13100009 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10336 N STELLING RD CONTRACTOR:MAINE ELECTRIC INC PERMIT NO: 13100009
OWNER'S NAME: PRUDENCIO ESPANOL 599 LEISURE ST DATE ISSUED:10/01/2013
OWNER'S PHONE: 4082429545 LIVERMORE,CA 94551 PHONE NO:(925)443-3377
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESH)ENTIAL COMMERCIAL
License Class r® Li,.# G 20 SERVICE PANEL UPGRADE 200AMP, REMOVE AND
�' j fp REPLACE
Contractor IUB rat e (��QG(Yf G l�tG Date f 3 CIRCUITS
, i
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 inl 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:$9000
I have and will maintain Worker's Compensation Insurance,as provided for by
ection3700 of the Labor Code,for the performance of the work for which this APN Number:32630090.00 Occupancy Type:
it 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 A80 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 DAY OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,hic judgments,
costs,and expenses waccrue against City in consequence of the Issued b Date:
granting of this p i. ddit nally, a applicant u etstands and will comply Y'
with all non-poi t ce reg ation er the uio Municipal Code,Section
9.18.
tv RE-ROOFS:
Signature ate m/1 Lf 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-BUILDE 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 y 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 forty 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 t rtino M rcr al hapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se s , ,a 534
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a
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'$'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 maylI 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
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO Lai (408)777=3228•FAX(408)777-3333•building(ftupertino.org MISC
❑PliUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS A/` �`��!I I� �J _1^ DPN @#
OWNER NAME /(� {,/�V�iL(l !t fly v PHONE V L.-r L E-MAIL
�I�k S !�
STREET ADDRESS ' _ ' STATEZo C 6 FAX
103-3k, y hh- I
CONTACT NAME
/ ✓7
CITY,STATE ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑OWNER AGENT ❑ CONTRACTOR ACRNTRACTOR AGENT ❑ ARc=cT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME �^/%c�e LICENSE NUMBER O LICENSE TYPE_ 9 0 BUS.LIC#
tL�cc'tr'rC �c . G
COMPANY NAME r I�J ( r 7 A a s EMAIL F
STREET ADDRESS (� `(� f CITY,STATE,ZIP a Qr- PHO
5M l4e 1311 rG S+- �rver,�wr¢I r1�5—S/ - �``3-33"�7
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME - FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD 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 „/J (� ( "l a Oil-
_I._
r/"I�JL�+b,,.
TOTAL VALUATION: REC D M,
NO
By my signature below,I certify to each of the following: I am erty owner or authorized agent to act on th pr rty owner's behalf. I have read this
application and the information I have provided is correct. I h e read t D -nation of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c nstru ion. or' se f s 09pertino to enter the above-id en'fled p operty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPP E ORMATION RE D �
Ul 11
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MOM
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SON.-
revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10336 N Stelling rd DATE: 10/01/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: 1$9,000
*PERMIT TYPE: 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 3 circuits
SCOPE
sir
' ac .�3� _� Jk�§� � rK
3 � as ,✓7 - a\� : ft
: �., �
SO
klech, l'lt r,.C'iac+c
111unib, I'lcasa Cdec><d Elec.Plan Check 0.0 hrs $0.00
Afeck Z2rtnnh Fee: Elec.Permit Fee: 1EPERMIT
t:3tl = 1f,t>..Ips:,, )arc r dirsynr Iran , Other Elec.Insp. 0.0 hrs $47.00
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 Eff. ZIL13 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 200 amps Electrical
Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $47.00 IBELEC200 I Services
PME Plan Check: $0.00 0 Electrical
Permit Fee: $0.00 $47.00 1BREMRECEP Recep/Switch/Outlets
Suppl. Insp.Fee.-(D Reg. 0 OT TO,O hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
(,°oaash-ucclior x: .
Administrative Fee: 1ADMIN $44.00 O
Work Without Permit? 0 Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure O
i
Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC . $1.00
` °o
s gg�N,g&r' $139.90 $94.00 TOTAL FEE $233.90
.. - :
Revised: 08/01/2013