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14030130CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10201 STONYDALE DR CONTRACTOR: ROMANO ELECTRIC PERMIT NO: 14030130 OWNER'S NAME: JOSEPH WILSON 2198 LAUREL DR DATE ISSUED: 03/21/2014 OWNER'S PHONE: 4087397792 SANTA CLARA, CA 95050 PHONE NO: (408) 564-0583 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION PANEL UPGRADE 200 AMP, REPLACE 3 CONDUITS, ii-a� ' Lie. # License Class C kV REPLACE 'C1� �M aC &ate 3 tl�47 SUB PANEL BOX Contractor 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 Valuation: $8840 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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: 32637019 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 WITBIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter to save 180 DAYS = LAST CALLED INSPT�CTON. upon the above mentioned property for inspection purposes. (We) agree indemnify and keep harmless the City of Cupertino against liabilities, judgments, 4 costs, and expenses which may accrue against said City in consequence of the Date: Issued by: 4" - " granting of this permit. Additionally, the applicant understands and will comply si with all non -point source regulations per the Cupertino Municipal Code, Section « 918. RE -ROOFS: Date All roofs shall be inspected prior to any roofing material being installed. If a roof is Signatureo���Qth 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, do the work, and the structure is not intended or offered for sale (Sec.7044, will Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1, as owner of the property, am exclusively contracting with licensed contractors to 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: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. will maintain the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent: 1 ate"2-t 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 I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code, I must work's for which this permit is issued (Sec. 3097, Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 ,('- MFP DEVELOPMENT DEPARTMENT •BUILDING DIVISION COMMUNITY 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a1cugertino.org I7>_�r+v AwrrnnT 1MPT Pr7PTr AT 7 MISCELLANEOUS MISC MEPMisc-4pp_2011.doc revised 06/21/11 Ookll CJS v ` PRO DRESS APN# /1� � /IS ��Ji►�$"(� OWI NAME ! PHON4CX _j E MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAVE H NE E-MAIL D STREET , _ (� �BUI CTl Y, ST TE, ZIP OA O O FAX ❑ OWNER 11 OWNER DEIL 0 OWNER AGENT VONTPICTOR ❑ CONTRACTORAGENT ❑ ARCIE ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR AME LICENSE N'UMBER LICENSE TYPE BUS. LIC # COMPANY` E-MAIL FAX 0.�� STREET D ST ZIPCil J ARCHTTECT/ENGINEER NAME LICENSE NUMEER. BUS. LIC # COMPANY NAMEEMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WII.DLAND ❑YES 7PR0JECT IN ❑YES IS THE BLDG AN ❑YES ❑ BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA O OD ZONE ❑ NO EICHLER HOME? NO DESCRIPTION OF WORK ON lap ,mss TOTAL VALUATION:REGEIC+EDB' c By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr erty owner 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.4 mply with all applicable local ordinances and state laws relatin buil mg construction. I autho ize representatives of Cupertino to enter the above-identi ed property for inspection purposes. Signature of Applicant/Agent:Date: SUPPLEMENTAL INFORMATI QUIRED OFr�cE usohY ' a � �l�•I�OVER=T$E-COIJi9TE� 'T.... 'An FPPRRCC MEPMisc-4pp_2011.doc revised 06/21/11 Ookll CJS v ` CITY OF CUPERTINO 10 UcTTA/i A ri "ID _ R-1 TIT .T111%6T(`_ TIIVIRICIN ADDRESS: 10201 stonydale dr DATE: 03/21/2014 REVIEWED BY: Mendez QTY APN: I BP#: T 71 "VALUATION: $8,840 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex Conduits PENTAMATION 1 REAP2 PERMIT TYPE: i USE: 1 # $139 WORK anel upgrade 200 amp, replace 3 conduits replace sub panel box PME Permit Fee: $47.00 SCOPE APPLIANCE / EQUIP TYPE FEE ID --•--- --- _ QTY/FEE QTY UNITS BP FEES T 71 Services 1 ERT<200 200 Amps $47 Conduits 1BREMMISC SuPp/, Insp I ee 1 # $139 PME Unit Fee: $186.00 PME Permit Fee: $47.00 C `0t7SO-11(iion Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $186.00 Strong Motion Fee: 1BSEISMICR Phrt,rh. ]Tarr Check Elec. Plan Check 0.0hrs $0.00 Mc', -h. Pe reit Fee: Ph.rmh. Permit Fee; Elec. Permit Fee: IEPERMIT OtHer Plumb Iyup Li Other Elec. Insp. Loj hrs $47.00 lllwrth. hapFee: )"Iec. tnsl� t. -r NOTE: This estimate does not include fees due to other vepartments (I.e.rtannmg, �uu«� rrufn�, roic, �w.w.w.y ,�..�• - .�•• Uistriet, etc.. [nese ees ure uuseu un uec ruw.w.ow• FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113) �.• ....•.»•..,•. ».».-»�-- FEE --•--- --- _ QTY/FEE ____ ___ _____ _ _ MISC ITEMS Plan �. �heclL T 71 5'tr17pl. I'C' P'ec F71 PME Plan Check: $0.00 SuPp/, Insp I ee PME Unit Fee: $186.00 PME Permit Fee: $47.00 C `0t7SO-11(iion Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 4,11,U)I 'C'L? Plai'dt inn Ices: A Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.88 Select an Administrative Item Bldg* Stds Commission Fee: 1BCBSC $1.00 y �. $325.88 $0.00 = T©SAL FSE: $325.88 Kevisea: uw!)/zui4 . - r;� �.�