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13100045 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7998 WOODLARK WAY CONTRACTOR:MAINE ELECTRIC INC PERMIT NO:13100045 OWNER'S NAME: BRADLEY JACK TRUSTEE&ET AL 599 LEISURE ST DATE ISSUED:10/04/2013 OWNER'S PHONE: 9254433377 LIVERMORE,CA 94551 PHONE NO:(925)443-3377 El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALE] License Class C-1 C) Lia# INSTALL DEDICATED CIRCUIT FOR SOFT PUMP 20 AMP Contractor MAi1.9 e6EC F_r(? A10 Date )bM 13 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 self4risure 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:$1228 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:36204034.00 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 180 DAYrM LAST CALLED 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 b granting of this permit. Additionally,the applicant understands and will comply Y Date: 16 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. JD m I6 Ott RE-ROOFS: Signature a 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) 1,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 the Health&Safety Code,Sections 25505,2 ,and 2 534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date: OSI 3 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 �/ a MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION P10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 " MISC (408)777-3228•FAX(408)777-3333•building a�cupertino.orcl CUPERTINO 10❑PLUMBING []MECHANICAL ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS V W��..'A •\ ` APN# OWNER NAME � r (Q� �}� PHOI�iFq ) qq3 33� E-MAIL STREET ADDRESS 1 ' CITY, STATE,ZIP FAX CONTACT NAME 7 PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-Bua.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# RIn1� �L�TtLtC �ilC • o5a C-1� COMPANY NAME E MAII FAX STREET ADDRESS 2-4 9 `�� ' CITY,STATE,ZIP 1 ��N^A '?q551PHONE /Q ) �� ARCHITECT/ENGINEER NAME LICENSE NUMBER L �`I'u7 BUS.LICI# COMPANY NAME E-MAII FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMB.Y PROJECT IN WILDLAND ❑ YES TPROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK �. _ `tb1 20 A C4 kW rF -M PSOV TOTAL VALUATION: - - �� 1 2 ,tel] By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on t roperty owner's behalf. I have read this application and the information I have provided is correct. ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constructio I anthorize r resentatives of Cupertino to enter the above-identif ed ro erty for inspection purposes. Signature of Applicant/Agent: Date: I i SUPPLEMENT INF TION REQUIRED O F CE(fiSE" Pi I RES 6- - I. 1 YY r+ MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10576[a,roda dr DATE: 10/04/2013 REVIEWED BY: APN: BP#: *VALUATION: 1$1,228 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION p 1REAP2 USE: PERMIT TYPE: WORK install dedicated circuit for soft pump SCOPE Mech.Plan Check Plumb.Plan Check Elec.Plan Check 0.0 hrs $0.00 1�1ecfi. 11ennrrtl�ee:• Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT F7 Other;Teich.Insp. Other Plumb Insp. Lj Other Elea Insp. 0.0 �rs $47.00 hlech. Inst.Fee: Plumb.Irish.Fee: Elec'.Asp.Fede: NOTE:This estimate does not include fees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). These fees are based on the prefinWha information available and are only an estimate Contact the De t or addn7 in o. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 20 amps Electrical Suppl.PC Fee: Reg. Q OT 0.0 hr's $0.00 $47.00 1BELEC200 Services PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee Q Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 (.7onso-fiction.Tax.' Administrative Fee: IADMIN $44.00 0 Work Without Permit? 0 Yes (j)No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an:Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 39.50 $1 $47.00 — — :.� �.� v-�. ,s,. � $186.50 Revised: 10/01/2013