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13050155 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20665 ACADIA CT CONTRACTOR:ALTAP ELECTRICAL PERMIT NO:13050155 OWNER'S NAME: MSG FAMILY LP PO BOX 41009 DATE ISSUED:05/21/2013 OWNER'S PHONE: SAN JOSE,CA 95160 PHONE NO:(408)561-2806 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL❑ License Class C– f O Lic.# �' 9 2 Z 9' PANEL UPGRADE FROM 100 AMP TO 125 AMP Contractor,A LT A /e C-'P r,,nD'ate 7r> 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:$1850 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 "N Number:32656020.00 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 WIT 80 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 OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, a//I costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Si ature c 414-- L Date any roofing gn ��2/43 All roofs shall be inspected prior to any roofing material being installed.If a roof is �4— installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 1,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. 1 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 permit is issued. Owner or authorized agent: (> Date: . 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 06'5 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 misc CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(&CUDertino.ora. ❑PLUMBING ❑MECHANICAL &&ECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 204.65 /� I APN# �� U OWNER NAME At i J �� 1- 5C-1 YmA� J � I PHONE O �7o� I EMAIL A f� ,% STREET 2 6S4�� A� ��i�a 0� ` CITY,STATE,ZIP /v FAX CONTACT NAME 13�a �Q yK ._rr{^ S, r� . PHONE I E-MAIL STREET ADDRESS 1j� � CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT NcoNTRAcTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME p LICENSE NUMBER LICE SE TYPE BUS.LIC# ¢� LT a° feC�hn � /0-9 22 9 1 6 Zg COMPANY NAME A/] q— / / ' t E-MAIL / FAX N � KCG �1��2LeC"�tr�C-a� �SsK oa ,COf� STREET 3l h7A,/-0a 1'�c� CITY�rT�k �� A -9,51 C.-r/ PHONE ARCHITECT/ENGINEER NAME I LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SM.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK �a n / �i ®D� ' 2- 5.4— 0 � TOTAL VALUATION: RECEI��i] By my signature below,I certify to each of the following: I am the property owner or authorized agent to ac YorAe property owner'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. I agree to comply with all applicable local ordinances and state laws relating to build' g construction. I authorize representatives,Off Cupertino to enter the above-id entif ed property for inspection purposes. Signature of Applicant/Agent: Lx !,��✓`i tom` Date: �/Z 17 3 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY �W ❑ OVER-THE-COUNTER t" ❑ EXPRESS x U ❑ STANDARD U .a7 ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR=BUILDING DIVISION ADDRESS: 20665 ACADIA I DATE: 05/21/2013 REVIEWED BY: MENDEZ APN: I BP#: *VALUATION: 1$1,850 *PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex I I PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK PANEL UPGRADE 100 AMP TO 125 AMP SCOPE mum IN 50 L1ech,Ptan Check Plzazrb. Alan Check Elec.Plan Check 0.0 hrs $0.00 :�1ech. l'ernait Fee: I Plumb.Permit Pee: I Elec.Permit Fee: IEPERMIT Other Tech.Insp. Other Plumb Insp. I Other Elec.Insp. 0.0 hrs + $45.00 R9ech.Insp.Fee: Plumb. Insh.Fee: Elec.Insp,Pee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelimina information available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 125 amps Electrical Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 $45.001 1BELEC200 I Services PME Plan Check: $0.00 Permit Fee: I $0.00 Suppl. Insp.Fee-.0 Reg. ®OT 0 0 hrs I $0.00 PME Unit Fee: I $0.00 PME Permit Fee: I $45.00 Conso-fiction Tax: n Administrative Fee: IADMIN $42.00 Work Without Permit? ® Yes 0 No I $0.00 I I 0 Advanced Planning Fee: I $0.00 Select a Non-Residential Travel Documentation Fee: ITRAVDOC I $45.00 I I Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $133.50 $45.00 $178.50 Revised: 04/29/2013