The URL can be used to link to this page

14050135 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1234 BELKNAP CT CONTRACTOR:STEVE GRIMES PERMIT NO: 14050135 TRUSTEE OWNER'S NAME: STEVE GRIMES TRUSTEE 3722 CAMERON AVE DATE ISSUED:05/22/2014 OWNER'S PHONE: 9255192521 PLEASANTON,CA 94588 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION ]� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# I" r MECH RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION REMOVE&REPLACE MAIN ELECTRICAL PANEL 200 AMP 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:$500 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:36210024 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 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, oe costs,and expenses which may accrue against said City in consequence of the AA granting of this permit. Additionally,the applicant understands and will comply Issued by: �`ry� Date: 'l with all non-point source regulations 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 equipm t 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 Ar Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupe no Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 5125533 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this -�t permit is issued. Owner or authorized agent: Dater 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which y accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.A nally,the applicant understands and will comply with all non-point sourc egulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date��Z" �� GENERAL PERMIT APPLICATION E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408) 777-3228•FAX(408)777-3333•buildino(a cuoeriino.orcl MISC ❑nuiau,,G ❑MECHAATICAL ELECTRICAL ❑MISCELLANTEOUS PROTECT ADDRESS ,r^y� �l\t_ cA I APN4 Cq- /p pa ow1.ER l:v�IE rj�- Q 'aN I Plt2 S S ) 2_5 2\ E Man Cs Co w•Cos.�-_ inc} STREET ADDRESS a a44e CrrY,, STATE,Z1F_A0444-17/0 FAX X 45 4- S Z via C q-115-1 CONTACT NA1,4E ( %�_ a\ w,{,5 PHONE E-WLAjL STREET ADDRESS Z 15 -k 2LV\\ C� CITY&V L; FA.+u VA 2570% IZIP FAX 11 OVTr''[.L ElOWNER-B=-.R E3OVNERAGENT ❑ CONTRACTOR (/❑COA7R,.ACTORAGENT ❑ ARCHrmcT ❑ENGR',EFR ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMEER LICENSE TYPE BUS.LIC 4 COMPANY N.aME E-MAIL FAX STREET ADDRESS I .CITY,STATE,ZIP I PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER I BUS.LIC 4 COMPAMY NTAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ISFD or DUPLEX ❑ MULTI-FAMILY I PROJECT INWnAL AND ❑ YES I PROJECT IN ❑YES I IS THE BLDG AN ❑YES BLTIIDING: ❑CObOaRCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICLII.ER HOI E7XITO DESCRIPTION OF WORKAAS Z6v A4w ` I - : TOTAL VALUATION: J DO •�' �-EIVEDB�X � By my signature below,I certify to each of the follo-,N,! . am the property o. er or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is co I have read the scription of Work and verify it is accurate. I agree to comply A ith all applicable local ordinances and state laws relating to building cons Ion. I author presentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE TAL IIQFORMATION RE UIItED ,. Q a —g AEPMisc,4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1234 Belknap Ct DATE: 05/22/2014 REVIEWED BY: Sean lot APN: BP#: /5/OS 3 S *VALUATION: $500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: I PERMIT TYPE: WORK Remove and replace main electrical panel 200 amp). SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 200 Amps $47 TOTALS: $47.00Ac = 'rare y"rt..G iM"�u fit'k T �, lfech. I'lar,(:h.x.,k Plumb.Plan Check Elec.Plan Check 0.0 hrs $0,00 Adech. F'ermif Fee: Plumb.Permit Fee Elec.Permit Fee: IEPERMIT Clther r),tec:h.fns). Other Plumb Insp. Li Other Elec.Insp. L.0 hrs $47.00 rl,fech. Insp. Fee: Plumb.h7sh. Fee: Etce.Irasp,Fire: 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 prelimin information available and are on an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Phan Cheek Fee: .Supp/. PC.Fee PME Plan Check: $0.00 Kermit/`ce: ;Suppl. Insp Fee PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction:Tax Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes (E) No $0.00 !Idv lnced Plrannira�,.Fees: Travel Documentation Fee: 1TRAVDOC $47.00 Strom Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $1.00 $186.501 $0.00 TOTAL FEE= $186.50 Revised: 04/01/2014 W. OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPART MEN T•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO,CA 85014-3255 CUPERTINO. (408)777-3228• FAX(408)777-3333.- build!no(c-=Derilno.orQ Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: .. SITE C ADARZ 3 it �-G�l�� I �� I a� OVdf< R hANE I OWNER ADDRESS, � 3 A �\ t' 6� e—T DESCRIPTION[OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our o1,Ictal address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verity this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- ilder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder,may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �. I understand building permits are not required to be signed by property.owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an"Owner-Builder" I am the responsible parry of record on the permit. I understand that I may otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. a I understand Contractors are required by law to be licensed and bonded in California and to list their license nfimbers on permits and contracts. 5. I.understand if I employ or othen'rise engage any persons, other than California licensed Contractors, and the fofal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an"employer"under state and federal law. Jree6al I understand i I I am considered an "employer' under state and federal law, I must register with the state and government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family r-sidential structures cannot legally build them with the intent to oner them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfo-med under contract with a licensed general building Contractor. 8, I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. Ow%nerBsdlde;Fo;,n 2010.a:oc revised 04/1.1'/10 F v` 69; 1 understand I may o.btain.more information regarding my obligations as an "employer"from the Internal IF/Venue Service,the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or vww.cslb.ca.gov for more information about licensed contractors. 41'0. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am te part' legally and financially responsible for proposed construction activity at the site address listed above. 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 1rmp12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the '!on Ihave provided on this form. Licensed contractors are regulated by laws designed to protectthe public. Ifontract with someone who does not have a license,the Contractor' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. it is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage, CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby afnrm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 CIV.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property oievner's driver's license, form notarization, or other verification acceotable to the city ma be required to be presented when the permit is issued to verify the property owner's si nature. Property Owner's Signature: Date: S -2Z-1 k --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE. The following Authorization Form is required to be completed by the property owner only v✓hen designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an avner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, corm notarization, or other veriffcation acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Ov:nerBuilderronn 2010.doc revised 04'/14/10