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14070002 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 922 BROOKGROVE LN CONTRACTOR:B P PRICE ELECTRIC INC PERMIT NO: 14070002 OWNER'S NAME: KAVITA MAHTANEY 915 PLAZA DR DATE ISSUED:07/01/2014 OWNER'S PHONE: 4083662003 SAN JOSE,CA 95125 PHONE NO:(831)239-4240 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL Q� (� UPGRADE SERVICE PANEL 200 AMP License Class Lifc.# `/�7U 30 Contractor k�y ��� _G Date 7`0f l 41 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:$1800 have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:37539035 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT + IRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT 180 DA F 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 ROM LAS 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source reg u ions per the Cupertino Municipal Code,Section 9 18. �J RE-ROOFS: Signature Date ?©/!7 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 unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2 3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this G/ permit is issued. Owner or authorized agent. 'I"" Date: 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 GENERAL PERMIT APPLICATION E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION _ 10300 TORRE AVENUE•CUPEr'tTiNO, CA 95014-3255 AgMk (408) 777-3228• FAX(403)777-3333•bu11dIn0(5cUDerino.or0 �U M I S QUI?'E�Ttl�CQ ❑PLUIMII\,G ❑MECHANICAL ELECTRICAL NUSCELLANEOUS PROir.Cr ADDRESS IAPN" 3-7G 3S, OV11� Irt1tAM ��� A(, lAc Y\ A 1` V I PHOh'E�n� .✓V� O03 I NLd� m STRE_zT f�DP.ESS CT-i S', STA7"c,VZIP t 4X ZZ �ook C-�V�- L-V�• I e,t, �.o �I SO 1 co"N AcrN4N" �J�IKN P� G I P3oI. 31�Z J-Iz-g0 EI✓ price,eleck,L.(J2 mq 05pl,, CITY,STATE,ZIP ea��o5�(i PX A 13O4i-a ❑ 0'A`1T�-3Ln3.D` ❑ m 1t0/+��1 AQ I CO?.iR4CT0R ❑COI.TR cTOR 1 • E3,GE\- ��.R=EcT ❑ENm''- ❑ D--nFLO?=,R, ❑ TF".i*qu Co?-17Lk rmNAI✓-- �1 �n I LIC' �t�ZJI✓ nR rl'S 3 Ol, I LICr7�SEiY?E C�/� I BUS.LIc' 3 / O COA�ANl NAME F E-1✓d.II, `- • 1 'I ° FAX STREET ADDRESS I CRY,STATE,ZIP` JvC �' �' ( PHO?a 2( -ZzA-r A z-q o ° la7A. -0 ,.. J O J _t l ARCIUTE.CTIENGINEER NAME I LICERSE NU--ER I BUS.LIC R COUP/�Y N.4I E 1JAII I FAX STRIE-PT ADDRESS CRY,STATE,ZrP I PHONT- li SE OF '�SFD or DUPLEX ❑ MULTI-FAMILY I PROJ-ECT IDI WIIALAND ElYES PROJECT A ❑YES I IS THE BLDG AN Y Es BLTLDAP: ED COM1✓.ERCL4L JW AN A•ir tFA AREA -'O I FLOOD ZOl� `�'NO EICffi..=R 74011M ❑ h0 DESCRIPTION OF WORK - e- 1 �\usD 0c, XW4� to w\� o e. At> O- Zsvo aw. 'S•2,W1 t- 4-�us L. ea-e!' w\•�.i,. �.�r,,.10 o. a n e L. ���n aY. e, 1�12� �e/'� wi Q ry IK D, Cle- M o rid" C V"0( 1 OWAe -S -� IRON- � EW 3p : Sv�r?roTdL,dsvATION: Oo_ V By my signa-ture below,I certify to each of the follo-wing: I am the property owner or authorized agent to act on t e prope oun e.al£ I have read this application and the information I have provide • orrect I have read the Description of'Work and verify it is accu-ate. I as*ee to comply v iih all applicable local ordinances and state lams relating` wilding o -^action. I authorize r epresentaltives of Cupertino to enter the -abboovve�-identifiy�ed property for inspection purposes. Si abire of"-pplicart/Agent: Date: �\ V LX U I/ ZV 1 Y T� —� - -- SUPPLEMIEITTALL?3FOR1\ TIONRBQUIl2ED OF CE�SE�.t om oT _ 000 52� r IvjEP1v1isc�pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 922 brookgrove DATE: 07/01/2014 REVIEWED BY: Mendez APN: BP#: 'VALUATION: 1$1,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK u rade service panel 200 am SCOPE gnit 11"1 ...11a�`w4 vxd..`.'d Plumb. Nol't Chccl, Elec.Plan Check 0.01 hrs $0.00 Fee: T'lum . 1'r:rmit Pic: Elec.Permit Fee: IEPERMIT —,—I Other Elea Insp. 0.0 hrs $47.00 P—i c /;x�p l°C> 1'iurztZi 1,s. Fec: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resolution 11-053 Ef' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-2-007 amps Electrical Suppl. PC Fee: Reg. 0 OT0.0 hrs $0.00 $47.00 1BELEC200 Services PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:(•) Reg. ® OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Cort ;IT'uction L[1.; F71 Administrative Fee: ]ADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 L G Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure i Strong;Motion Fee: IBSEISMICR $0.50 Select an Administrative Item BldgStds Commission Fee: 1BCBSC $1.00 ` 7OALS $186.50 $139.50 $47.00 TOTAL FEE: m h - Revised: 07/01/2014