13050185CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10720 MARTINWOOD WAY
OWNER'S NAME: CARLSON ERIC R TRUSTEE
OWNER'S PHONE: 4082572597
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 1—,— (Lica# L�,,�. \Q/
Contractor Vin . iacXAy, to 2t 2
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. t,
Sianature Date S 2 t
❑ 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)
I, 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. It after making this certificate of exemption, I
become subject to the Worker's Compensation provisionss 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
CONTRACTOR: ROMANO ELECTRIC PERMIT NO: 13050185
2198 LAUREL DR DATE ISSUED: 05/24%2013
SANTA CLARA, CA 95050 PHONE NO: (408) 564-0583
JOB DESCRIPTION: RESIDENTIAL COMMERCIALO
INSTALL (N) ELECTRICAL ATTIC FAN
Sq. Ft Floor Area: I Valuation: $681
APN Number: 36935032.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DARMIT ISSUANCE OR
180 DA M CALLED INSPECTION.
eA Date: Z K
/13
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 Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534. - , n
Owner or authorized agent(^�c�`1
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
CUPERTINO
GENERAL PERMIT APPLICATION 46"MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION t1\
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10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 � MISC
(408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.org
❑ PLUMBING ❑ MECHANICAL `'ELECTRICAL ❑ MISCELLANEOUS
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PROJECT ADDRESS vt. o
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APN # 76 � Q 2,
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONT TOR NAME
LICENSE NUMBER
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LICENSE TYPE
BUS. LIC #
COMPANY N E LL _�.
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STREET ADDRESS
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CITY, STATE, ZIPPHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF [3SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: COMMERCIAL
PROJECT IN WIIALAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑YES
FLOOD ZONE ❑ NO
IS THE BLDG AN El YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION:
REC B
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prop o r s behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. ragree to comply with all applicable local
ordinances and state laws relatin to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: �j Z
SUPPLEMENTAL INFORMATI REQUIRED
OFFICE USE ONLY
COUNTER
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❑ EXPRESS
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❑ STANDARD
❑ LARGE
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❑ MAJOR
MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
WIMIM TCyT7AR A TAD 1137Tr7 11IIV -' nTVicinN
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Appliances 1ERESAPP 1 # $23
TOTALS: $23.00 "
NOTE: This estimate does :not ineluaeJees aue to orner uepanments (ae. rau lsrsg, jµ�«� �• nom, •• �, . -••- _. _ ____ ___, _ __ _ _ _
District, etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addh7 in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
>{'
ADDRESS: 10720 martinwood
DATE: 05/24/2013
REVIEWED BY: melissa
APN: 369 35032
BP#:
"VALUATION:
$681
*PERMIT. TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
$0.00
PENTAMATION 1 REAP1
PERMIT TYPE: A
USE:
Sup r) Insp Fee
WORK
install n electrical attic fan
PME Unit Fee:
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Appliances 1ERESAPP 1 # $23
TOTALS: $23.00 "
NOTE: This estimate does :not ineluaeJees aue to orner uepanments (ae. rau lsrsg, jµ�«� �• nom, •• �, . -••- _. _ ____ ___, _ __ _ _ _
District, etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addh7 in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Per mit Fee:
Sup r) Insp Fee
PME Unit Fee:
$23.00
PME Permit Fee:
$45.00'
Construction.Tax.-
F71
Administrative. Fee: 1ADM1N
$42.00
Work Without Permit? 0 Yes (2) No
$0.00
Advanced Planning Fees:
i
Travel Documentation Feer ITRAVDOC
$45.00
Strona Motion .Fee: IBSEISMICR
$0.50
Select an Administrative Item
Commission Fee: IBCBSC
$1.00
61BII�dgStds
$156.501 $0.00 f r,. $156.50
Revised: 040/2013.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10720 MARTINWOOD WAY
CONTRACTOR: ROMANO ELECTRIC
PERMIT NO: 13050185
OWNER'S NAME: CARLSON ERIC R TRUSTEE
2198 LAUREL DR
DATE ISSUED: 05/24/2013
OWNER'S PHONE: 4082572597
SANTA CLARA, CA 95050
PHONE NO: (408) 564-0583
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE]
❑ LICENSED CONTRACTOR'S DECLAfRATION
License Class_ Lic. #
INSTALL (N) ELECTRICAL ATTIC FAN & ADD
�el
Contractor \
_ O
DEDICATED
CIRCUIT FOR FAN
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
Sq. Ft Floor Area:
Valuation: $681
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
APN Number: 36935032.00
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
WITIIIN 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 LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Is Date: r
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
�' `� t
Signature � J1� Date "'e 2—�&
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
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)
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 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, Sections 25505, 25533, and 25534. �^%
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent- CIJ(9s' Ull
Date• r l 313
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