14100027 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22281 BELLEVUE AVE CONTRACTOR:VOLTZ ELECTRIC PERMIT NO: 14100027
OWNER'S NAME: YUL INN 6245 LEAN AVE DATE ISSUED: 10/06/2014
OWNER'S PHONE: 4087189177 SAN JOSE,CA 95123 PHONE NO:(408)464-8588
LICENSED CONTRACTOR'S DECLARRATION BUILDING PERMIT INFO: BLDG F ELECT F_ PLUMB r
License Class L^ Lie.# !� //7-3: L—
MECH RESIDENTIAL COMMERCIAL
ContractorJp1.T� j f C"112 IC Date 16 -
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTIONREPLACE(E)200 AMP METER,SAME LOCATION
(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
Comp sation,as provided for by Section 3700 of the Labor Code,for the
Zormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1500
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
permit is issued. APN Number:35701011 00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PE CE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS LED INSPECTION.
costs,and enses which may accrue against said City in consequence of the
granting f t is permit. Additionally,the applicant understands and will comply
with all on- oint s ce regulations per the Cupertino Municipal Code,Section < Da e
9 18.
Signatu Date /0
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
He &ASafetyde,Sections 25505,25533,and 25534.
I certify that in the performance of the work for which this permit is issued,I shallnot employ any person in any manner so as to become subject to the Worker's wne orgent:
Compensation laws of California. If,after making this certificate of exemption,I Date:/ bjLf
become subject to the Worker's Compensation provisions ofthe Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
ereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18. Licensed Professional
Signature Date
GENERAL rPERMf i r4PPLICATION M E P
COMMUNI TlY DEVELOPMENT DEPARTMENT- BUILDING DIVISION O
OSOO TORRE AVENUE- CUPERTINO,CA 95014-3255
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By nay sigrat-re below,I cerij,to "he I01107v1T1z I-. ule prope_-t} o;;�er or autho iwd agent to act en r e-y o;,per's beI a � e r ,d th's
application and i_he information I h ,e aro ided is torr- I h e:---adA Description of F,rork and verily it is a'C, ate. 1 PET-=t0 co-roly'Aith ail applicable locz
ordinances and state la;vs relating t build a corsr,. I t_hor re -esenta lues of Cupertino to eater r-1e above-idenzi:Hed�r �_ae!'y for rlsptction p=oses.
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?141 Z.� �J 2�1_7.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 22281 BELEBUE AVE DATE: 10/06/2014 REVIEWED BY: MELISSA
APN: 357 01 011 BP#: *VALUATION: 1$1,500
'PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 REAP
WORK REPLACE E 200 AMP METER SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 200 Amps $48
TOTALS: $48.00
v
Wcecil. Plan Check Phlwh. Plan Check" Elec.Plan Check 0.0 hrs $0.00
a r>clr_ Pe"'Imil Fee: Plurrh. Peer-Mit PkC: Elec.Permit Fee: IEPERMIT
Other Plumb Insr- Lj Other Elea Insp.
0.0 hrs $48.00
Jnv. 111711,11b, Iisp. fee: l Srr.iec
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn I info.
FEE ITEMS (Fee Resolution 11-053 E . 7/11131 FEE QTY/FEE MISC ITEMS
/lun ('heck k P'e C:
Solpvi, PC
PME Plan Check: $0.00
Pelvni£/''"T:
PME Unit Fee: $48.00
PME Permit Fee: $48.00
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
,d""Ceat( 6i/'raailing Fees.
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg,Stds Commission.Fee: IBCBSC $1.00
$190.50 $0.001, TOT FEE: $190.50
F W
Revised: 08/20/2014