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13070051 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23200 VIA ESPLENDOR#33 CONTRACTOR:MISSION VALLEY PERMIT NO:13070051 ELECTRIC INC OWNER'S NAME: ALAN WINTERBOTHAM PO BOX 3332 DATE ISSUED:07/09/2013 OWNER'S.PHONE: 6509652260 FREMONT,CA 94539 PHONE NO:(510)745-8847 [f LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS License Class G ►D Lic.# �{70'. 3 Z INSTALL 16(N)LED LIGHT FIXTURES IN KITCHEN& BEDROOMS.REPLACE 2 FANS IN BATHS,REPLACE ALL Contractor KS►u� tl�tByDate q 1 _ SWITCHES(17)AND OUTLETS(30)AND ADD 5(N) 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:$9500 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:34255018.00 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 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 FR A ALLED 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: granting of this permit.,Additionally,the applicant understands and will comply with all non-point s rce gulatio per the Cupertino Municipal Code,Section 9.18. o RE-ROOFS: Signature Date7— L"1 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 will maintain compliance with the C tino Mu ipal Code,Chapter 9.12 and performance of the work for which this permit is issued. the Health&Safety Code,Se 'ons 55 I have and will maintain Worker's Compensation Insurance,as provided for by ,25533 nd 2553, r: Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: te: 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 CONSTRUCTION LENDING AGENCY 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 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 Lcertify 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 MER .... �� :I COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (1 (408)777-3228•FAX(408)777-3333•building(c�cupertino.org �O mtsc CUPERTI: Wo ' Q PLUMBING. ❑MECHANICAL R ELECTRICAL ❑MISCELLANEOUS FRT ADDRESS APN# PHONEEMAIL T ADDRESS CITY, STATE,ZIP FAX CO ACT NAME I'I PHONE E-MAIL ruI.. t S ADDRESS CITY STATE,ZIP FAX ..�► Gsd 4YS' sro zz6- 6Z: ❑ OWNER ❑ OWNER-BUIIAER:� ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑"TENANT .. CONTRACTOR AME I. LICENSE NUMBER LICENSE TYPE BUS.LIC# 5t ✓a1Le C ANY NAME ` FAX / / 'J E-MAIL S�o-�i •6l b Z STR�T ADD ' CITY,STATE,ZIP PHONE 1 ,1 - f3 SIo• S-S'8'Y ARCHITECT%ENGINEER:,NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX I, STREET ADDRESS j CITY,STATE,ZIP PHONE USE OF I ❑SFD m DUPLEX 13.MULTI-FAMILY PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO - EICHLER HOME? ❑NO- DESCRIPTION'OPWORi U i ivy i ' 'I�e1.�- � L�� G� � L iEt T ►J IG t Yzt�r� C �t�� lw II Ii I! i�Vv TOTAL VATUATIOI�' ,'i By Tiny slgnahire!below,I certify to each of the,ollowing: I am the property owner or authorized agent to act on the property owner' ehalf. I have read this apglicatiolx and the Jnformatwn,I have pr ed'is correct I ave read the Description of Work and verify it is accurate. I agree to comply with all:applicable local) ordinalices and state Iaws relating o b d construction. authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Slgnatwe ofAp�liCantiAgent •!" ' '' Date: 7— 9—IM i I' SUPPLE NTAL INFO TION QUIRED �... � III i Inca®M, o MEPMiscApp_2011.doc revised 06/21111 idI CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 23200 VIA ESPLENDOR#33 DATE: 07/09/2013 REVIEWED BY: MELISSA APN: 342 55 018 BP#: `VALUATION: 1$9,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP10 USE: PERMIT TYPE: i WORK INSTALL 16 N LED LIGHT FIXTURES IN KITCHEN & BEDROOMS. REPLACE 2 FANS IN BATHS SCOPE REPLACE ALL SWITCHES (17)AND OUTLETS (30)AND ADD 5 (N) RECEPTACLES IN KITCHEN Mech.Plan Check 0.0 hrs $0.00 .Plumb.Plari Cheek Elec.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: 1MPERMIT Plumb. Permit Fee: Elec.Permit Fee: IEPERART [O4",hther Mech.Insp. 0.0 hrs $47.00 other Plumb Insp. Other Elea Insp. 0.0 hrs $47.00 .Imp,P'rc: Plumb. hasp.Fee., Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prellmina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 L12_j Electrical Suppl.PC Fee: (2) Reg. 0 OT 0.0 1 hrs $0.00 $207.00 IBREARECEP Recep/Switch/Outlets PME Plan Check: $0.00 F 16 Electrical Permit Fee: $0.00 $70.00 IBREMFLYT Fixtures,Lighting Suppl. Insp.Fee.e Reg. ® OTO,O hrs $0.00I 2 I # Mechanical PME Unit Fee: $0.00 $48.00 IBREMVENF Ventilation Fan PME Permit Fee: $94.00 Conslrziction Tax: -F-T I L Administrative Fee: IADARN $44.00 Work Without Permit? ® Yes (E) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential (E) Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure ®, Strom Motion Fee: IBSEISAffCR $0.95 Select an Administrative Item Bldp,Stds Commission Fee: IBCBSC $1.00 $186.95 $325.00 x O A0! $511.95 . j �\ Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: Z3Zod �/ p �s'PlN #3 PERMIT# 3 osl OWNER'S NAME: ,, rL PHONE# 6'sO -46 -ZZG GENERAL CONTRACTOR k ,ry�p,.1 �fp,<<,Gt C ' BUSINESS LICENSE# ADDRESS: .0,fix 3 Z CITY/ZIPCODE. ,� T CO- *Our municipal code requires all businesses working,in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL�BE%SCI3EDULED UNTIL THE GENERAL CONTRACTOR AND ALL S ONTRACTORS HAVE OBTAINED AIXITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Al `� rl Signa re Date Please check applicable subcontractors and complete the following`informaton: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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/Contractor Signature Date