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13100008 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10400 OAKVILLE AVE CONTRACTOR:MAINE ELECTRIC INC PERMIT NO:13100008 OWNER'S NAME: BRANAMAN GLORIA JOYCE 599 LEISURE ST DATE ISSUED:10/01/2013 OWNER'S PHONE: 4082571236 LIVERMORE,CA 94551 PHONE NO:(925)443-3377 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIALCOMMERCIAL License Class (_,. 1D Lie.# 956 D SERVICE PANEL UPGRADE 200AMP, REMOVE AND REPLACE Contractor NQ in C El&h,rL &rDate l 9 CIRCUITS 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 37.00 of the Labor Code,for the performance of the work for which this permit is issued.. Sq.Ft Floor Area: Valuation:$15000 I have and will maintain Worker's Compensation Insurance,as provided for by ction 3700 of the Labor Code,for the performance of the work for which this APN Number:36913012.00 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 00 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 180DT LAST CALLED 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 Issued b Date:/O 3 granting of this pe itionally,the applicant understands and will comply Y' with all non-po' so gul ' s per Cupertino Municipal Code,Section OL 9.18. fp RE-ROOFS: Signature to t 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 lam 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 de4ter Air Quality Management District I performance of the work for which this permit is issued. will maintain compliaMunicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for bythe Health&SafetyC ,and 5Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized e: UV 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 GENERAL PERMIT APPLICATION MEP [1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 1 O CUPERTINO (408)777-3228•FAX(408)777-3333•building a0cupertino.org 1 MISC ❑PLUMBING ❑MECHANICAL LECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS D � Oi yI Ave- APN if C`j 1 3o 12- OWNER NAME C PHONE STREET ADDRESS rr CITY, STATE,ZIP FAX ® Gb D dry G B e w�a b CONTACT NAME 0 1 PHO $S-, E-MAIL STREET ADDRESS CITY,STATE, J / / FAX ❑OWNER ❑ OWNER-BUILDER ❑t OWNER AGENT 13 CONTRACTOR �CONTRACTORAGENT 11 ARCHITECT 11 ENGINEER 11 DEVELOPER 11 TENANT CONTRACTOR NAME� 1,Ib�T Jlj1 LICENSE NUMBER©20 LICENSE TYPE6-to BUS.LIC#fit COMPANY NAME ��` �G G �•L ` E-MAILr7g (�7 F '�--� STREET ADDRESS 591 j e[;,4,reG C� CITY,STATE,ZIP �1 G� ��r J PHONE ARCHITECT/ENGINEER NAME G J LICENSE NUMBER 7 BUS.LIC# Y COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ;MSFD or 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 3 ervi e e fL e n 100 of ►5 �t,G to �5� \ � �` TOTAL VALUATION: RLCEI�ED& + v x 7 1 > 5 . By my signature below,I certify to each of the following: the r r or authorize to act on th pr erty owner's behalf. I have read this application and the information I have provi d corr read the Des n of and ve fy it is accura I agree to comply with all applicable local ordinances and state laws relating to buildin c struct on. uthorize r ntat es in enter the above-idejfiedtroperty for inspection purposes. Signature of Applicant/Agent: Date: f SUPPLIEMNTAL INFORMATION REQ � o cE t7sE o I WS ..MAST $Nt. to MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10400 Oakville ave DATE: 10/01/2013 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: 1$15,000 q*PERNHTTYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK Service panel upgrade 200amp, remove and replace 9 circuits SCOPE ww / �, Rr�� � rHE- ,� ' .� I' bt €3 an C;'J eck Elec.Plan Check 0.0 hrs $0.00 l�rr 1 e nit l•<ce del.=.ar,h' pt•o;nit1`r:r: Elec.Permit Fee: IEPERMIT Ir,. (3rrier I J�ssrs 1t2s . Other Elec.Insp. 0.0 hrs $47.00 L es h, tits . I'z'r: Plumb,Inst,Fee: Mso. t=c:r.:: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (Fee Resolution 11-053 E . 7,ff /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 200 amps Electrical Suppl.PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 $47.00 IBELEC200 Services PME Plan Check: $0.00 0 Electrical Permit Fee: $0.00 $47.00 1BREMRECEP Recep/Switch/Outlets Suppl. Insp.Feer Reg. 0 OT p,p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 C,'o"'Istr€€CP ren17-1ix. Administrative Fee: 1ADMIN $44.00 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure 0 i Strong Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 kT, $140.50 $94.00 TOTAL FEE $234.50 t� Revised: 08/01/2013