The URL can be used to link to this page

10020086 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10340 MANN DR CONTRACTOR:A-1 ELECTRIC PERMIT NO: 10020086 OWNER'S NAME: CROSARIOL STEVE 421 E HEDDING ST DATE ISSUED:02/16/2010 JER'S PHONE: 4089259171 SAN JOSE,CA 95112 PHONE NO:(408)975-9171 �— LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r License Class t--V Lic.# ` l I y7 MECH RESIDENTIAL COMMERCIAL Contractor 44C'--k Cl, t Date 2_—(4v—t0 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE EXISTING 200AMP SVC**BSL RNWD (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:$2100 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:32645004.00 Occupancy Type: 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 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 DAY OM LAST CALLED INSPECTION. 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 Issued by: Date: 9.18. Signature Date L'lb-I J RE-ROOFS: Lr 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: 1,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. I 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. 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 uthori agent Compensation laws of California. If,after making this certificate of exemption,I Date: 2--140-10 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 it' -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 gr—ting 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 2--1 0-t O CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 32645004 . 00 DATE ISSUED. . . . . . . : 02/16/2010 RECEIPT # . . . . . . . . . BSC00009755 REFERENCE ID # . . . : 1OC20086 SITE ADDRESS 10.40 MANN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CROSARIOL STEVE ADDRESS 10340 MANN DR CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM A-1 ELECTRIC CONTRACTOR R0:3ERT LAMANTA LIC # 27061 COMPANY . . . . . . . . . . : A- L ELECTRIC ADDRESS 42L E HEDDING ST CITY/STATE/ZIP SA:J JOSE, CA 95112 TELEPHONE (4D8) 975-9171 FEE ID UNITQUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -------- ---- ------ -- ---------- - 1BCBSC VALUATION 2, 100 . 00 1. 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 2, 100 . 00 0 . 50 0 .00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 .00 114 . 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 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 - --- 42_ - ---- 00 0_00 ---------- ---------- TOTAL PERMIT 241.50 0 . 00 241 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- CHECK 241.50 #10835 --------------- TOTAL RECEIPT 241. 50 SN CITY OF CXPERTINO CUPER ANO GENERAL BUILDING PERMIT APPLICATION FORM APN# , f 5 1 Date: Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: Exterior work only) Yes No ❑ Ifes, rovide letter from HOA Owner's Name: Phone#: Contractor: Phone: i i eF I k 1 .c 1,c��,/`c Fax: Contractor License#: 3o iL17 " z.'o Cupertino Business License#: ' � Phone: Contact: ^ vw7"�N Fax: Residential Commercial Job Description: Q,� l�Wc- -� 1,s�c-n zoo (-e Building Permit Info: Bldg Elect 91 Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B LZ S r L-- Val ation: Square Footage: Z �rc> Project Size: Express ❑ Standard ❑ Lar c: ❑ Ma'or ❑ Green Building: Please complete relevant portion of the Green Building/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.buildityreen.or Revised 07/14/09 E A CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTiNO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco A,)plications (up to 400 sf) B additions. stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Wir.dow-structural shear B wall/masonry(includes plan ck fee) IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P I ELCPLNCK Stand Al one Electric Pln Ck(hourly) E IMECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standarc Plan Check (when no E/M/P) B when not over counter) hourl -s:and alone 1BCBSC Cal Bldj;Standards Commission Fee B ALL PERMIT l TYPES 1BSEISMICR Seismic Residential B l 1BSEISMICO Seismic Commercial B ITRAVDOC Travel �t Documentation B 1 BUSLIC Busines 3 License B 5 of 5 Community Development " 10300 Torre Avenue - 4 Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF :UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: C evS 1✓`l o PHONE # i vjr c.C,S-3z GENERAL CONTRACTOR ,r+; FAX # 01 I am not using any subcontractors: z— a Sit, Le Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date