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14120087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21719 BEAVEN DR CONTRACTOR:GARZA ELECTRIC INC PERMIT NO: 14120087 OWNER'S NAME: SAN JOSE,CA 98148 PHONE NO:(408)238-2739 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL _ REPLACE SUB 100 AMP PANEL IN GARAGE License Class�� L�iic.# T�/p� .2 Contracto& LrJL.0<l r% Wate !a" 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:$0 have and will maintain Worker's Compensation Insurance,as provided for by tion 3700 of the Labor Code,for the performance of the work for which this APN Number:32647057 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMITXP ORK IS NOT STARTED E 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 L ALLED 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 Issued by: Date: � 7 granting of this permit. Additionally,the applicant understands and will comply with all non-point sour a reg ations per the Cupertino Municipal Code,Section 9 18. /�y / 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 Date: Signature of Applicant: 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) 1,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. 1 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 the Health&Safety Code,Secti 25 5,25 3,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by / 7 l Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: ( ` 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 CONSTRUCTION LENDING AGENCY 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 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 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 misc (408)777-3228• FAX(408)777-3333•building aC-cupertino.org ( \ CUPERTIiNO \ ❑PLUMBING ❑MEC^HANICAL ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS �/f V- q Bea V ej/ / G` APN# -3:2u q-705-76()[-/r 5-6() OWNER NAME ----"` � jV�� y �, ��D I FAX CONTACT NAMEL- /n//LVv� C PHG 5?2„12 -m STRtT,fT5 1<1fA l� - C E Zyp,�1e CA . 6/ F " )V-1-3 2-15 2- ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT goNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT e-dl LN�FyAlUMBEI�72 Z LICEI�B£T,YP$ / BUS.LIC CUM- A Y NAM �� =i111 ,-.rj(/' ' (` AIL tJ _ ✓ w FAX � J�✓ ST E A R� t i?id%V /i��/ CITU��P�V l G V/{ L c V90430-2--7 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAM LY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL TURBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: / /v V RECEIVED jI Y By my signature below,/certif4b ' he folio ing: I am t e property owner or authorized agent to act on the property owner's behalf. I have read this application and the informationded is rrect. I h ead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatg c ruction. I o' e e resentatives of Cupertino to enter the above-ide/if7ied rerty for inspection purposes. Signature of Applicant/Agent: Date: ` (/ SUPPLEMENTAL INFORMA ON REQUIRED OFFICEUSEONLY ` V ,� "� OYER THE-COUNTER E" EXPRESS Y C>vi E4�t STANDARD � ® LARGE MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21719 beaven ct DATE: 12/17/2014 REVIEWED BY: Mendez APN: BP#: VALUATION: 1$1,100 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY PENTAMATION 1 REAP2 USE: SFD or Duplex PERMIT TYPE: WORK re lace sub 100 amp panel in garage SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 100 Amps $48 TOTALS: $48.00 A&I h 9�,<}t 1'Frarr _ l'Ixry;b. Pian{:"rrcci; Elec.Plan Check 0.0 hr, $0.00 Ile77 Fee: 1111Inh. Pe:rmil T°'cue;: Elec.Permit Fee: IEPERMIT <1rl�cr ilecki. Irrsn- l flier ,Phwnb Ins�p. Other Elec.Insp. 0.0 hrs $48.00 �t-7fr.�i. Itcs7. r�� I rttratL�, haip. Vee: !ns" ", 1,,1-,"-- NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/f 1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: >l. PC Fce PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 TO"'.. Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes (E) No $0.00 ,'Pc:ft°Frac{d Nanning Ices: Travel Documentation Fee: 1TRAVDOC $48.00 i Strong Motion.Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Std s Commission Fee: IBCBSC $1.00 tet. $190.50 $0.00 TOTAL FEE:. $190.50 Revised: 10/01/2014 Address SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building aQcupertino.org FILE CIS ,76667 PURPOSE This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single- family and multi - family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: 111 dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: Signature...................... ................ j ......................................... ............................... Date:................... Contractor Name: S nture ... . ........ illy/ . . I / L". ....�� .�...... Date: J Smoke and CO forn?.doc revised 03118114