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14030112 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10300 MORETTI DR CONTRACTOR:MASUDA SERVICES INC PERMIT NO:14030112 OWNER'S NAME: PATRICK HAMILL 423 SALMAR AVE DATE ISSUED:03/18/2014 OWNER'S PHONE: 4084893029 CAMPBELL,CA 95008 PHONE NO:(408)691-9408 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 0 TEMP POWER License Class Lin.# Contracto ate �i I hereby affirm that I am licensed under the provisions o Chap r 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:$200 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:37515011 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 WITIIIN 180 O + PE IT 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 ROM LA LLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, Q costs,and expenses is may accrue against said City in consequence of the Issued b Date: V granting of this pe 't. A ditionally,the applicant understands and will comply y' with all non-poin rce eg ions per the Cupertino Municipal Cod Section 9 18. RE-ROOFS: Signature Date 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,shoulda quipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by e B Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance waL erp Municipal Code,Chapter .12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, 05,2 33,and 25534e� �� Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent 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 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 'jj MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION b\ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ('1� (408) 777-3228•FAX(408)777-3333•buildinaCgDcupertino.org VV MISC �Upi`� 'TtHO ❑PLUMIiING ❑mEmAIN`ICAL ECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1 � iT, �/ APN# t^��,}('�{ ��VJJ��JJJP`HO. � 6C�i 1:rMAII- 0 OW'NERNAME k o lam- TTFF 1A Aye �,,,� STREET ADDRESS o \ L 1 C ' \Z1P` �1�- I F ll��\ CONTACT NAMEteoff PHON�E\//�` (fi Cj E-M4II V��' STREET ADDRESS / CITY, NJ ❑ OWNER '❑ OwI4ER-BUIIAER ❑ ON;WMAGENT QAQNTRACTOR ❑COr.TI o,=RAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME !� LICENSENUMBER LICENSE TYPE BUS.LIC# COMPANY NAME \� E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECVENGINEERNAME 7� \ LICENSENUMBER BUS.LIC# COMPANYNAME � . { E MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROIECT INWILDLAND ❑ YES PROSECT IN ❑YESIS THE BLDG AN ❑YES BUILDING. ❑C01aERCIAL AN INTERFACE AREA ❑ NO FLOOD ZONE ElNO FEICHLER HOME? ❑ NO DESCRIPTION OF WORK v TOTAL VALUATION:<=<=7�-+�—� R�ECE�E BX � : a By my signature below,I certify to each of the fol ging: I am the perty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is orrec. I have read a Description of Work and verify it is acc te. I e comply with all applicable local ordinances and state laws relating to building co cti . I authorize re resentatives of Cupertino to enter the o e f 'operty for inspection purposes. Signature of Applicant/Agent: Date: I pm SUPPLEIl4ENTAL INFOIWATION REQUIRED oFFsCEzrs i,r� � AL'ERSHECOUIiTtiR � � � :KESS b MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10300 MORETTI DR DATE: 03/18/2014 REVIEWED BY: MENDEZ APN: BP#: *VALUATION: $200 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: p PERMIT TYPE: WORK I TEMP PERMIT SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 1 Amps $47 TOTALS: $47.00 , v ON , a > ft<1r. Ph:?n Lcc - pl2w;b. Ilam Cilect� Elec.Plan Check 0.0 hrs $0.00 G1t>clr. t'1>.r,rut l ea.>.: 1:'lrirfib, f,er°rn:l Fee: Elec.Permit Fee: IEPERMIT ?i.'rarr,l FTt.Irtspr 01her-1'1?u,,nb trtsp. E3-L- Other Elea Insp. 0.0 hrs $47.00 111urrrir. tlrsp. Fee: Y-W(,Ins,) NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 11-053 U 7/f 1/13) FEE QTY/FEE MISC ITEMS 1,10-1 ("'heck Fee: njopl. f 'free PME Plan Check: $0.00 PME Unit Fee: $47.00 PME Permit Fee: $47.00 J-�,Ix: F Administrative Fee: 1ADMIN $44.00 Work Without Permit? Yes (j) No $0.00 ,jelvonce4l Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $186.50 $0.00 TOTAdl L FEET $186.50 Revised: 01/15/2014