14020016 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10119 SANTA CLARA AVE CONTRACTOR:MAINE ELECTRIC INC PERMIT NO: 14020016
OWNER'S NAME: RICHARD LUMACTOD 599 LEISURE ST DATE ISSUED:02/04/2014
OWNER'S PHONE: 4088230849 LIVERMORE,CA 94551 PHONE NO:(925)443-3377
^qO LICENSED CONTRACTOR'S DEpC—LARATION JOB DESCRIPTION- RESIDENTIAL El COMMERCIALE]
License Class �' Liicc.# ✓�Z7 C) REMOVE AND REPLACE MAIN PANEL 100 AMP
Contractor J�Jq lh Q L e C)r(G Date 2 114 1 /f
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000
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:32624024 19&21 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 LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ,(J
costs,and expenses which may accrue against said City in consequence of the a• /-
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point urce r ul tions er the Cupertino Municipal Code,Section
9 18.
( RE-ROOFS:
Signature ate f 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 Cupertm ua..cipaL.Gode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 5 1 W15544.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized Date:2L�
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
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333-building(cDcuper ino.org O MISC
CUFF- TING 1�
PLUMBING ❑MEECHANICALA e ECTMCAL []MISCELLANEOUSS
PROJECT ADDRESS / Ian {/{fiAPN
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OW?NERNAME � // d L u�4d z d PHONE91SJ, aZ3- 68Y FrMAII
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STREETADDRESS 0/Zr g� CITY,STATE ZIPI I f I FAX
CONTACT NAME Ne
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STREET ADDRESS / `l CITY,STATE,ZIP FAX
❑ OWNER ❑ OwTIER-BUILDER ❑ OIAMM AGENT ❑ CONTRACTOR J21CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
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COMPANY NAME t. // L C l a E-MAIL FAX c �/
STREET ADDRESS (la 1 CITY,STATE,ZIP PHOhB A"� / 7�'33 77
Leisyre s � L�v��n��r� cis 5'yrS/
ARCHITECT/ENGINEER NAME LICENSE NUMBER. BUS.LIC 4
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY,STATE,Z PHONE
USE OF FD or DUPLEX ❑ MULTI-FAMILY PROTECT IN WILDLAND ❑ YES PROJECT IN ❑YES I IS TIB;BLDG AN ❑YES
BUILDING: ❑COMMERCIAL 'URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? [3 NO
DESCRIPTION OF WORK
ace wA&}- Mooi h a l's . i00
gNk
1Y" RECELT ED BYE - IN` r �
TOTAL VALUATION: /" a ;ate r7 x_' 9 c v F
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is.correct. I have 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 construwdq7. I author' a epre tative f e ino to enter the above-id ntif d property for inspection purposes.
S i gnature of Applicant/Agent: ate: 2 9
SUPPLEMEORMATION REQUIRED -
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MEPAliscflpp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10119 santa clara ave DATE: 02/04/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$5,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1 REAP2
USE: SFD or Duplex PERMIT TYPE:
woRK remove and replace main panel 100 am
SCOPE
luarml, Plan CheA Elec.Plan Check "00 $0.00
L1�>clr_ Pei-rrrrt F"?e' 1'hamh. Permit Fee; Elec.Permit Fee: 1EPERMIT
�i?r€'1•'elecwr. Irtsi3. 0116er Phwnh Iru'v. I Other Elec.Insp. 0.0 hrs $47.00
P ollf) lrtclz Fee, tarc. Inst, Pc
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). 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: Reg. 0 OT 0.0 hrs $0.00 $47.00 IBELEC200 Services
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
T_
Administrative Fee: IADMIN $44.00 0
Work Without Permit? 0 Yes (F) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure ,
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission.Fee: 1BCBSC $1.00
" ®T- S
$139.501 $47.00 TOT
ALFEE: ` $186.50
Revised: 01/1512014