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14040154 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19270 TILSON AVE CONTRACTOR:BJ ELECTRIC INC PERMIT NO: 14040154 OWNER'S NAME: LUIS E LINDO 985 SPENCER AVE DATE ISSUED:04/21/2014 OWNER'S PHONE: 6508471934 SAN JOSE,CA 95125 PHONE NO:(408)971-6849 I!!X LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F] REPLACE(E)200 AMP PANEL WITH(N)200 AMP,SAME License Class `�/ q 1 Lic.# O �O� / LOCATION Contractor t7� L,L gc ty— Date 7 o- 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:$2300 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:37540054 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 WITBIIN 180 DAYS O 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 DA LAS ED 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 Z granting of this permit. Additionally,the applicant understands and will comply Is ate: with all non-point source re Mations per the Cupertino Municipal Code,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) 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. 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 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: / Date: 1 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(See.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 E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION v\O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 eu051kTtNo (408) 777-3228•FAX(408)777-3333•building acupertino.ong v� MISC []PLUMBING [:]MECHANICAL EELCTRICAL ❑MISCELLANEOUS 7N PROJECT ADDRESS A yJ y i 0/0) APN# OWNER NAME �v ' r� I O PHONE0 Y� % E-MAIL STREET ADDRESS 1 I v V/, t i�� CITY, STATE,ZII .(/ FAX CONTACT NAME /� II- C PHONE 2I-MA STREET ADDRESS Lj�/,Z// Iii/ CITY,STATE, ZIP ❑OWNER '❑ OWNER-BUILDER ❑ OWNER/RAGENTV CONTRACTOR ❑CONTRACTORAGENT ['❑l ARCHITECT/oEl ENGINEER ❑ DEVELOPER ❑JTFNANTCONTRACTOR NAME LICENSE NUMBER i LICENSETYPE BUUS..LICCOMPANY NAME � �/ E-MAIL / STREET ADDRESS V")/�I`G CITY,STATE,ZIP �(,� /L /1 ( PHt2p f)p}� Qo/G ARCHITECTIENGINEER NAME ^' LICENSE NUMBER (��S off' BUS.LIC#U 1S a T COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.,DUPLEX ❑ MULTIFAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO - DESCRIPTION OF WORK i TOTAL VALUATION: 3 By my signature below,I certify to each of the following: I am the property owner or on owner's beha this application and the information I have provided is.correct. I ILve read the Description of Work and veri curate. I agree to comply with all applicable o ordinances and state laws relating to building u representatives of Cupertino to enter the above-i erpled p petty for ins ection purposes. Signature of Applicant/Agent: Date: 4449-1 d 1 SUPPLEMENTAL INF TION REQUIRED oFizcEusE�i\ r . .NE -* E ®OVER-THE COLTtiTER US Ogg rEII`EXPRESS 118 � OOEM Sk R _ is MEPMiscA4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19270 TILSON AVE DATE: 04/21/2014 REVIEWED BY: MELISSA APN: 375 40 054 BP#: *VALUATION: 1$2,300 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP USE: PERMIT TYPE: WORK REPLACE E 200 AMP PANEL WITH N 200 AMP SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $47 TOTALS: $47.00 PhIn"k Plapl C'hcci( Elec.Plan Check 0.0 hrs $0.00 Ph='Mh. Permit 1"Ce: Elec.Permit Fee: IEPERMIT 3ahr�'r�1rFi. irs,n. Li thl,<�f I'7wrrah IYasp�. Other Elea Insp. 0.0 rs $47.00 Phsuh. hzsp. hire: 1 tot_inp P"'(".. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelhiniina information available and are only an estimate Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eft' 7/1/131 FEE QTY/FEE MISC ITEMS PXtra (`hc ck < ' PME Plan Check: $0.00 Perinit I`('c: .`sup'loi. hIsp Pee PME Unit Fee: $47.00 PME Permit Fee: —F—F $47.00 Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 �If,LYd77t-'t'Cd ri7lanIlh-Ig Fees: Travel Documentation Fee: ITRAVDOC $47.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp-Stds Commission Fee: IBCBSC $1.00 U$ TATOTAL FEE: OLS $186.50 $0.00 $186.50 Revised: 04/01/2014