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14110067I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 7512 LEEDS AVE CONTRACTOR.,. , JPERMIT NO: 14110067 I OWNER'S NAME: 1 . I PHONE NO: I ❑ LICENSED CONTRACTOR'S DQECL(A�RATION License Class 10 Lic. # Contractor Date Z � 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. gp affirmunder penalty of perjury one of the following two declarations: d will maintain a certificate of consent to self -insure for Worker's ation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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. 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 to building construction, and hereby authorize representatives of this city to enter 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 granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. � A" — Date (2 1 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 to building construction, and hereby authorize representatives of this city to enter 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 granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ MAIN ELECTRICAL PANEL UPGRADE 200 AMP). Sq. Ft Floor Area: I Valuation: $3000 APN Number: 36616022.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, See iy CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Signature_ Date i i CITY OF CUPERTINO ICI FEE ESTIMATOR - BUILDING DIVISION imlADDRESS: 7512 Leeds Ave DATE: 11/12/2014 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$3,000 xPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p PENTAMATION PERMIT TYPE: 1 REAP WORK Main electrical panel upgrade 200 amp). SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 200 Amps $48 TOTALS: $48.00 11111mL. Plum t'heck Elec. Plan Check 0.0 hrs $0.00 i,,,>',t,, ller„„ l Fee: 1111"' 7h. 1)er nfit J�'Cc. Elec. Permit Fee: 1EPERMIT I��>r�. 01her P urnh Imp. Other Elec. Insp. 0.0 hrs $48.00 tc,r I.rsp. °ec: EiL�] 1117i 1b. hisp. Fee NOTE: This estimate does not include fees due to other Departments (a.e. Planning, Public Works, mire, sanitary Fewer Distract, scnooi 1)ictrint otn 1 Thoco fooc aro hacod nn tho nroliminary information availahle and are onlv an estimate. Contact the Dept for addh7 info. FEE ITEMS (lee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS j,"! l3dCtYl �_'rBe:Ch 0. PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 l Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 :'Pt'�'rartE°cs�a't'r`ctr?atist�; ,T<�c':S': Travel Documentation Fee: ITRAVDOC $48.00 Stroup, Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg* Stds Commission Fee: IBCBSC $1.00 $190.50 $0.00 �, TOTAL FEE:' $190.50 Revised: 10/01/2014 1-vllo� 7 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building Cftupertino.org I-1_ 1/ICiC/�ITIAT FIMT.CCF.T.T.ANROTJS MEP misc UPLUMBINCT IJ NECHANICAL LJi---••u•-•••• "--------- - PROJECT ADDRESS � 51V FtS AN 1f ? LEAN) APN # OWNERNAME CHP-IST'INC UUV PHONE E-MAIL O LA-(-uq STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME ps, V✓ i F PHON 8 3 ) 2_4 4 23 E-MAIL _ r hiI I f STREET ADDRESS nJ� r (� ` ` �/ CITY, STATE, ZIP � �^ O O N V FAX � ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 5t -t S LICE E NUMBER LICENSE TYPE to BUS. LIC 4 COMPANY NAME /s��p) (� ►-7-.y--/� �t l K-�l� E-MAIL 1 % I r C6 FAX STREET ADD SS r CIT STAN ZIP PHONEQ %j CJ �� r `7 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD or DUPLEX ❑ MULT[-FAMILY PROJECT IN WII,DLAND ❑ YES PROJECT IN ❑YES O IS THE BLDG AN ❑YES EICHLER HOME? O BUILDING: COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE DESCRIPTION OF WORK t )\j U Y "YL too 1—t) " A- W TOTAL VALUATION: r- RECEIVED 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 this it is I agree to comply with all applicable local application and the information I have provided is rrect. I have read the Description of Work and verify accurate. representatives of Cupertino to enter the aboveied property for inspection purposes. ordinances and state laws relatin building;on uthprize Signature ofApplicant/Agent: Date: r!/ ♦*� j ux& UPPLEMEN AL INFORTWATION REQUIRED OFFICE USE ONLY W OVER-THE-COUNTER P. E EXPRESS 0 STANDARD W U -I] LARGE a. MAJOR 1, ccv} MEPMiscApp_2011.doc revised 06121/11