14080093CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10493 S DE ANZA BLVD
CONTRACTOR: HOWARD BUTLER
PERMIT NO: 14080093
ELECTRIC
OWNER'S NAME: BDC HAYWARD LC
3155 MORGAN TERRITORY RD
DATE ISSUED: 08/13/2014
OWNER'S PHONE: 9255882219
CLAYTON, CA 94517
PHONE NO: (925) 672-3434
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
10493 & 10457- RELOCATE 400 AMP W/ 200 AMP BETWEEN
License Class ��� LLic. # 7
TENANTS
"��7
Contractor WWr/aAic-Gam; Date �y
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
Sq. Ft Floor Area:
Valuation: $11000
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: 35917019 10493
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMI — — WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WIT 80 DAYS OF IT 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 F LAST C LLED 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 -point source regulations per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signat 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
1, 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 re r Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with t C er ' unicipal Code, Chapter 9.12 and
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
the Health & Safety Code, 533, and 25534.
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
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CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10493 s de anza
DATE: 08/13/2014
REVIEWED BY: Mendez
1w,
APN:
BP#:
EVALUATION: j$11,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Amps
PENTAMATION
PERMIT TYPE: 1 CEAP
& 10457- relocate 400 am w/ 200 am between tenants
E10493
APPLIANCE / EQUIP TYPE
FEE ID
] llwl:h. I lon t_ hc(. A
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPERMIT
Services
1 ECT2001 K
Elec. Insp. ELhrs $48.00
400
Amps
$72
Services
1 ECT<200
200
Amps
$47
PME Unit Fee:
$119.00
PME Permit Fee:
$48.00
�,r °1`1,C'1ir1 1 Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$119.00
Strom Motion Fee: IBSEISMICO
,
l
FEE
] llwl:h. I lon t_ hc(. A
Elec. Plan Check 0.0 hrs $0.00
;I Fei,:
t I,'f /;. I't, i t / ct :
Elec. Permit Fee: IEPERMIT
LjOther
Elec. Insp. ELhrs $48.00
PME Plan Check:
LICC- 1 1. F"'C.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public woras, rare, January Sewer viscricr, acnooa
llictrint atn 1 Thaca toot aro hncod nn tho nroliminan, i"Mrmatinn availahle and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff' 711113)
FEE
QTY/FEE
MISC ITEMS
Plan ( '11E ciC f'
PME Plan Check:
$0.00
PME Unit Fee:
$119.00
PME Permit Fee:
$48.00
�,r °1`1,C'1ir1 1 Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? Yes 0 No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: IBSEISMICO
$3.08
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
°LS;`
n ®;�...�s ..
$264.08
$0.00[ ---,,--,TOTAL FEE:
$264.08
Revised: 07/10/2014
• 1 _
ELECTR/C Commercial • Residential *Industrial
ELECTR/CAL CONTRACTOR butlerelectric@aol.com License #710564
3155 Morgan Territory Road • Clayton, California 94517.Off ice: (925) 672-3434 • Fax: (925) 672-3535 • Cell Phone: (925) 383-8242
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ELECTRIC
Commercial • Residential • Industrial
ELECTRICAL CONTRACTOR butlerelectric@aol.com License #710564
+ 3155 Morgan Territory Road • Clayton, California 94517* Office: (925) 672-3434 • Fax; (925) 672-3535 • Cell Phone: (925) 383-8242
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