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14020165 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10121 SANTA CLARA AVE CONTRACTOR:MAINE ELECTRIC INC PERMIT NO: 14020165 OWNER'S NAME: LUMACTOD RICHARD 599 LEISURE ST DATE ISSUED:02/28/2014 OWNER'S PHONE: 4086607260 LIVERMORE,CA 94551 PHONE NO:(925)443-3377 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] >11 DUPLEX-REPLACE BOTH ELECTRICAL PANELS License Class G 1 C� Lic.#_ uZ S d (125AMPS)AND RE-WIRE BOTH UNITS Contractor a Pot ,k` iELEa2-0 CA to Z 2 UNIT#1(10119)23 OUTLETS/10 SWITCHES/9 LIGHT FIXTURES I hereby affirm that I am licensed under the provisions of Chapter 9 UNIT#2(10121)24 OUTLETS/11 SWITCHES/9 LIGHT FIXTURES (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:$52500 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 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 WITHIN 180 DA ' T 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 D OM L ALLIED 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: S / granting of this permit. Additionally,the applicant understands and will comply.--O' Issued y: Date: with all non-point source regulati er the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature 09 LA ate Z Z� 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) 1,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 Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25 and 255 4. Z Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: � ate: Z permit is issued. t' 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 PERMIT APPLICATION ` GENERAL P nMEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION V 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408) 777-3228•FAX(408)777-3333•building(5cupertino.org MISC CU p9k`t'tt�t Q �❑P �G ❑MECHANICAL MELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS O I SM�M QLWprn J� I APN# 7 !1 OWNER1'AME Zc-"Nzu wpRc oi> I� PH(2Zb 0--7 Z 47p E-MAIL STREET ADDRESS J O I Zl CITY.STATE,Z1P_ I FAX (Ji,��t2T't N 0 CONTACT NAME PHONE STREET ADDRESS CITY,STATE,ZIP FAX ElNER 13OW0-,XWM-B=ER ❑ O"M ERRAGEN'T ElTR CONACTOR 11CONI'RACTORAGENT 11ARCHITECT ❑ENGRTEER 13 DEVELOPER TE'ANT CONTRACTOR NAME 1Vt:iZj LICENSENUMBER Q2OZ&O LICENSETYPE C jC BUS.LIC# COMPANTY NAME E-MAIL C V FAX I"\�1 htl✓ LC7t-1z l C Tint C STREET ADDRESSCITY,STATE,ZIP P ONE 5alq L.�tSUR� sT �.tv�m 2>v C.fl . °l x:51 ��5 yL13-331 ARCHrIECT/ENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF MSFD.,DUPM ❑ MULTI•FAM1r.Y PROJECT IN W11MLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑ NO DESCRIPTION OF FORK ( -L5 AIKF PC--?LA Wo rnw�� 1, Rk--V,)tM o WAITS WE �* t 250 Fr I (.q SaA.-4 . Oa nL Ave- (ANkT -tA;-z 0100 s . : 1-150 . GT CID 2 I S4,4r, c(a . Avee (AN A IT 1 J OUTL;E 5 D Sw S U T PSS UN ) Z DOT L-eT III swk coos 9 U AT Fr XTU f?L a.�',a SOV a 4 ,3 .c;,,. �;��c..! • TOTAL VALUATION: Jr`Z, , 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 t1Se Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constructio, a thorize re esenta. s of Cupertino to enter the above-i entified roperty for inspection purposes. Signature ofApplicant/Agent: Date: Z �� i✓ SUPPLEMENT INFOPI IATION REQUIRED -- tL EXPRESSWUlff y ' b: v w m r STAI\DA72D _�, MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION 7ADDRESS: 10119 &10121 SANTA CLARA AV DATE: 02/28/2014 REVIEWED BY: MELISSA 32624024 BP#: *VALUATION: $52,500 OPERMITT'YPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK DUPLEX- REPLACE BOTH ELECTRICAL PANELS 125AMPS AND RE-WIRE BOTH UNITS SCOPE UNIT# 1(10119)23 OUTLETS/10 SWITCHES/9 LIGHT FIXTURES p APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 125 Amps $47 x C Services 1ERT<200 125 Amps $47 Recep/Switch/Outlets 1BREMRECEP 68 # $47 Fixtures, Lighting 1BREMFIXT 18 # $70 TOTALS: $211.00 Pl a b. Plan Check Elec.Plan Check 0.0 hrs $0.00 vi<>crt. f'E<rnnt 1'et>; PlumbPerini!Fete: Elec.Permit Fee: IEPERMIT 0fh(r hJf,ch hi,v= C.)ttt<:�r Phamb Msi,,), Other Elec.Insp. 0.0 hrs $47.00 NOTE:This estimate does not include fees due to other Departments(I e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fims are based on the prelimina information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fce: PME Plan Check: $0.00 1i 7.s/.)!,'ec F71 PME Unit Fee: $211.00 PME Permit Fee: $47.00 Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 �fl:Cdtlt't'C/I3�::r1'tF?tf't tr�`E'E?S: Travel Documentation Fee: ITRAVDOC $47.00 Strom Motion Fee: IBSEISMICR $5.25 Select an Administrative Itemp 11 Bldg Stds Commission Fee: IBCBSC $3.00 •� ! T12-5 zg 011S' $357.251 $0.00 TOTAL FEE: $357.25 Revised: 01/15/2014