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13110091 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18620 RUNO CT CONTRACTOR:LAM ELECTRIC CO PERMIT NO:13110091 OWNER'S NAME: SUSAN PUT TRUSTEE 2177 GOLDEN DEW CIR DATE ISSUED:11/13/2013 OWNER'S PHONE: 4083132769 SAN JOSE,CA 95121 PHONE NO:(408)219-7726 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL 11 COMMERCIAL License ClassLic.# -© � PANEL SERVICE UPGRADE/GU A AP40 (L4-- MPvp. A Contractor ( A-NL q-f,-q-)Llt4Date t I hereby affirm that I am licensed under the provisions 4 Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. he by affirm under penalty of perjury one of the following two declarations: ave 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 penitis issued. Sq.Ft Floor Area: Valuation:$1500 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:37525033.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this applicatiorrand state thatthe 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 80 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 DA OM 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:11331-3 granting of this permit. Additionally,the applicant understands and will comply 3' with all non-point source regulations per-the Cupertino Municipal Code,Section 9.18. J p RE-ROOFS: 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 novintended 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 th Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec• s 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date 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.prov'is'ions 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 arid: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 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \\ CUPERTINO (408)777-3228•FAX(408)777-3333•buildin cu ertino.or MISC ❑PLUMBING MECHANICAL /ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 9 6 (� • n i\ I 0 �_ APN VA OWNER NAME Its /-A' J[1�( V��/ — PHONE f E-MAIL STREET ADDRESS J rf 1 v ✓ [� CITY,STATE,ZIP ! FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r 1 LICENSE NUMBER LICENSE TYPE BUS.LIC# IV e COMPANY NAME / n n/1 �^ f .may -� 'w EMAIL FAX STREET ADDRESS f 'V t ✓fj�l IL-v�l,I�� -/,'W� CITY,STATE 4_,,, / nil J H 9/ r ARCHITECT/ENGINEERNAME t/� LICENSENUMBER (/�-- S.LIC# !J COMPANY NAME EMAIL 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 V, TOTAL VALUATION: IiEC$IVED� By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro owner's behalf. I have read this application and the information I have prod a is correct. I have read the Description of Work and verify it is accurat . agree to comply with all applicable local ordinances and state laws relating to buil ng 6onstruction. I aut rize repres tatives of Cupertino to enter the above-Iden'fie prope for inspection purposes. Signature of Applicant/Agent: Date: SUP NTAL INFORMATION REQUIRED fr ' ARy 6^ 2 �t°Tt�kt'q Ri ase rnu MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 18620 runo ct DATE: 11/13/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: $1,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Du lex PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK ane/ service upgrade:200 am SCOPE 40,ass �q a. , � � t.i � ;��' ,��,asq�� rns€�, x��•�..'��?�� , .kir a Meclr.flan Check Plumb.Plan Cheek Elec.Plan Check 0.0 hrs $0.00 Wc;h. Permit Fee: Plumb.Permittee: Elec.Permit Fee: IEPERMIT C)rher Alecch.In. Other Plumb Insp. Other Elec.Insp. 0.0 hrs $47.00 1lech.Insp. Fee: Plumb. lush. Fee: Elec.Insp.Fee: 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 prelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = amps Electrical Suppl.PC Fee: (F) Reg. 0 OT0;0 hrs $0.00 $47.00 IBELEC200 Services PME Plan Check: $0.00 Permit Feer $0.00 Suppl. Insp.Fee-0 Reg. ®OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tax: Administrative Feer 1ADDffN $44.00 Work Without Permit? ®Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure 0 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 #, 0 T )SEE 186.50 _ $139.5 $47.00 $ Revised: 10/01/2013