Loading...
14100085 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 922 BROOKGROVE LN CONTRACTOR:B P PRICE ELECTRIC INC PERMIT NO: 14100085 OWNER'S NAME: SAN JOSE,CA 95125 PHONE NO:(831)239-4240 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ADD ELECTRICAL CIRCUIT FOR ADDITION SEE PERMIT License Class Lic.# "// $3 I # Contractor AN ?J�' V C E Date 10—f'S/y 14020097 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:$485 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:37539035 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PE RMI /ORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT 180 DAYS OFRMIT 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 T 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 licant understands and will comply Issued by: Date:�C�. �J with all non-point source regulations per Cupertino Municipal Code,Section 9 18. �(1 �j�/ RE-ROOFS: Signature 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date- 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 Vpnicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, Section 3700 of the Labor Code,for the performance of the work for which this 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 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 MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION its 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building GUPERTINO (ocupertino.org misc 1� PLUMBING nMECHANICAL RELECTRICAL WSCELLANEOUS PROJECT ADDRESS 2 Z � ,o G O�A� � 1 `3-7 TN# `w /17�C�v OWNER CITY,STATE,ZIP fig_ FAX "1 ZZ (��©Ok G C✓j>C.t n.0 lyv. CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑"OWNER ❑OWNER-BUILDER ❑ OWNERAGENT' I}CONTRACTOR ❑CONTRACTOR AGENT ❑ ARc TTECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME p1 I A1v ��` C/ LICENSE NUMBER nf / LICENSE TYPE C/n BUS.LIC# 351 Qq COMPANY NAME '✓ 7 !i ` i a ( (f FAX 13 ? 1 fZ\C G- E/erl c �rlc, E l P ri ce.2�ec.�' L a h �.C� elt?. STREET ADDRESS I < �I Tic CITY,STATE,ZIP 5 a S65Cret` C </Z_j ARCHITECT/ENGWEERNAME _( J LICENSENUMBER Iv BUS.LIC## C 7! COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF PSFD or DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WRDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN j5r YES BUILDING: []COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK p Vn 3/� .P.v e _ ", V , U ut q. U � ( ado]141 b_ . Fo r c,lc 0�v, A +,, LA So B h t: 5 W"Ac�, Uj I ©VE!�' klAk , P065/6 l 4�GY itv\. � e�h owe GCjjer 01'\� � 1/L( ?ve . 1r ��MCG", 4� d SiAt, 0' _ Ilpvse_ 'Por -fZ irc_ TOTAL VALUATION: q g.j. RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read flus application and the information I have provided is co . I have read the Description of Work and verify it is accurate. I agree to comp] pPic* ocal ordinances and state laws relating to g cons 0 I authorize representatives of Cupertino to enter the above-identified /ectlon purposes. Signature of Applicant/Agent: Date: 0 /5, Zo 1 ! SUPPLEMENTAL INFORMATION REQUIRED O USE ONLY W ❑' OVER-THE-COUNTER EXPRESS x STANDARD Uz a D LARGE a 0. MAJOR MEPMiscAPP 2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 922 brookgrove In DATE: 10/15/2014 REVIEWED BY: Mendez APN: BP#: "VALUATION: $485 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION USE: I I PERMIT TYPE: WORK add electrical circuit for addition see permit# 14020097 SCOPE P bee: 1''lumh,. Permit 1'ee: Inv- Other 1'iumh In:so. Lj Iec % 11rp, /,'C6' !'hwlb. hisp. bee: 1,1(x. Is it j' 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 prefinddha information available and are only an estimate. Contact the Dept./or addn'l in o. FEE ITEMS (Fee Resolution 11-053 gff 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: (F) Reg. ® OT 0.0hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp.Fee:Q Reg. ® OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? ® Yes C) No $0.00 G Advanced Planninna Fee. $0.00 Select a Non-Residential G t xiivl Ducrcrr-,enfoiiorl Fees. Building or Structure i Strong Motion.Fee: IBSEISMICR $0.50 F 1.0 1 hrs Inspections Bldg.Stds Commission Fee: IBCBSC $1.00 $143.00 ISTINSP Inspection,Hourly ti $1.50 $143.00 TOIL FEE: $144.50 Revised: 08/20/2014