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14020148 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23350 SERENO CT#25 CONTRACTOR:MISSION VALLEY PERMIT NO: 14020148 ELECTRIC INC OWNER'S NAME: KOESTNER E G ET AL PO BOX 3332 DATE ISSUED:02/25/2014 OWNER'S PHONE: 6509682664 FREMONT,CA 94539 PHONE NO:(510)745-8847 LICENSED CONTRACTOR'S DECLARATIO1 4 JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] 2. c.se Class INSTALL(N)OUTLET RECEPTACLE FOR PATIO AWNING icense Class G' �� Lic.# 7 �d � 3 � Contractor CL,9CDate -� I hereby affirm that I am licens d under the provisions of Chapt r 9 (commencing with Section 7000)of Division 3 of the Business&I rofessions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following twc declarations: I have and will maintain a certificate of consent to self-insure for Wo ker's Compensation,as provided for by Section 3700 of the Labor Code,f ir the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$350 have and will maintain Worker's Compensation Insurance,as provi Jed for by aU 55 0(O,00 Section 3700 of the Labor Code,for the performance of the work for which this APN Numbers3425499925 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above info ation 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 SSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)a ree to save 180 DAY + LLED INSPECTIO indemnify and keep harmless the City of Cupertino against liabilities judgments, costs,and expenses which may accrue against said City in consequet ce of the Z Z� granting of this permit. ditionally,the applicant understands and ill comply e' with all non- int so c gulations per the Cupertino Municipal Code,Section 9 18. Z^ J/ , RE-ROOFS: Signature ` ate [ 7 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 sol 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 license 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 thi ee 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 forWorker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,I or 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 Cupeorn-o-klunicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 05,2 3,a 25534. Section 3700 of the Labor Code,for the performance of the work fo which this Owner or authorized agent: te: 7— permit 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 o exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Lai or 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 deeme J 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 st ite laws relating to building construction,and hereby authorize representatives of thi 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 liabiliti ,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 Nill comply with all non-point source regulations per the Cupertino Municipal C ode,Section Licensed Professional 9 18. Signature Date GENERAL PERMIT APPLICATION 6\ MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408) 777-3228•FAX(408)777-3333•building(cDcupertino.org �O M I C ❑PLUMBING - O MEC iANI ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# t I Z O I r) OW57 INTERNAME G� / "/� STREET ADDRESS CITY, STATE,ZIP I FAX CONTACT NAME PHONE E-MAJL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER '❑ OWI ER-BUIIAER ❑ OVWERAGENT C014 rRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAMb� r ��; ICENSENUMBER LICENSETYPE BUS.LIC# r c C'�r�c COMPANY NAME ` I E-MAIL ( FAX is 10 r� v [ �1G 1 ��tea fkN t551a�V�c �LcCiR�c, � CO STREET ADDRESS CITY,STATE,ZIPPHONE 3�L -IuL wlaR-" SIS-7�f5 ARCHITECT/ENGINEER NAME LICENSE NUMBER. BUS.LIC# COMPANYNAMEE E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑TES BUILDING: ❑COMMERCIAL IMAM 5 IERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK Q— A-uo P TOTAL VALUATION By my signature below,I certify to each of the following: I am tie property owner or authori agent to act on t o s behal this application and the information I have * d is corr t. I have read the Description of Work and verify it is accurate. I agr to y v✓ith all applicab e ordinances and state laws relating -111 to g constrvc n. I au rize repres tives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent: - Date: SUPPLEMENTAL INFO TI N REQUIRED —� _ --�ICP�-.RE. �r AR1� —M �0 MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIN ATOR-BUILDING DIVISION ADDRESS: 23350 SERENO CR V 5 DATE: 02/25/2014 REVIEWED BY: MELISSA APN: 342 55 010 BP h *VALUATION: $350 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 REAP1 WORK INSTALL N OUTLET RECEPTACLE FOR PATIO AWNING SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Recep/Switch/Outlets 'IBREMREC P 1 # $47 TOTALS: $47.00 Plundt. Plan C'hccG Elec.Plan Check 0.0 hrs $0.00 Pc%rraz: hey: Ph,,mb, P e rmil f,sc: Elec.Permit Fee: IEPERMIT Other 11,11nl) Li Other Elec.Insp. 0.0 hrs $47.00 ah.c+ f,. �.e. PlUm/ 11:sp. I've. NOTE: This estimate does not include fees due to oi her Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimint ry information available and are only an estimate. Contact the Dept-for addn'l info, FEE ITEMS Fee Resolution 11-053 Eff 7/1/13 FEE QTY/FEE MISC ITEMS Plan Check Fce., PME Plan Check: $0.00 Perinif S11j)p/. 117sp P'ee PME Unit Fee: $47.00 PME Permit Fee: $47.00 Administrative Fee: IAD.Alffj $44.00 Work Without Permit? ® Yes (F) N $0.00 %�t:Y1`E17,'L'et;'i`1t7i7ti71'1Q 1't'c',1': Travel Documentation Fee: ITRA VDo $47.00 Strong Motion Fee: IBSEISMIC $0.50 0 # Revisions Bldg Stds Commission Fee: IBCBSC $1.00 $0.00 IREVSFDWL SFDWL r l $186.50 $0.00 TOTAL FEE $186.50 Revised: 01/15/2014