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10040175CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10735 PINOLE CT 'IWNER'S NAME: KELLY & DAN COOK . ,WNER'S PHONE: 6505435894 LICENSED CONTRACTOR'S DECLARATION -icense Class t Lic. # 7 5 172- Date 32ao10 Contractor I hereby affirm that I am licensed under the provisions of Chapter 9 (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. 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. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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. - , 1ff c:,..,�r„ra Date CONTRACTOR: MTT ELECTRIC 7086 BRET HARTE DR SAN JOSE, CA 95120 JOB DESCRIPTION: RESIDENTIAL PERMIT NO: 10040175 DATE ISSUED: 04/30/2010 PHONE NO: (408) 728-2909 COMMERCIAL PROVIDE 60 AMP SUBPANEL FOR FUTURE LANDSCAPE NEEDS Sq. Ft Floor Area: Valuation: $650 APN Number: 36934019.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: �1 Date: ] --EQ III 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, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. RE -ROOFS: 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. 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 thiscity to saveer -on the above mentioned property for inspection purposes. (We) agree emnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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. _L11 , .� -� C:.,n ofi,ry Date -! C 1'P )(0 Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, 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. Owner or authorized agent: 4d&T-7-- Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST ADDRESS: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECSION(S) WILL BE HAVE OBTAINED AHCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCOEULED UNTIL THE NTRACTOR BUSINESS LICENSE. I am not using any subcontractors: Signature and emmnlete the following information: Date Date Owner / Contractor Signature 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36934019.00 DATE ISSUED ....... : 04/3BSoO0020100 RECEIPT #•••• .....: 10040175 29 REFERENCE ID # •• SITE ADDRESS .....: 10735 PINOLE CT SUBDIVISION •••...: CUPERTINO CITY ............ IMPACT AREA ...... OPERATOR: SylviaM COPY # : 1 OWNER KELLY & DAN COOK 10735 PINOLE CT ADDRESS CITY/STATE/ZIP CUPERTINO CA, CA 95014-4425 RECEIVED FROM RL BRACKETT CONST CONTRACTOR TONY DAO LIC # 29650 COMPANY MTT ELECTRIC 7086 BRET HARTE DR ADDRESS CITY/STATE/ZIP ...: SAN JOSE, CA 95120 TELEPHONE (408) 728-2909 QUANTITY AMOUNT PD -TO -DT THIS REC ------- NEW BAL --- ---- - ID UNIT ----------- ---------- ---------- ----- 1.00 0.00 --FEE --------------- 1BCBSC VALUATION 650.00 1.00 0.50 0.00 0.00 0.50 0.00 1BSEISMICR VALUATION 650.00 1.00 114.00 0.00 114.00 0.00 0.00 1BUSLIC FLAT RATE 1.00 42.00 0.00 42.00 42.00 0.00 JEPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1ERT<200 UNITS 1.00 42.00 0.00 ---------- 1TRAVDOC FLAT RATE --- - - - - - -- ---------- 0.00 241.50 0.00 241.50 TOTAL PERMIT AMOUNT REFERENCE NUMBER METHOD OF PAYMENT -- _-------- ------------- 241.50 visa CREDIT CARD - 241.50 TOTAL RECEIPT CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # U Date: ( 1'o �� avev Building Address: Com- 9 J d Mailing Address (if different from building address): Ereaardous Materials being used as part of this project? Yes ❑ No xterior work ons) Yes ❑ No If es, rovide letter from HOA Phone #: Name- �X43 ��QL' (� Phone: Cfj ntractor: r le�+ii Fax: STT �� EContractor License #: "?Z} 5 17 2- S Business License #: Phone: -roe -3 5- o Contact: `c, / 3 - Fax: 1408 Residential Commercial ❑ Job Description: e.1 �, t, - tP u. b,ra V"��J e�� ned?s . EBuildingermit Info: Elect Lc,Y Plumb ❑ Type of Construction (Usage Class): I -A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B Valuation: o " ect Size: Standard Mech ❑ Occupancy Type: 1`-' Square Footage: Maior attach it the Green Green Building: Please application for f applicable, include s include in planest a & the sheet index. to the app Points Achieved: For help,contact Build it Green at www.builditgreen.org Revised 07/14/09 CITY OF CUPERTINO c►y of GENERAL BUILDING APPLICATION CUPETINO FEE SCHEDULE Fee Permit Type Quantity /Sf Fee ID Fee Description Group IGENRES or 1GENCOM Stucco Applications (up to 400 sfl B 1STUCOAP additional stucco application B lass Replacement windows/slidingg 1WINREP door (ea 8 windows) B 1WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) IEPERMITFEE E Electrical Permit Fee 1MPERMITFEE M Mechanical Permit Fee 1PPERMITFEE P Plumbing Permit Fee Stand Alone Electric Pln Ck (hourly) E IELCPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1MECPLNCK Stand Alone Plumbing Pln Ck (hrly) P 1PLMBLNCK STPLNCK-( 3 Hr Min Standard Plan Check (when no E/MIP) B 1 not over counter) hourly -stand alone when Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BCBSC B Seismic Residential 1BSEISMICR B Seismic Commercial 1BSEISMIC0 1TRAVDOC B Travel & Documentation B 1BUSLIC Business License i 1 5 of 5