13070127CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10292 TERRY WAY
CONTRACTOR: MAINE ELECTRIC INC
PERMIT NO: 13070127
OWNER'S NAME: I:ER�`�dt+�i4LLCr A.
599 LEISURE ST
DATE ISSUED: 07/19/2013
OWNER'S PHONE: 4088398279 1Q (Yid
LIVERMORE, CA 94551
PHONE NO: (925) 443 -3377
JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
61 # 3'� 2-57D
UNITS 1 -4, CHANGE OUT ONE 400 AMP RATED JUNCTION
License Class Lic.
BOX &DISCONNECTS AND 5 60 AMP SUBPANELS
_ jj � tt �" q
Contractor t�fa��.e e �ZCT1'�� t> , /�tGDate 7 � l
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: $19000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35917013.00
Occupancy Type:
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
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 ?QVMT 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 FRO ALLED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued Date: /
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source th ertino Municipal Code, Section
9.18.
q �j
RE- ROOFS:
Signature Date 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. 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 Cup ' icipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 33, an A5534. 1 I
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:
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
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
MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
F FF.F. FCTIMATnR — RITII.DING DIVISION
im,
ADDRESS: 10292 TERRY WAY
FEE
DATE: 07/19/2013
REVIEWED BY: MELISSA
BP FEES
APN: 35917 013
BP #:
*VALUATION: $19,000
*PERMIT TYPE: Electrical Permit
400
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
p
$0.00
PENTAMATION 1 REAP3
USE:
60
PERMIT TYPE:
WORK
UNITS 1 -4 CHANGE OUT ONE 400 AMP RATED JUNCTION BOX & DISCONNECTS AND 5 60 AMP
SCOPE
SUBPANELS
$211.00
APPLIANCE / EQUIP TYPE
FEE ID
FEE
QTY
UNITS
BP FEES
Services
1BELEC1000
400
Amps
$70
$0.00
Services
1BELEC200
60
Amps
$47
Services
1 BELEC200
$211.00
60
Amps
$47
Construction Tax:
Services
IBELEC200
60
Amps
$47
Work Without Permit? 0 Yes (E) No
TOTALS:
Advanced Planning Fees:
$211 00
$47.00
iWech. Plan Check
F—w, ch. Perrnul Fee.
C ?ther Alech. In. p.
ilech.Insp.. ee:
Phuub. Plum Check
Plumb. Permi7 Fee:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec. Plan Check 0.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 1 hrs $47.00
Elec. Insp. lee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pere, aamlary newer utsnicr, ocnoot
District, etc). These ees are based on the preffinWdna information available and are only an estimate Contact the Dept for addn7 info,
FEE ITEMS (Fee Resolution 11 -053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check I *ee:
Suppl. PC Fee
PME Plan Check:
$0.00
Permit Fee.:
Su131)1. Insp Fee
PME Unit Fee:
$211.00
PME Permit Fee:
$47.00
Construction Tax:
Administrative Fee: IADMIN
$44.00
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$1.90
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$351.90 $0.00 �� a
O $351.90
Revised: 07/01/2013
CUPERTINO
Address
PURPOSE
SMOKE/ CARBON MONOXIDE ALARMS.
OWNER CERTIFICATE OF COMPLIANCE
COMM�NITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 ORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 7�7 -3228 • FAX (408) 777 -3333 • buildingCcDcupertino.org
# of
Permit No./ 3 0 7,.,51/ Z 7
CiFICATE
- Cr_gk'I.
This affidavit is a self - certification for the installation of all required Smoke Mid Carbon 1VIonoxide Alarms for
compliance with 2013 CRC Sectior L R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single- family and multi-fitmily dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and C BC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in e following locations:
Z
2
Carbon Monoxide alarms are not
do not have an attached garage.
CBC Section 420.6 and shall be ar
Power Supply: In dwelling units
In existing dwelling units,'alarms
not result in the removal of wall a
space. Refer to CRC Section R314
alarms which must be connected 1
As owner of the above - referenced
installed in accordance with the rr
and California Residential Codes.
below.
I have
uired in dwellings which do not contain fuel- burning appliances and that
bon monoxide alarms combined with smoke alarms shall comply with
by the Office of the State Fire Marshal.
1 no commercial power supply, alarm(s) may be solely battery operated.
permitted to be solely battery operated where repairs or alterations do
ceiling finishes or there is no access by means of attic, basement or crawl
I CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
the building wiring.
?erty, I hereby certify that the alarm(s) referenced above has/have been
Eacturer's instructions and in compliance with the California Building
alarms have been tested and are operational, as of the date signed
and a ree to complv with the terms and conditions of this statement
(or Owner Agent's) Name:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping
bedroom(s)
area in the immediate vicinity of the
X
X
On every level of a dwelling uni
including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not
do not have an attached garage.
CBC Section 420.6 and shall be ar
Power Supply: In dwelling units
In existing dwelling units,'alarms
not result in the removal of wall a
space. Refer to CRC Section R314
alarms which must be connected 1
As owner of the above - referenced
installed in accordance with the rr
and California Residential Codes.
below.
I have
uired in dwellings which do not contain fuel- burning appliances and that
bon monoxide alarms combined with smoke alarms shall comply with
by the Office of the State Fire Marshal.
1 no commercial power supply, alarm(s) may be solely battery operated.
permitted to be solely battery operated where repairs or alterations do
ceiling finishes or there is no access by means of attic, basement or crawl
I CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
the building wiring.
?erty, I hereby certify that the alarm(s) referenced above has/have been
Eacturer's instructions and in compliance with the California Building
alarms have been tested and are operational, as of the date signed
and a ree to complv with the terms and conditions of this statement
(or Owner Agent's) Name:
`Owner
Si nature ......... ....... T............. .... Date: ......f...
Contractor Name:
Signature.................................... ............................... Lic.# ....... ............................... Date: ...................
Smoke and CO form.doc revised 03118114