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10080071
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22050 REGNART RD COIITRACTOR:HERITAGE ELECTRIC PERMIT NO: 10080071 OWNER'S NAME: GREGORY S YOUNG 381 E MCGLINCY LN STE B DATE ISSUED:08/10/2010 NER'S PHONE: 4083660581 CAT4PBELL,CA 95008 PHONE NO:(408)253-8946 LICENSED CONTRACTOR'S DECLARATION/l ((1� BU[LDING PERMIT INFO: BLDG r— ELECT F PLUMB ( r License Class `© Lic.# �• �4 - `--� , MECH RESIDENTIAL COMMERCIAL r Contractor Date V I hereby affirm that I am licensed u e provisions of Chapter 9 JO]I DESCRIPTION:METAL BLDG;6 LIGHTS,FIREBELL&SWITCH&PLUG (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:$2000 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. APIA Number:36602048.00 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 8 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DA OM LAST CALLED INSPECTION. costs,and exp26-e which may accrue against said City in consequence of the granting of pe t. Additionally,the applicant understands and will comply with all non- int s e Cupertino Municipal Code,Section Issued by:- _w Date: 9.18. Signature Date` RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is insl alled 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, Sig iature 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 h the 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 Ca ifornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the cot ipliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Salety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Ad 3itionally,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 cot ants as defined by the Bay Area Air Quality Management District I will permit is issued. in ntain ompliance with the Cupertino Municipal Code,Chapter 9.12 and the p He filth&S fety Code,Sections 25505,25533,and 25534. 1 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 ized ager Compensation laws of California. If,after making this certificate of exemption,I _ 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 h-:reby 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 Le tder'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 Le rder's Address upon the above mentioned property for inspection purposes.(We)agree to save it-lomnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION andFen:t hich may accrue against said City in consequence of the b in .Additionally,the applicant understands and will comply I u rderstand my plans shall be used as public records. withall n gu er the Cupertino Municipal Code,Section 9.18. Lig ensed Professional Signature Date `D\ CITY OF CUFERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: I,ot: APN 36602048 .00 DATE ISSUED. . . . . . . : 08/10,2010 RECEIPT #. . . . . . . . . BS000011143 REFERENCE ID # 10080071 SITE ADDRESS . . . . . : 22050 REGNART RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : GREGO2Y S YOUNG ADDRESS . 22050 REGNART RD CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM ANJALI TATE CONTRACTOR DAVE MURRAY LIC # 31950 COMPANY HERITAGE ELECTRIC ADDRESS 381 E MCGLINCY LN STE B CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : .(408) 253-8946 FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- 1BCBSC VALUATION 2, 000. 00 1 .00 0. 00 1.00 0 .00 1BREMFIXT NO. FIXTURES 1. 00 63 . 00 0.00 63 . 00 0 .00 1BREMRECEP NO. OUTLETS 1. 00 42 .00 0 .00 42 . 00 0 .00 1EPERMITFE FLAT RATE 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 190 .00 0.00 190 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---------- CHECK 190 .00 47216 ----- --------- TOTAL RECEIPT 190 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL 512 FINAL HANDI-CAP CITY OF CUP ERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: 08/05/2010 REVIEWED BY: GS its APN: BP#: *VALUATION: $2,000 PERMIT TYPE: Electrical Permit PLAN CH':CK TYPE: Alteration/Addition/ Repair 01,I 1 APPLICATION 1 REAP 11 PRIMARY SFD or Duplex TYPE: USE: (•i CX)R �Ift(�t: � W a, a QO 3 � APPLIANCE/EQUIP TYPE CAPACITY FEE ID QTY BP FEES Fixtures, Lighting 16REMFIX f 1 $63 Re ce p/Switch/Outlets 1BREMREC.P 1 $42 TOTALS: $105.00 Elec.Plan Check 0.0 1 hrs $0.00 'st, _7rr Elec.Permit Fee: IEPERMIT Uirr 11rrtr 1t7 �,, T771 Ctiher f'lrtml. lusjz Other Elec.Insp. 0.0 hrs $42.00 NOTE: Thesefees are based on the relimina information avail<<ble and are onl an estimate. Contact ITEMS addn'1 info, FEE ITEMS (Fee Resolution 09-051 Eff.' 7,/1/29) FEE QTY/FEE /''lura C'11c(I" Fcc'- PME Plan Check: $0.00 sjg)pi. 117.A11, P-cc PME Unit Fee: $105.00 PME Permit Fee: $42.00 ( r1t'1sl7`tr( ?rtlil 1 t.7.1 7 3 Work Without Permit? 0 Yes (D No $0.00 1'7t1F7iitC14_' Travel Documentation Fee: ITRAVDOC $42.0) Select an Administrative Item �tl?lll t,lrIion Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS. ` $190.00 $0.00 TOTAL FEE. $190.00 Revised: 7/28/2010 UX ft CITY OF CU PERTINO Y OF CUP f�T]NO 'GENERAL BUILDING PERMIT APPLICATION FORM APN # r U C) Date: Building Address: 2-7-0150 ke-& JAgT em Tl X10 CA. otSa Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes 0 No HOA: (Exterior work only) Yes ❑ No ❑ If es, provide letter from HOA Owner's Name: Phone#: bVrl 0S- Contractor Phone: �o�--2,,g ;5 -- y wez- (� i.EC:-I1'Z�L Fax: --57/— e7 Za- Contractor License#: c.f 157 Cupertino Business License#: 0 Contact: Phone: &-7-7 DO-E A�ar " Fax: Residential Commercial Job Description: Building Permit Info: Bldg ❑ Elect Pluinb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ' S Valuation:,/1�l Square Footage: Project Size: Ex ress ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Bu' ding/LEED Checklist & attach it to the application or if applicable, in-.lude in plan set& the sheet index. `3oints Achieved: For help, contact Build it Green at www.builditgreen.)r Revised 07/14/09 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST PERMIT# JOB ADDRESS: 2 -cO— l 0 PHONE# 7-5 OWNER'S NANIE:Q�� BUSINESS LICENSE# 5 U GENERAL CONTRACT R: F�� CITY/ZIPCODE: yC�SY� ON g52 ADDRESS: C CCo\: ty to have a City of Cupertino business license. *Our municipal code requires all esses working in the c. WILL BE SCHEDULED UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITV OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signatu re Date Please check applicable subcontractors and complete We following information: SS LICENSE # SUBCONTRACTOR BUSINESS NAME BUSINESS 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 t Rock Tile Date Owner/Contractor Signature