Flip /'cc.
BP FEES
Elec. Permit Fee: IEPERMIT
Temporary Power
1ERT<200
1
PME Plan Check:
$42
l?hru,h. Lr.y,. hc'._•: I
l;li'c_ !ns/!. /•tcr°
Fcc
PME Unit Fee:
$42.00
PME Permit Fee:
$42.00
It r;!;cr; '
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
Il"iil'F.'! I )r)c'/fl1'(C''l!lL1JlO17 I'e't'.S':
$42.00
,.. .
777
FEE
i'/1,,,,/, t /im Ch t (A
Elec. Plan Check 0.0 hrs $0.00
Flip /'cc.
Elec. Permit Fee: IEPERMIT
.Si ppl PC f' (rc'
PME Plan Check:
Other Elec. Insp.0.0 hrs $42.00
l?hru,h. Lr.y,. hc'._•: I
l;li'c_ !ns/!. /•tcr°
NOTE. These fees are based on the preliminary infarmatinn nvnilnhln and —i., n..... t:._ ._.r r.- to
--------------- ---------___ ... ... ... .. ..... ...., ..u..o...•r. vv.s..as s.fG
FEE ITEMS (Fee Resolution 09-051 Eff 7,1110)
FEE
QTY/FEE
-.I,. IV, ""Goff r Lr/ V.
MISC ITEMS
Flip /'cc.
.Si ppl PC f' (rc'
PME Plan Check:
$0.00
/' dt'fT"iiI
Fcc
PME Unit Fee:
$42.00
PME Permit Fee:
$42.00
It r;!;cr; '
Work Without Permit? 0 Yes E) No
$0.00
I' unn/ln0
Il"iil'F.'! I )r)c'/fl1'(C''l!lL1JlO17 I'e't'.S':
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
p
$85.00
$0.00
$85.00
Revised: 8/12/2010
1. Use Low/No-VOC Paint
1 IAQ/Heal h pts
y --yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Heal h pts
y --yes
3. Use Low/No VOC Adhesives
3 IAQ/Heal th pts
y --yes
4. Use Salvaged Materials for Interior Finishes
3 Resourc: pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
y=yes
Formaldehyde
6 IAQ/Hea th pts
y --yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Hea th pts
y=yes
7. Seal as EVosed Particleboard or MDF
4 IAQ/Hea th pts
y=yes
B. Use FSC Certified Materials for Interior Finish
4 Resourc: pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resourc: pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y --yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
y=yes
2 Use Rapidly Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Hea th pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total Points Available:
Total Points Project Received:
140 1301 57
01 01 0
k" 6 - ./ (, lo
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3 ITEMS OF 3
CITY OF CUPER-INO
PERMIT RECE=:PT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36935032.00
DATE ISSUED.......: 08/16/2010
RECEIPT #......... BSOOOO11L92
REFERENCE ID # ...: 10080104
SITE ADDRESS .....: 10720 MAZTINWOOD WAY
SUBDIVISION ......
CITY CUPERTIND
IMPACT AREA ......
OWNER ............: ERIC CARLSON
ADDRESS 10720 MARTINWOOD WAY
CITY/STATE/ZIP ...: CUPERTIND, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM GUS KANAKIS
CONTRACTOR GUS KANAKIS LIC # 31285
COMPANY ANCHOR ELECTRIC
ADDRESS 1005 N 2ND ST
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE (408) 921-9292
FEE ID UNIT
QUANTITY
AMOUNI
PD -TO -DT
THIS REC
--------
NEW BAL
-----------------------
1BCBSC VALUATION
----------
5,000.00
----------
1.00
----------
0.00
1.00
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
----------
TOTAL PERMIT
----------
8E.00
0.00
85.00
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
85.00
---------------
85.00
REFERENCE NUMBER
--------------------
AME):
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------
402 TEMPORARY POWER
CUPERTINO
CONTRACTOR / SUBCO]vTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 0 6!4PERMIT# dlWo
OWNER'S NAME: ILA C S PHONE # Gl0 8l - ?02 j • Z
GENERAL CONTRACTOR: UAz/l (� L&L7,Z is BUSINESS LICENSE #
ADDRESS: CITY/ZIPCODE:2-
*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
Please
Please check applicable subcontractors and complete the following information:
fs-tIG ..la
Date
V
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
Cignature
Date