10070086 CITY OF CUPERTIT40 BUILDING PERMIT
BUILDING ADDRESS: 10232 PARLETT PL CONTRACTOR:VOLTZ ELECTRIC PERMIT NO: 10070086
OWNER'S NAME: BILL BARTHELL 6245 LEAN AVE DATE ISSUED:07/12/2010
VNER'S PHONE: 4088738146 SAN JOSE,CA 95123 PHONE NO:(408)835-3866
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor _Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL ELECTRICL SUBPANEL IN GARAGE,ADD
CIRCUIT
(commencing with Section 7000)of Division 3 of the Business&Professions FOR FURNACE
Code and that my license is in full force and effect.
1 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
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31626062.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnity and keep harmless the City of Cupertino against liabilities,judgments, .
costs,and expenses which may accrue against said City in consequence of theDate
granting of this permit. Additionally,the applicant understands and will comply Issued by:
T)with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature _ Date 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
inspection.
OWNER-BUILDER DECLARATION
Signature of.Applicant: _Date:
I hereby affirm that 1 am exempt from the Contractor's License Law for one o'
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property.or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1.as owner ofthe property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will mainiam a Certificate of Consent tc self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' 25505,25533,an 5534.
Section 3700 of the Labor Code,for the performance of the work for which this 7/11/ (1
permit is issued. Owner or authorized agent: Date:
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,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I mus: I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that 1 have read this application and state that the above information is
correct.1 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
1.1011 the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
nnify and keep harmless the City of Cupertino against liabilities,judgments,
,s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all no source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18,
Signature_ Date f Z r 1
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
FIZIA7DDRESS: 10232 Parlett Place DATE: 07/12/2010 REVIEWED BY:
BP#: *VALUATION: $1,000
,`PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY r` APPLICATION
USE: SFD or Duplex TYPE:
a a Install electric subpanel in garage-, add circuit f)r furnace
o �
3 �
APPLIANCE/EQUIP TYPE CAPACITY FE E ID QTY BP FEES
Apparatus 1BRE.MMISC 1 $126
TOTALS: $126.00
Elec.Plan Check 0.0 hrs $0.00
Elec.Permit Fee: I EPERMIT
Other Elec.Insp. 0.0 hrs $42.00
NOTE. These fees are based on the relimina information available and are onlyan estimate. Contact the Dept or addn'l info.
FEE ITEMS (Fee Resolution 09-051 Elf i,-/,.09) FEE QTY/FEE
MISC ITEMS
PME Plan Check: 90.00
PME Unit Fee: $1:1_6.00
PME Permit Fee: $42.00
Travel Documentation Fee: ITRA VDOC $42.00
Select an Administrative Item
Bldg= Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $211.00 $0.00 TOTAL FEE: $211.00
Revised: 6/30/2010
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blit: Lot :
APN 31626062 . 00
DATE ISSUED. . . . . . . : 07/12/2010
RECEIPT # . . . . . . . . . : BS000010843
REFERENCE ID # . . . : 10070086
SITE ADDRESS . . . . . : 10232 PARLETT PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BILL BARTHELL
ADDRESS . . . . . . . . . . : 10232 PARLETT PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2208
RECEIVED FROM . . . . : WILLIAM BARTHELL
CONTRACTOR . . . . . . . : MATT SABICH LIC # 31809
COMPANY . . . . . . . . . . : VOLTZ ELECTRIC
ADDRESS . . . . . . . . . . : 6245 LEAN AVE
CITY/STATE/ZIP . . . : SA9 JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 835-3866
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
1BREMMISC FLAT RATE 1 . 00 126 . 00 0 .00 126 . 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 211 . 00 0 . 00 211 . 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 211 . 00 visa
---------------
TOTAL RECEIPT 211. 00
C,_eERTINO
CITY OF OUIL-DING
GENERAL I+ ION FARM
c�n 1 SND T AppLI(,AT
CUPER PER Ai
Date: �
tA
XP
Address: 18 2� address):
Bull ding om building r10
Mailing Address
if different fr art of this project`' Yes
be used as P letter from gOA
Materials
b I f es, rovide lett
Are Hazardous ❑ No ❑ phone#� C�d
xterior work onl ) Yes
110A: (E �,� Phone- (�J 6�
Owner,s Nie. �J Fax'
Contractor:
Co
retractor License#: 1 1 phone.
icense#: ` Fax:
Cu ertino Business L i � h
Contact*.
Commercial ❑ 6J A
Residential ,�Y(t, S u�
lob Description:
` V� aO Ott
U ( eui �
Mech�
it info: plumb Occupancy Type..
Building p e'er' Elect
Usage Class):
Bldg on T V-B ❑ Square Footage
Type o f con stru IV-H
-B ❑ 11/1111N
-PL-A ❑
IV111 B,
1-A, 1 1 1
V aluation: Ma or ❑ is
& attach
Large❑ EED Cheeky
ress Standard e G Buildin he sheet index.
project Size: EXp ortion
of the Green In set&
completer
,IV P licable�delude In P
please o r if aPP
Green Building to the application p�114
t ��,�,,buildit reen•or Revised
oojnts Achieved. wild it Green a
For hel ,contact B