14050038CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10362 NOEL AVE
CONTRACTOR: q43$—+e-BE PERMIT NO: 14050038
DF�a11NED
OWNER'S NAME: GUTIERREZ PETER P AND KATHLEEN S TR
— e V lC DATE ISSUED: 05/06/2014
OWNER'S PHONE: 4082977339
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL
V)U
INSTALL 50 AMP, 220 DEDICTED CIRCUIT FOR
License Class Lic. # (10
AUTOMOBILE
/
-Contractor A o e ( k_ 7_'Ln k5ate
Kn
f1fC
I hereby affirm that I am licensed under the provisionh pter 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
Sq. Ft Floor Area:
Valuation: $300
performance of the work for which this permit is issued.
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: 32647047 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 MO DAYS OF PERMIT 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 DAY R LAST 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
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -poi ere io s 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
will maintain compliance with th Cu ino Municipal Code, Chapter 9.12 and
ode,ro05, 5533, and 25534.
the Health & Safety C4�x
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agen 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
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 ' \tl MEP
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 6v
(408) 777-3228 - FAX (408) 777-3333 • buildino(ftupertino.ora �A MISCU
1`7 TTgxmrntr_ M I =1-14 A -IJ7r A 7 nFT.Rf`T MAT, 7MSCELL.ANEOUS
PROJECT ADDRESS 9 2 /) j d— � I APN #
OW?SERNAME 14 �4l / /JI V / G� D PHOA �7
E IvLAII
STREET ADDRESS
CITY, STATE, ZIP .
I FAX
CONTACT NAME PHONE
E -MATE
STREETADDRESS
CITY, STATE, ZIP
FAX
❑ OWPTER ❑ Ovi' TNER-BUIIDER ❑ OWNTR ❑ CONTRACTOR ❑ CONTRACTORAGEN'T
❑ ARCc cT ❑ ENGINEER ❑ DEVELOPER ❑ TE.NAxr
CONTRACTORNAME LI SE
LTCEN� TYPE
BUS. LIC R
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
I PHONE
ARCHTTECTIENGINEERNAME
LICENSE NU)aER.
I BUS. LIC#
COMPANY-NANS
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ muLn-FAMII Y I PROJECT IN WII.DLAND ❑ YFS PROJECT IN ❑ YES
BLT11DWG: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZANE ❑ NO
IS THE BLDG AN ❑ -.ES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK ` J/ /� f
TOTAL VALUATION: 6 G r I
B
v -
By my signature below, I certify to each of the follow' g.: 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 the Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to g ction. I authorize representatives of Cupertino to enter the above-idety6fied property for inspection purposes.
S ignature of Applicant/Agent: Date:
SUPPLEMENTAL INTFOR1,1ATION REQUIRED
—,
oF�cE�Is»I�Tlr�
Uy
WIN
1tEPMisc4pp_2011.d6c revised 06/21/11
CITY OF CUPERTINO
WNW FFF ESTIMATOR BUILDING DIVISION
im,ADDRESS: 10362 noel
FEE
DATE: 05/06/2014
REVIEWED BY: MENDEZ
APN:
BP#:
*VALUATION: $300
rPERMIT TYPE: Building Permit
$0.00
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
Suppl. PC Fee: Reg. OT
PENTAMATION
PERMIT TYPE: 1 REAP;
WORK
install 50 amp, 220 dedicted circuit
SCOPE
$0.00
Fre:
C)e riff ltf�t•?i. IJ "r
1'17?tllhMari (..Iiecl;
1'hfnnb. Permit
011wi. Pium?; Irrsf>.
Pluoih, Insp. Fee:
Elec. Plan Check 1 0.0 1 hrs $0.001
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 hrs $47.00
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, Sanitary sewer Utstrict, school
n...1.. ,. 1 rz... .. lr .. .. A-14 i.... fl.n ....nt:..,.:.,n... ir.f rz„nf:nm n n:tnt.to Omit Oro nmh, nn octirmnto Cnntn/'t tho nont fnr addm'I info_
FEE ITEMS (Fee Resolution 11-053 Eff 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= amps Electrical
$47.00 IBELEC200 Services
Suppl. PC Fee: Reg. OT
O,Q
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -(j) Reg. () OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
(,'CJns!/wcfion TtIV:
T77
Administrative Fee: IADMIN
$44.00
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
i
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission .Fee: 1BCBSC
$1.00
,SIIB T�I.S `:
$ 139.50
$ 47.00
TOTAL FEE:RM
$186.50
Revised: 04/01/2014