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14060153 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11093 WILKINSON AVE CONTRACTOR:GREENTECH ELECTRIC PERMIT NO: 14060153 OWNER'S NAME: STEVEN AND TINA SANDKE TURSTEE 12333 SARATOGA SUNNYVALE RD DATE ISSUED:06/24/2014 OWNER'S PHONE: 4088387194 SARATOGA,CA 95070 PHONE NO:(408)280-1180 L� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] INSTALL I (N)30 AMP/240 VOLT CIRCUIT FOR 20 AMP License Class LI l0 Lic.# �15b8i3(7 CLIPPER CREEK PLUG CAR CHARGER.WILL NOT 1I RFOiT�� ELEew?l6we v°h(/�/ INTERFERE ' Contractor WITH CLEAR 20' X 20 GARAGE AREA 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 ompensation,as provided for by Section 3700 of the Labor Code,for the erformance 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:35617037 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 ANCE 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 F C 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 Y granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. ROOFS: Signature Date L�{/ `�' All roofs shall be inspected pn o 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,Seq, 2�� /Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 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 ALTERNATIVE ENERGY PERMIT APPLICATI Nn COMMUNITYDEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 AE GUPERTINO (408)777-3228•FAX(408)777-3333•building0cunertino_org PROMICTADDRESS 110ft WILK1NSONAV�NU� AMI Z56 . 033 OWNERNAME � 1 f, 6AN12KO momC�� M- 7184 .�►1(/1kew•Com STREETADDmsj11Q W�LKIN6UK AV1MU 'r1N0 CA 61%1 FAX COMACT NAME PHONE B MAM STREET ADDRESS CIN.STATE.ZIP FAX ❑o"FA ❑ o"m-a mom�i,J❑oammtAma 11CONTRACWR ❑CWJTaACIORACMT ❑ ARCM1r= ❑ R Cl DVIS1,0�eERQ�❑•INAxr CONTRACTORNAME h A A A .r{w 60Rr1 N A� LICENSENum"R�0 V LI(�NSElYPB�s ,n BUS LIC 2 L2O C 'Y//i,v (`I& 9D"Ludo MvKAel rffn e(c&n irf vmJ 3 RA A- NNWVA.E RP STA. r A a5'D�� 2gO (Ago x ARCH TECT/ENGBfM NAME LICENSE NUMBEt BUS.LIC. COMPANY NAME E-MAIL FAX STREET ADDRESS aff.STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family PROTECT IN WB.DI.AND PROTECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes 9K No MOOD ❑ Yes ❑ No ❑SOLAR PANES CVEHICLECHARGMSTATION ❑ SOLARWATERHEATING ❑ Onwt FOR SOLAR PANF". NUMBER OF PANELS/U14M. 1 KQAWATTs(LbbAA m.aAL ONLYr TOTAL VALUATION. 300-00 DESCRSIIONIN WORK IOrA VN 01r-- Ci NI�: 90 MP P40V URN IT CiLI YU0 IN OAR GHAR641NCS. MilO N • V lLI Nof y) 1�0X w/ AR b By my signahhre below,I certify to each of the following: 1 am the property owner.or agent to act wm�co z ..I e application and the information I have providod is correct. I havered the "o Work and verify it is acxu ft. I agree toall applicable local ordinances aid state laws relating ce of Cupermtio to calor the /�rty �inspection purposes. Signature of Applicant/Agent Date IW(/V `T INFORMATION REQUIRED PYApp 2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION kDDRESS: 11093 WILKINSON AVE DATE: 06/24/2014 REVIEWED BY: MELISSA PN: 356 17 037 BP#: *VALUATION: $500 PERMIT TY RPE:: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Du lex PENTAMATION 1REAP7 USE: p PERMIT TYPE: WORK INSTALL 1 N 30 AMP/240 VOLT CIRCUIT FOR 20 AMP CLIPPER CREEK PLUG CAR CHARGER. SCOPE WILL NOT INTERFERE WITH CLEAR 20' x 20' GARAGE AREA APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Special Circuits 1BREMMISC 1 # $139 Recep/Switch/Outlets 1 BREMRECEP 1 # $47 TOTALS: $186.00 !'firer,). 1'11un C°Frcr./,� Elec.Plan Check 0.0 hrs $0.00 F71 11 e-'arlit Fce N"MI). Permit Fee: Elec.Permit Fee: /EPERMIT t.•rE;r° plc c . Trr,�n Other Plvmb lrr,%vED Other Elec.Insp. 0.0 hrs $47.00 M1<fc'cit Irts1�_iezf:: I'i2trttb. I;r��. ( :�: r ec.Is=i�: 1°2>s�: 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 11-453 Ef.. 7/1/13) FEE QTY/FEE MISC ITEMS Plan ('l2 crr l''t C PME Plan Check: $0.00 PME Unit Fee: $186.00 PME Permit Fee: $47.00 Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRAVDOC $47.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission.Fee: IBCBSC $1.00 $325.501 $0.00 TOTAL FEE: $325.50 Revised: 04/01/2014