13050064CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10335 STONYDALE DR CONTRACTOR: BAY LIGHT ELECTRIC
OWNER'S NAME: HOSE RICHARD K TR AND JANET K
OWNER'S PHONE: 4083680907
❑ LICENSED CONTRACTOR'S DECLARATION
License Cla,0— t A Lio.# A q 9JI) n
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 3.700 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 ap licant understands and will comply
with all npTpoint source regulatio s pef, thlCupertino Municipal Code, Section
9.18. K ) /J J' A
❑ OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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.
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.
Signature Date.
22461 MT EDEN RD
SARATOGA, CA 95070
JOB DESCRIPTION: RESIDENTIAL
PANEL UPGRADE 200 AMP
Sq. Ft Floor Area:
APN Number: 32637011.00
PERMIT NO: 13050064
DATE ISSUED: 05 /08/2013
PHONE NO: (408) 234 -1832
COMMERCIAL E]
Valuation: $2500 .
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 0 AYS OF PERMIT ISSUANCE OR
180 DAY F OM LAST CALLED IN SP CTION.
Issued by: Date: S.
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.
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 nagement District I
will maintain compliance wit the Cupertino Municipal C de, Chapter 9.12 and
the Health & Safety Code, t ns 25505, 2553 5
Owner or authorized agent: Dater
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
MEPMiscApp_2011.doc revised 06121111
�� CITY OF CUPERTINO
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APPLIANCE / EQUIP TYPE
10335st6nydale dr
FEE
DATE: 05/08/2013
REVIEWED BY: Mendez
limADDRESS:
APN:
BP #:
*VALUATION:
$500
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
$45
PENTAMATION 1 REAP2
PERMIT TYPE: i
USE:
Suppl. Insp Fee
WORK
panel upgrade 200 am
$45.00
PME Permit Fee:
$45.00
SCOPE
Construction Tax:
APPLIANCE / EQUIP TYPE
FEE ID
FEE
QTY/FEE
QTY
UNITS
BP FEES
Suppl. PC .Fee
Services
1 BELEC200
200
Amps
$45
Permit Fee:
i
:s
Mech. Plan Check
Llech. Permit lee:
Other Nlech. Insp.
rt ech. Ins -p l ce: .
NOTE: This estimate does not
Plumb. Plan Check Elec. Plan Check 10.0 1 hrs $0.00
Plumb. Permit Fee: Elec. Permit Fee: 1EPERMIT
Other Plumb Insp. Other Elec. Insp. 0.0 hrs $45.00
Plumb. hrsp. Fee: Elec. Insp. Fee:
due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are,
$178.501 $0.00
uonraer me uepi_
MISC ITEMS
Select an Administrative Item
r _ $178.50
Revised: 04/29/2013
FEE ITEMS (Fee Resolution 11 -053 E . 711112)
FEE
QTY/FEE
Plan Check Fee:
Suppl. PC .Fee
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? 0 Yes (j) No
$0.00
A(Jvutaced Planning Fees:
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Bldsz Stds Commission Fee: IBCBSC
1 $1.00
$178.501 $0.00
uonraer me uepi_
MISC ITEMS
Select an Administrative Item
r _ $178.50
Revised: 04/29/2013
*Our municipal code requires l businesses working in the city to have a City ofe.Cupertino bus ess license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPE !ION ) LL BE .SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND A SUBCONTRACT S E OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
gn ure Date
Please check applicable subcontractors and complete the following information:
✓
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
dl i h
3
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
Tile
Owner'/ ontractor Sign Date