14080238CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19503 STEVENS CREEK BLVD UNIT 328
CONTRACTOR: GARZA ELECTRIC INC
PERMIT NO: 14080238
OWNER'S NAME: ERIC ELIAS
2423 KLEIN RD
DATE ISSUED: 08/25/2014
OWNER'S PHONE: 4087056395
SAN JOSE, CA 98148
PHONE NO: (408)238-2739
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
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(� tU Z3 � )
ADD (2) 220 V CIRCUITS IN KITCHEN AND FURNACE
LicenseClass Lic. #
CLOSET; (1) 110 V CIRCUIT IN BATHROOM
,,
Contractor ,ry, W,22_Date
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: $15000
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
ction 3700 of the Labor Code, for the performance of the work for which this
APN Number: 31649096 00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT E WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 AYS OF RMIT 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 FR M LAST CALLED INSPE IO .
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 regulat' ns per the Cupertino Municipal Code, Section
9 18.
�j ,, r /
RE -ROOFS:
Signature Date U yJ l
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:
1 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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 2 5,2 33, and 25534.
C�
v
Owner or authorized agent..731Date:
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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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GE N E R A L P ERMI I T A PPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVIS1011,41 eq
10300 70RRE AVENUE - CUPERIT INO, CA 95014-3255
(40B) 777-3222--B - FAX (408) 7777-3333 - buildinoO=uDastlno.oro
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SUPPLEMENTAL D�TOIR2,IATITONI- -REQLJ-:IP:--D
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revised 06121111
CITY OF CUPERTINO
9W FEE ESTIMATOR — BUILDING DIVISION
19503 scb
FEE ID
DATE: 08/25/2014
REVIEWED BY: Mendez
jimlADDRESS:
APN:
BP#:
`VALUATION: 1$1,500
PERMIT TYPE: Electrical Permit
1 BREMPOWER
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: 1 REAP 8
WORK
add 2 220'v circuits in kitchen and furnace closet 1 110 v circuit in bathroom
SCOPE
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APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Other Power Devices
1 BREMPOWER
3
#
$215
; cr 7j?l. 1r-Isl / Ve, '
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$215.00
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Divirirt etc )_ Thave feev are havod an the nroliminary infnrrnatinn availahlo and are nnly an estimafn_ Cnntart the Dent for addn'l inia_
FEE ITEMS (lee Resolution 11-053 Eff. 711/13)
FEE
QTY/FEE
MISC ITEMS
Mon Ch(Y L � 1'c�e:
F
'(" FCC .� 3.i f I�i 1 � E
PME Plan Check:
$0.00
; cr 7j?l. 1r-Isl / Ve, '
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (F) No
$0.00
r
H ca €ai?C'c'L: Plarming l'e'es:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
BldF, Stds Commission.Fee: 1BCBSC
$1.00
Y ri
v' n
$357.50
$0.00 TOTAL FEE:
$357.50
Revised: 07/10/2014
COivli"" "TfDEVELOPMENT DEPARTMENT
W;,.DiNG DIV!,` -1"101q - CUPERTINO
6"!r711 2,: ni O'� ED
Tnf and spec-ifiontions MUST be kept at the
It is unlawful to make any
of i same, or to deviate
appvc^va! frorn the Building Official.
�H, plan and s"ecifications S. ALL NOT
V" in i, -i t i n n
(0 W C_ U_ r'm' _n ft)
En -c Elias
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Page 2 of 4
Switch for new 20 A line
(for tater and towel warmer)
Suilding Depprtnent
AUb Z 5 201
REVIEWED FOR CODE (;OMPL.IANCE-
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