14020122CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 922 BROOKGROVE LN I CONTRACTOR: B P PRICE ELECTRIC INC I PERMIT NO: 14020122
OWNER'S NAME: KAVITA MAHTANEY 1915 PLAZA DR i DATE ISSUED: 02/21/2014
OWNER'S PHONE: 4083662003 1 SAN JOSE, CA 95125 ' PHONE NO: (831) 239 -4240
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lie. #
Contractor
I hereby affirm that 1 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.
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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature
Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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 (See.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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 Califomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that l 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
BUILDING PERMIT INFO: BLDG F ELECT r- PLUMB F_
MECH r— RESIDENTIAL r— COMMERCIAL r—
JOB DESCRIPTION: PANEL UPGRADE 200 AMP
X
Sq. Ft Floor Area: 001 'W I Valuation: $2000
APN Number: 37f420'%5.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE- ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Lnl
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I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 922 BROOKGROVE LN I CONNTRACCTTODR:� PCME I PERMIT NO: 14020122 I
OWNER'S NAME: KAVITA MAHTANEY DATE ISSUED: 02/21/2014
OWNER'S PHONE: 4083662003 PHONE NO:
❑ LICENSED CONTRACTOR'S
CONT RAC TO R 'S DECLARATION
License Class Cr t c) Lie. #q-7q3 o q
Contractor 'V) P ?R \% &IeC�KJC
Date 2- —Z-/' /q
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.
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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source re lat' ns per the Cupertino Municipal Code, Section
9 18.
Signature �/%/i/ Date Z-_24
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Date
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
PANEL UPGRADE 200 AMP
Sq. Ft Floor Area: I Valuation: $2000
APN Number: 37539035 00 1 Occupancy Type:
PERMIT E WORK IS NOT STARTED
WITHIN 1 0 DAYS O PERMIT ISSUANCE OR
180 DAYS F OM LA T CALLED INSPECTION.
i
Issued by: Date: .2�1 /I V
RE- ROOFS:
All refs 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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25 3, d 25534.
Owner or authorized agent: Date: Z -� 1 -1
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION h
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 "
(408) 777 -3228 • FAX (408) 777 -3333 • buildinga- cuaertino.oro
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❑.OWNER ❑ OWNER - BUILDER ❑ OWNERAGENT Sin CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME l ^ f
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LICENSE NUMBER T? J 2 0 L
LICENSE TYPE C _ o
BUS. LIC #
COMPANY NAME �
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ARCHITECT/ENGMER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
EMAIL
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 1XSFD or DUPLEX ❑ MULTI - FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND E1777
URBAN INTERFACE AREA E] NO
PROJECT IN [:I YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
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DESCRIPTION OF WORK n In c'* I n a I G e r V) cc U c% 0 M 0 O �,T,
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TOTALVXCUATION: 'L 0d O
RECEIVED BY
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pkperty o er's behalf. I have read this
application and the information I have provided is rrect. I have read the Description of Work and verify it is accurate. to comply with all applicable local
ordinances and state laws relatin to building ction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: /I-L— Date: — I
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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VER -THF COUNTER
❑ EXPRESS
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❑ STANDARD
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MEPMiscApp_201 Ldoc revised 06121111
CITY OF CUPERTINO
ON— �, FF.F. F,4TIMATOR — BUILDING DIVISION
im,
ADDRESS: 922 brookgrove In
QTY/FEE
DATE: 02/21/2014
REVIEWED BY: mendez
APN:
BP #:
*VALUATION:
1$2,000
PERMIT TYPE: Building Permit
Suppl. PC Fee: (F) Reg. 0 OT
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
$0.00
PENTAMATION 1 REAP
USE:
$0.00
PERMIT TYPE:
WORK
upgrade 200 am
$0.00
Suppl. Insp. Fee-.(j) Reg. Q OT
�anel
1 hrs
SCOPE
I C)lftcr';l'fc'c:�i_ Ir'i,�j�
11hii);b. 1'lao ChecA
Plumb. 1'ermit Fee:
O7lwr I'hdmb Irur).
Phrmh. has ). Fee:
Elec. Plan Check 0.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public worics, tare, Nanuary sewer vastrict acnooa
n_ - ml. _ r_ .. L,. ..4 ., IL ,. ..7:,.... ., f;,.........t :..., ......:1..1. /., ...,.d — 1,, n ctimnto /'nntnpt tho nont fnr ofid"'I info_
FEE ITEMS (Fee Resolution 11 -053 Ef. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
200 amps Electrical
$47.00 IBELEC200 Services
Suppl. PC Fee: (F) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-.(j) Reg. Q OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Co � w1ion
F
Administrative Fee:
IADMIN
$44.00
E)
Work Without Permit? ® Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
G
0
i
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee:
IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
$139.50
$47.00
TOTAL FEE:
$186.50
Revised: 01/15/2014