14100145 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10538 SAN LEANDRO AVE CONTRACTOR: RMINED PERMIT NO: 14100145
OWNER'S NAME:
U PHONE NO:
LICENSED CONTRACTOR'S DE`C']LARATION BUILDING PERMIT INFO- BLDG I ELECT F PLUMB r
License Class /0 Lic.# 7 ` (� F
MECH RESIDENTIAL COMMERCIAL
Contractor l r Date Q
I hereby affirm that I am licensed under the provisio sof Chapter 9 JOB DESCRIPTION.RELOCATE&REPLACE 100 AMP SECONDARY PANEL
(commencing with Sectio 7000)of Division 3 of the Busidess&Professions (SUB
Code and that my license in full force and effect. PANEL)
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
formance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as provided for by
P
ction 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$5329
permit is issued.
APPLICANT CERTIFICATION APN Number:35705032.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 1 DAYS OF P RMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS OM LAST CALLED INSPECTION.
with all non-poi�tegulations per the Cupertino Municipal Code,Section
9 18.
Iss d y: Date:
Signature DatelD y✓ / 2
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health ety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must O/ authorized agent: /,
forthwith comply with such provisions or this permit shall be deemed revoked. Date:*?
ate:� 0 7
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS:10538 San Leandro Avnue DATE: 08/29/2014 REVIEWED BY:
0APN: kseconondwary
*VALUATION: 5,329
*PERMIT TYPE: Electrical permiPLAN CHECK TYPE: Alteration/Addition/Repair
USE: RY SFD or Duplex PENTAMATION
�,1t0 relocate and rep ace 100 aPEST TYPE: 1 REAP2
panel sub pane
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200
100 Amps $48
TOTALS:
:jeeh.Plana C'hcck I, ��.
hrmh.Plan Check Elec.Plan Check 0 hrs 0
r�Cec•t;..Pe?mit Feer Plrrrnn.Per,Mit1"c:e:
Elec.Permit Fee: IEPERMIT
C)zhe rt fech lncf,. other Plnmh lav). Other Elec.Ins 0
P• hrs L $48.00
Afec:f.. I,xsp.Fee: Plumb.Itzsp.Far.':
Eke.ents f,r,sy.Fee:
NOTE:This estisurte does not include fees due to other Deparbn
D' etc. These fees are based on the relinrin o r Planning,Public Works,Firs Sanitary Sewer Drstrzc School
available and are on&an esdmate. Contact the Drpt for adds'[info.
FEE ITEMS IFee Resolution Il-053 FEET
QTY/FEE E MISC ITEMS
Platt C heck Fee:
Sul 1p1. PC Fee
PME Plan Check: 0
P(?17nit Fee:
Setl.)p/. 1nsp
PME Unit Fee: $48.00
PME Permit Fee: $48.00
c'vnatr•uc:riott:l'ux:
Administrative Fee: 1ADMW $45.00
Work Without permit? Yes No 0
.4cls,ctrL�,�d Ptrrnrtinh Fees;
Travel Documentation Fee: 1TRAVDOC
Strong Motion Fee. IBSEISMICR
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$190.00 0 $ 0.00
Revised: 08/20/2014