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13070187CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7612 RAINBOW DR CONTRACTOR: NB ELECTRIC PERMIT NO: 13070187 OWNER'S NAME: HELEN LEWIS 3916 LA MESA LN DATE ISSUED: 07/30/2013 OWNER'S PHONE: 4082534443 SAN JOSE, CA 95124 PHONE NO: (408) 499-5400 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[] LICENSED CONTRACTOR'S DECLARATION License Class C [O Lica # PO 67 7_!�_ UPGRADE (E) 100 AMP PANEL TO (N) 200 AMP PANEL, A' 6,oc., " �� P� �1�, 7 ' 3 0 / 3 SAME LOCATION Cdn_tr ctor Date 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: $1500 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: 36611036.00 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 FROM LAO'Ll—A I LED 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 ate: 0 granting of this permit. Additionally, the applicant understands and will comply Ue with all non-point so rce regulations per the Cupertino Municipal Code, Section RE-ROOFS: 9.18. -T 3 �`�3 Signature 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 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 for of the for this the Health & Safety Code, Sections 25505, 25533, and 25534. Pai a Section 3700 of the Labor Code, the performance work which 4c_ Owner or authorized agent: f'� Date:__7/0 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 shallbe 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 � MEP 10 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �b misc CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(&-cupertino.org \ ❑ PLUMBING ❑ MECHANICAL RkLECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS / / 2 &^ APN # ,MAIL 2 v OWNER NAME Le w �-s PHONF�q n j �-g- 3 _*V4,3 *V4, 3 E- STREET ADDRESS / /� ' / CITY, STATE, ZIP l^ _ _ FAX CONTACT NAME /4ee, PariL PHO E-MAIL / f j e r r C „p ^ (,ar 4 (rl Ja if'�J 0 STREET ADDRESS 9Q%% / „ j� \ CITY, STATE, ZIP �N I6� C(� �� \/ FAX �2 p� / /' ('❑ ❑ OWNER ❑ OWNER -BUILDER 0 OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER TENANT CONTRACTOR NAMEn(.e %i _ LICENSE NUMBER Q� SFJ 6 77-0 r 7- LICENSE TYPE CPO BUS. LIC # COMPANY NAME �'�L E-MAIL FAX V� STREET ADDRESS 3q i / _ d oA �Q` ✓, r _ . if vi CITY, STATE, ZIP / /yH (2 f / `r ` �J / `/r PHO Q, ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ .MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WII,DLAND ❑ YES URBAN INTERFACE AREA ❑ NO TR'0;ECT❑YES OD ZONE ❑ NO IS THE BLDG AN ❑YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK Pao C,2 I A jn!;;� M JVo . C�`n,C_ lb '0 TOTAL VALUATION:/ev RECE By Iny signature below, I certify to each of the following: I am the property owner or authorized agent to act e pr If. I have read this application and the information I have provide is correct. I have read the Description of Work and verify it is accurate. I agree to ompl with all applicable local ordinances and state laws relating to building onsli -On. I autho ' representatives of Cupertino to enter the above -id 'fled pr for inspection purposes. Signature of ApplicantlAgent: Date: 0 13 tI SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY w VER -THE -COUNTER U EXPRESS U x ❑ STANDARD a ❑ LARGE MAJOR MEPMiscApp_2011.doc revised 06121111 19 CITY OF CUPERTINO ,.7 FEE ESTIMATOR — BUILDING DIVISION APPLIANCE/ EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 100 Amps $47 TOTALS: $47.00 .44,.h. Plan Check Phimb. Plan Check Elec. Plan Check 0.0 1 hrs $0.00 welch. Pennit Fee: Plumb. Permil Fee: Elect. Permit Fee: IEPERMIT 714,, ,leech. Insp. Other Plumb Insp. Other Elec. Insp. 0.0 hrs $47.00 . Insp. Fee: Plumb. Insp. Fee: I Elec. Insp. kee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, tire, sanitarysewer uisirict, scnooi nictriet ate ) Thoca fooc aro hncod an tho nroliminary infarmation availahle and are only an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) ADDRESS: 7612 RAINBOW DR DATE: 07/30/2013 REVIEWED BY: MELISSA Jim APN: 36611036 BP#: *VALUATION: 1$1,500 %PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex $0.00 PENTAMATION PERMIT TYPE: 1 REAP WORK UPGRADE E 100 AMP PANEL TON 200 AMP PANEL SAME LOCATION SCOPE APPLIANCE/ EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 100 Amps $47 TOTALS: $47.00 .44,.h. Plan Check Phimb. Plan Check Elec. Plan Check 0.0 1 hrs $0.00 welch. Pennit Fee: Plumb. Permil Fee: Elect. Permit Fee: IEPERMIT 714,, ,leech. Insp. Other Plumb Insp. Other Elec. Insp. 0.0 hrs $47.00 . Insp. Fee: Plumb. Insp. Fee: I Elec. Insp. kee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, tire, sanitarysewer uisirict, scnooi nictriet ate ) Thoca fooc aro hncod an tho nroliminary infarmation availahle and are only an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plein Check Feer: :Suppl. PC'.Fee PME Plan Check: $0.00 Perinit .Fee: Supp 1. Insp Pee PME Unit Fee: $47.00 PME Permit Fee: $47.00 Canso-tictlon lax. Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 Advunc:ed Planning Fees: A Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $186.500: 00 $186.5ME,0 Revised: 07/01/2013 i `�