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15010077 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10470 STOKES AVE CONTRACTOR:MAINE ELECTRIC INC PERMIT NO: 15010077 OWNER'S NAME: LIVERMORE,CA 94551 PHONE NO:(925)443-3377 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ PANEL UPGRADE 125 AMP,ADD SUBPANEL IN GARAGE License Class C(0 Lic.# 3 02-5 D 125 Contractor 1 ',)c ��L �. Date AMP 13 1 5 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 eecon sation,as provided for by Section 3700 of the Labor Code,for the ance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7631 nd will maintain Worker's Compensation Insurance,as provided for by 3700 of the Labor Code,for the performance of the work for which this APN Number:32647025 00 Occupancy Type: s 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 WITHINPERMIT 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&rCALLEDIN SPE ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in conseque of the i granting of this permit. Additionally,the applicant underst d will comply Issued by: Date: I with all non-point source regulations er the Cuperti unicipal Code,Section 9 18. RE-ROOFS: Signature Date -3115 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. ❑ OWNE ILDER 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 Distric I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533 . 534. Section 3700 of the Labor Code,for the performance of the work for which this3 f permit is issued. Owner or authorized agent: 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 CONSTRUCT DING 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 �!� M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ^U 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1 MISC CUPER TINO (408)777-3228•FAX(408)777-3333•buildina(a)cupertino.ora o ❑PLUMBING [:1MECHANICAL 2ELECTRICAL ❑MISCELLANEOUS P toCTA625-6Z---'SS C 140c ADDRESS 4-1A�L� OWNER NAME � - CITY, STATE,ZIP FAX O D S T© E CoP/_-2-Tr'J O G14 q SOI CONTACT NAME JEFF RAINEY PHONE510-427-4260 E-MAIL jeffrey.rainey@att.net STREET ADDRESS 1069 EDGEMERE LANE CITY,STATE,ZIP HAYWARD, CA 945454 1 FAX510-783-1041 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR R CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I/lA A tIJ f �C���1C LICENSENUMBER��O- O LICENSEETY/PE BUS.LIC# COMPANY NAME y 1 n G �Ft,JE l�c�i2l E-MAIL FAX 12-5, � -3376 STREET ADDRESS L / !/ ' r� CITY,STATE, �� �j,/� PHONE ��- ARCHITECT/ENGINEER NAME LICENSE NUMBER P1 / BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 2rSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK OP4a&7� t:- 1004 l J E 20 1 YK�z� ��� r,J -A fI 125 �cJ .� a 7rfC E A)6 IJ vi ��r „X-'),/L/C4 5,14 TOTAL VALUATION: RECEIVEIDBY:. By my signature below,I certify to each ofthe following: I am the property owner or authorized agent to act on the pr rty o al£ I have read this application and the information I have provided is correct. I have read the Description of Work and verify Itis accurate. re to comply with all applicable local ordinances and state laws relating to building construction. I autho fives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: e: / ENTAL INFORM ON D OFFICE USE ONLY yy. ❑ OVER-THE-COUNTER ❑.EXPRESS ❑ STANDARD V J ❑ LARGE P• El.-MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10470 stokes ave DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$7,631 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP USE: PERMIT TYPE: WORK anel upgrade 125 amp, add subpanel in garage 125 am SCOPE kctr /'s'c�n('yr��r.i,: 1'larrtrb. P/a/,r('heek Elec.Plan Check 0.0 hrs $0.00 a ,ch. pe"Init f=ees F'tumh. Perm;[Fee Elec.Permit Fee: IEPERMIT Ori?er l fuck lav, Other Plumb fnsp. Li Other Elec.Insp. El hrs $48.00 ;t,/t'.Crt. �i dS), f`f'e;: llhi ib/ 1nv). Fee: 1.—Jec.In Sj?7. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-1257 amps Electrical Suppl. PC Fee: (j) Reg. ® OT 0.0 1 hrs $0.00 $48.00 IBELEC200 Services PME Plan Check: $0.00 125 amps Electrical Permit Fee: $0.00 $48.00 IBELEC200 Services Suppl. Insp. Fee:(F) Reg. ® OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Consirt.iction TUX., Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.99 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 T r s $142.99 $96.00 TOTtI,FEE:'. $238.99 Revised: 01/06/2015