13050135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20199 PACIFICA DR CONTRACTOR:SOUTHWEST ELECTRIC PERMIT NO: 13050135
OWNER'S NAME: BHUPINDER KHATTRI 14435 BIG BASIN WAY STE130 DATE ISSUED:05/20/2013
OWNER'S PHONE: 6502246646 SARATOGA,CA 95070 PHONE NO:(408)506-6421
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class f 0 0 Lie.# (2-•—�(a d PANEL UPGRADE 200 AMP
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. Sq.Ft Floor Area: Valuation:$2500
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:36929011.00 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/00 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 DA F LAST CALLED INSPECTION.
indemnify and keep h less the City of Cupertino against liabilities,judgments,
costs,and expenses w may accrue against said City in consequence of the ,
granting of this pe Additionally,the applicant understands and will comply Issued by: Date: Q�
with all non-poin regulAons per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signator 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 I am exempt from the Contractor's License Law for one of
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 isnot intended or offered for sale(Sec,7044,
Business&Professions Code)
I,as owner of the 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
I 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 maintain a Certificate of Consent to 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 Ba Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the ertino Municipal Code,,_Chapter 9.12 and
I have'and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Seel505,2553 1
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorizedagent Date:5 rJ
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 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 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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 non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION ��j4'
MEP * . .
AP, i COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 J M
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(408)777-3228•FAX(408)777-3333•buildingCcD-cupertino.org
CUP'IER7"INaO ',
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❑PLUMBING ' . ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
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❑OWNER ❑ (1WNER-BUII.DER.�. OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
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BUIIDING• I. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NOOD ZONE ❑NO EICHLER HOME? ❑NO
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By I,rriy slgnatue bclow,'I certify to each o e following: I am the property owner or authorized agent to act o roperty owner's behalf. I have read this
apphcatloti and Ie Inforinatlon I Have pc coaect I have read the Description of Work and verify it is acc ate. I agree to comply'with all applicable loc.
ordutances and.sialIte laws relating to b ' traction. I authorize representatives of Cupertino to enter the abov 'dentif d property for inspection purposes
Signature ofAp)li AnYAgenti I' Date:
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NTAL INFORMATION REQUIRED
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MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20199 Pacifica dr DATE: 05/20/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$2,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY PENTAMATION
SFD or Duplex 1REAP2
USE: PERMIT TYPE: A
WORK PANEL UPGRADE 200 AMP
SCOPE
N�( -
.L1ech.Flan Check Plumb, Plan Check Elec.Plan Check 0.0 hrs $0.00
Nfec;h. Permit Fee: Plumb.Permi7 Fee: Elec.Permit Fee: IEPERMIT
L
Meeh.Insp. Other Plumb Insp. Other Elec.Insp. 0.0 hrs $45.00
.Insp.Fee' Plumb.Insp.Fee: Glec.Insp,I'ee:
NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the Mina information available and are onlyan estimate Contact the De t or addn'I info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = amps Electrical
Suppl.PC Fee: (D Reg. ® OT0.0 hrs $0.00 $45.00 IBELEC200 Services
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-(j) Reg. ®OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
€onstr•uction TaX., T7
Administrative Fee: IADMIN $42.00
Work Without Permit? ®Yes (E) No $0.00 0
Advanced Planning Fee. $0.00 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $45.00 Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item.'
Bldg Stds Commission Fee: 1BCBSC 1 $1.00
$133.50 $45.00 ;� O ,x� rEillu $178.50
Revised: 04/29/2013