14030048 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20100 PACIFICA DR CONTRACTOR:MAINE ELECTRIC INC PERMIT NO: 14030048
OWNER'S NAME: REDMOND MICHAEL J AND RITA A T 599 LEISURE ST DATE ISSUED:03/06/2014
OWNER'S PHONE: 4082577111 LIVERMORE,CA 94551 PHONE NO:(925)443-3377
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
REPLACING MAIN PANEL 125 AMP,INSTALL CODE
License Class C�(O Lic.# ISW2 p REQUIRED GROUND/BOND SYSTEM,RELOCATE SMALL
1 t ��
Contractortl� r�c��t�c. Date �� SUBPANEL TO MAIN PANEL
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:$5918
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:36928024 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 WIT'�IIN 180 D OF RMIT 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 FRO AS 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date Jho— 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. 1 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,SectigAs 25 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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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 rr\\� MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION by
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina(5cuoertino.org MISC
cuVtATENO
❑PLUMBING ❑MECHANICAL ELECTRICAL []MISCELLANEOUS
PROJECT ADDRESS APN#
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STREET ADDRESS CJl 1 CITY, STATE,ZIP:. / 4 I FAX +�
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CONTACT NAME I
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STREET ADDRESS CTTY,STATE,ZIP FAX��25\y-y3-�J ai CID
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❑ OwNm '❑ owNER-BuLDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGA'EER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSENUMBERLICI ISE TYPE C J t O BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CTTY,STATE,ZIP PHONE
5 1 l�iSwr'e�S [:t vwre Cc- -11AS2
ARCHITBCT/ENGINEER NAME LICENSE NUMBER BUS.LIC'#
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAMILYPROJECT IN WI DLAND ❑ YES I PROJECT IN EI YES IS THE BLDG AN E3 YES
BUIL-DING: ❑COMMERCIAL 'URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? NO
DESCRIPTION OF WORK ( �' ( ISA ('4%%Y "\ W 1 k
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TOTAL VALUATION: 5 1+ `f NESAM
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the timer'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 b 'Id'n o authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
LI
Signature of Applicant/Agent: Date: — `
SUPPLE AL INFORMATION REQUIRED � oF s is-ISE M1
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20100 Pacifica dr DATE: 03/06/2014 REVIEWED BY: mendez
APN: BP#: *VALUATION: 1$5,918
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 REAP
WORK re lacing main panel 125 amp, install code required round/bonds stem relocate small sub panel to
SCOPE main panel
Vr
F. a
1
a1Pttrrt C-%tack I'h�ftth. P.c,rt c"ilecn' Elec.Plan Check 0.0 hrs $0.00
14(?".h, Per,m;l Tee: Plurn1>, f'arrmit Feer: Elec.Permit Fee: IEPERMIT
fnsP P,unzh 7 Ll Other Elec.Insp. Fo.0 hrs $47.00
Tlumh.Insp. Fee
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS 6Fee Resolution 11-053 Eft 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 125 amps Electrical
Suppl. PC Fee: (F) Reg. 0 OT 1 0.0 hrs $0.00 $47.00 IBELEC200 Services
PME Plan Check: $0.00 = Electrical
Permit Fee: $0.00 $47.00 IBREMRECEP Recep/Switch/Outlets
Suppl. Insp. Fee:Q Reg. 0 OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
11'o a owc',iren TM.'
Administrative Fee: 1ADMIIV $44.00 0
Work Without Permit? ® Yes (F) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRAVDOC $47.00 1
Building or Structure 0
i
Strong Motion Fee: 1BSEIS1vffCR $0.59 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
L $139.59 $94.00 TOTAL FEE: $233.59
Revised: 01/15/2014